Ortho Patient Considerations

CBC

complete blood count

RBC

red blood cell (carries oxygen) (4.2-6.1 million/mm)

low RBC

anemia

high RBC

chronic anoxia

hemoglobin (Hb)

amount of iron in blood, needed for oxygen delivery to tissues (men: 14-18 g/dl, women: 12-16 g/dl

hematocrit (HCT)

amount of RBC’s in whole blood (men: 42-52%, women: 37-47%)

white blood cell (WBC)

fights infection, 5,000-10,000 mm,

high white blood cell

presence of infection, leukemia

low white blood cells

bone marrow failure, autoimmune disease, dietary deficiency

platelets (thrombocytes)

role in clotting time, 150,000-400,000 mm

blood potassium

high and low level of K+ affect normal heart contraction, 3.5-5 mEg/L is normal range, may be depleted in patients taking diuretics, levels always checked prior to surgery

urinalysis

indicates status/function of kidneys, predictor of how well kidneys will function intra/post-operatively

presence of cells in urine

indicate infection, bleeding

presence of protein in urine

indicate kidney disease

presence of sugar in urine

indicates diabetes

presence of high gravity urine

concentrated, could be dehydrated or kidney disease

presence of low gravity urine

diluted, hydrated

ECG/EKG (electrocardiogram)

indicates cardiac status, routinely done for patients 40 yr older or with history of heart disease

chest X-ray

indicates pulmonary status, can diagnosis unsuspected lesions, tumors

malignant hyperthermia

life-threatening syndrome that occurs individuals who have a hereditary skeletal muscle disorder, typically show no signs unless under anesthesia, causes hyperbolic crisis (muscle relaxants-succinylcholine, inhalation agents-halothane)

what are predisposing factors of malignant hyperthermia

spinal deformities, muscular dystrophy, family history

what are signs and symptoms of malignant hyperthermia

unexpected rise in CO2 production, cardiac arrhythmias, unstable blood pressure, metabolic acidosis, rapid rise in body temperature, cyanosis, muscle rigidity

treatment for malignant hyperthermia

stop administration of triggering agent, call a code, administer oxygen, administer dantrolene, treat cardiac arrhythmias, cool patients with ice packs

how many pediatric procedures have a malignant hyperthermia reaction

1 in 12,000 cases

how many adult procedures have a malignant hyperthermia reaction

1 in 40,000 cases