PATIENT ASSESSMENT PART TWO

Red blood cells

contain hemoglobin necessary for oxygen transport

Normal Red blood cells

4-6 mill/mm3

Low RBC

anemia

occurs with blood loss, hemorrhage

High RBC

polycythemia

occurs with chronic tissue hypoxemia

Hemoglobin

carries oxygen 1.34 mL per gram Hb

Normal hemoglobin value

12-16

Low hemoglobin

referred to as anemia

High hemoglobin

referred to as polycythemia

Hematocrit ( Hct )

Spin the whole blood and measure the % of RBC in the original blood volume

Hematocrit Normal value

40-50%

Low Hematocrit is referred to as

asthma

High Hematocrit is referred to as

polycythemia

White blood cell count changes in response to

infections

Normal value of WBC

5,000- 10,000

Increased WBC ( leukocytosis ) indicates

a bacterial infections best to recommend antibiotics

Decreased WBC ( leukopenia ) indicates

a viral infection best to recommend antiviral agents

Neutrophils

Major WBC

has bands and segs

Bands

immature cells normally 4% of WBC; increased with bacterial infections

Segs

mature cells; normally 60% of WBC ; decreased with bacterial infections

Eosinophils

associated with asthma ; 2% of WBC increased with allergic reactions

Monocytes

associated with tuberculosis ; 3% of WBC

Lymphocytes

30% of WBC

Basophils

1% of WBC

Potassium ( K+ )

important for acid base balnce and muscle function, including cardiac muscle

Normal range for potassium

3.5 - 4.5

Hypokalemia refers to

low K+ and it occurs with metabolic alkalosis, excessive excretion, vomiting, flattened T waves on ECG

Sodium ( Na + )

Major intracellular cation controlled by kidneys

Sodium normal range

135-145

Hyponatremia refers to

low Na+ can be due to fluid loss from diuretics, vomiting, diarrhea, fluid gain from CHF, IV therapy

Hyperkalemia refers to

High potassium, due to kidney failure, spiked T wave ( metabolic acidosis )

Hypernatremia refers to

High Na+ due to dehydration

Na+ is retained in exchange for

K+

Chlorine

Major extracellular anion

Chlorines levels are associated with

sodium

Chlorines normal range is

90-100

Hypochloremia refers to

Low Cl ( metabolic alkalosis )

Hyperchloremia refers to

High Cl ( metabolic acidosis )

Bicarbonate HCO3

Most of the CO2 in the blood is carried as HCO3 so that changes in total CO2 content reflect changes in blood base

Increased CO2 content reflects Increased HCO3 leads to

Metabolic alkalosis

Decreased CO2 content reflects decreased HCO3

Leading to metabolic acidosis

Increased PCO2 leads to

Respiratory acidosis

Decreased PCO2 leads to

Respiratory alkalosis

Creatine

excreted by kidneys

• evaluates kidney function

Creatine normal values

0.7 to 1.3 mg/dL

Blood urea nitrogen ( BUN )

evaluates kidney function

• increased BUN indicates kidney failure

Blood Urea nitrogen normal value

8-25 mg/dL

Mucoid sputum

white and gray

• indicates chronic bronchitis

Yellow sputum

presence of WBC ( eosinophils )

• indicates bacterial infection

Green sputum

Stargant sputum, gram negative bacteria

• indicates bronchiectasis, pseudomonas

Brown Dark sputum

Old blood,

• anaerobic lung infection

Bright red sputum

Hemoptysis

• bleeding tumor, TB

Pink Frothy Sputum

Pulmonary Edema

Sputum culture

Identifies the bacteria present, takes 48 to 72 hours

Sensitivity

Identifies what antibiotics will kill the bacteria, takes 48 to 72 hours

Gram stain

Identifies whether bacteria are gram positive or gram negative, takes an hour

Acid fast stain

identifies mycobacterium tuberculosis

Normal platelet count

150,000- 400,000 mm3

Decreased platelet count indicates

values associated with decreased bone marrow function and sepsis

Activated partial thromboplastin time

measures the length of time required for plasma to form a fibrin clot

• used to monitor heparin therapy

Activated Partial Thromboplastin time normal value

24-32 secs

Prothrombin time

used to monitor warfarin ( coumadin ) therapy

Normal value for prothrombin time

12-15 seconds

Urinalysis

Reflects metabolic status of patients and is a screening test for kidney disease

• can indicate urinary tract infections before blood culture results

• also measures appearance, specific gravity, pH, glucose, ketones, blood bilirubin and sedimentation

Troponin

Specific indicator of damage to heart muscle

• pt who has suffered a myocardial infarction would have elevated troponin levels

Troponin levels > 0.1 place the pt at

high risk for a death from MI

• recommend oxygen, morphine, aspirin, nitroglycerin

Brain Natriuretic Peptide ( BNP )

Secreted by the cardiac muscle when heart failure develops or worsens

• measurement if serum BNP is helpful to determine if the pts symptoms are the result of CHF or another condition indicate CHF

Normal BNP value

< 100 pg/mL

> 300 pg/mL may indicte

mild heart failure

> 600 pg/mL may indicate

moderate heart failure

> 900 pg/mL may indicate

severe heart failure

Normal axis is in a direction of

down and to the left

Hypertrophy

increases electrical activity, axis will shift toward hypertrophy

Infarction

dead tissue, no electrical acitivity, axis will shift away from infarction

When the electrical impulse of the heart moves toward the positive electrode

an upward deflection is made on the ECG paper

There are 12 leads used

• 6 limb leads

• 6 precordial chest leads

• 10 electrodes

Lead 1

left arm positive and right arm negative

Lead 2

left leg positive and right arm negative

Lead 3

left leg positive and left arm negative

AVR

right arm positive and everything else is negative

AVL

left arm positive and everything else is negative

AVF

left leg is positive and everything else is negative

V1

4th intercostal space on the right side of sternum

V2

4th intercostal space on the left side of the sternum

V3

Between V2 and V4 on the left side

V4

5th intercostal space, left mid clavicular line

V5

Between V4 and V6 on the left side

V6

5th intercostal space, left mid- axillary line

Flutter

> 200 beats per min

Bradycardia

< 60 bpm

Tachycardia

> 100 bpm

Treat sinus tachycardia by

giving oxygen

Treat sinus bradycardia by

giving oxygen and atropine

Treat atrial flutter by

giving digoxin, beta blockers, calcium channel blockers

Treat atrial fibrillation by

giving digoxin, beta blockers, calcium channel, anticoagulants, antithrombotics

Treat premature ventricular contractions and multifocal premature ventricular contractions by

giving oxygen, lidocaine, consider other causes

Treat ventricular tachycardia by

pulse present ( stable vt ) : cardiovert

pulse absent ( unstable vt ) : defibrillate, CPR, epi and amiodarone

Ventricular flutter treatment

defibrillate, CPR, epi, amiodarone

Asystole treatment

confirm in 2 leads first, CPR, epi

Ischemia

reduce blood flow to tissue

Injury

acute damage to tissue ( often from ischemia )