Diagnostics Memorization

Knowledge

• characteristic pattern of s/sx associated with disorder

• characteristic presentation of potential drug-related problems

• chronic disease guidelines for diagnosis and treatment

Subjective data

patient history

Objective data

• physical exam

  • inspection (visual)

  • palpation (touch)

  • percussion (tap)

  • auscultation (listen)

• lab tests

• vitals

• diagnostic imaging

Documentation for radiology/imaging

• dates/times taken

• location/body part

• results interpreted and documented

X-ray

• 2D

• ideal for bones/joints

MRI

• soft tissue

CT

• series of X-rays used to create cross sectional 3D image

• lungs, bone, brain

CTA

• CT scan

• blood vessels

Doppler Ultrasound

• high-freq sound waves

• blood flow

• DVT vs cellulitis

PET scan

• detect metabolic activity of lymphomas

• dead tissue vs live cancer

Bone scan

• activity of bone turnover

• prostate/breast cancer

Bone marrow biopsy

under microscope

assess for hematologic cancer

Cardiac imaging

• ECHO

• EKG

• Coronary angiogram

ECHO

• assess heart structure/function

• moving picture

• transthoracic (less invasive), transesophageal

EKG

• electrical activity of heart

• heart rate/rhythm graph

Coronary Angiogram

• determine bloodflow in arteries

• identify blockage

• still image

Normal temp

97.8-99 F

36.5-37.2 C

Normal HR

60-100 bpm

Normal SpO2Norm

93-100%

Normal RR

12-16 bpm

Normal BP

< 120/80 mm Hg

Fever

=/> 99.6 F

Hyopothermia

<95 F

Critical Ox Sat

88%

Factors influencing lab assessment

• assay used

• clinical presentation

• demographics

• drugs

• food

• nutritional status

• timing

• pregnancy

CBC labs

• RBC

• WHB

• HgB

• Hct

• Platelets

Anemia

low RBC/HgB/Hct

Erythrocytosis

high RBC

Leukopenia

low WBC

Leukocytosis

high WBC

Thrombocytopenia

low platelets

Thrombocytosis

high platelets

CBC- Differential Labs

• Polymorphonuclear neutrophils

• Band neutrophils

• lymphocytes

• monocytes

• eosinophils

• basophils

• % out of TOTAL wbc

RBC indices

• Mean corpuscular volume (MCV)

• mean corpuscular hemoglobin (MCH)

• mean corpuscular hemoglobin concentration (MCHC)

Mean corpuscular volume

average RBC size

mean corpuscular hemoglobin

hemoglobin per RBC

mean corpuscular hemoglobin concentration

amount of hemoglobin relative to size of the cell per RBC

Microlytic anemia

• MCV <80

• iron deficiency

Macrolytic anemia

• MCV >100

• folic acid and b12 deficiency

Normolytic anemia

• normal MCV

• low RBC, RC

BMP labs

• Sodium

• Potassium

• Chloride

• CO2

• BUN

• SCr

• glucose

• calcium

Sodium ref

134-145 mEq/L

Potassium ref

3.8-5 mEq/L

Chloride ref

95-103 mEq/L

CO2 ref

22-30 mEq/L

BUN ref

8-23 mg/dL

SCr ref

0.6-1.2 mg/dL

Glucose ref

70-100 mg/dL

Calcium ref

9.2-11 mg/dL

Impact of Na

neurological

Impact of K

Cardiac arrhythmias, muscle, GI

Impact of CO2

respiratory, metabolic

BUN impact

metabolic/endocrine

SCr impact

renal

Ca impact

• GI

• neuro

• cardiovascular

• renal

Max sodium correction rate

• 12 mEq/L in 24H

• 18mEq/L in 48H

• risk: osmotic demylination

K and glucose/insuline relationship

insulin shifts K intracellularly

Corrected calcium level

• only if albumin <4

• SCa +0.8(4-serum albumin)

CKD labs

BMP+GFR

CMP labs

• albumin

• total protein

• alkaline phosphatase (ALP)

• alanine amino transferase (ALT)

• Aspartate amino transferase (AST)

• bilirubin

Labs indicative of liver fx

• albumin

• ALP

• ALT

• AST

• bilirubin