Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
140 Cards in this Set
- Front
- Back
|
What does the chemistry panel measure?
|
Na, K, Cl, CO2, BUN, SCr, glucose
|
|
|
normal sodium values
|
135-145 meq/L
|
|
|
normal potassium values
|
3.5-5.0 meq/L
|
|
|
normal chloride values
|
96-106 meq/L
|
|
|
normal carbon dioxide values
|
24-30 meq/L
|
|
|
normal glucose (fasting) values
|
70-110 mg/dL
|
|
|
normal BUN values
|
7-20 mg/dL
|
|
|
normal serum creatinine values
|
0.7-1.5 mg/dL
|
|
|
hyponatremia
|
Na <135 meq/L
|
|
|
when do hyponatremia symptoms start
|
Na < 120 meq/L
|
|
|
signs of hyponatremia
|
agitation, anorexia, apathy, disorientation, muscle cramps, nausea, depressed deep tendon reflexes, and seizures
|
|
|
is immediate treatment needed with hyponatremia?
|
yes
|
|
|
sodium is regulated by ?
|
ADH, ANF, renin-angiotensin-aldosterone system
- renal GFR - Na reabsorption/excretion |
|
|
two main causes of hyponatremia
|
Na depletion in excess of total body water
and Dilution hyponatremia (water intake is greater than output) |
|
|
what causes Na depletion and how treat
|
diseases that cause edema (CHF, liver disease, renal failure)
Na and H20 restriction diurectics (balance) |
|
|
5 reasons for dilution hyponatremia
|
primary (renal failure)
neuroendocrine (adrenal problems) psychiatric osmotic (hyperglycemia) drug-induced (diuretics) |
|
|
signs of hypernatremia
|
thirst, restlessness, irritability, muscle twitching, siezures, coma, death
|
|
|
hypernatremia
|
>145 meq/L
|
|
|
when do you see symptoms of hypernatremia
|
>155 meq/L
|
|
|
how do you treat hypernatremia
|
water replacement
|
|
|
3 forms of hypernatremia
|
low total body sodium - loss of sodium and water, but more water (sweating, bigD)
normal total body sodium - loss of water (fever, burns) high total body sodium - administration of Na (CPR, IV's, Dialysis, sea water) |
|
|
three drugs that cause hypernatremia
|
amphotericin B
lithium colchicine |
|
|
sodium - intra or extracellular?
|
extra
|
|
|
potassium - intra or extracellular?
|
intra
|
|
|
hypokalemia
|
< 3.5 meq/L potassium
|
|
|
when does treatment for hypokalemia start and what is it
|
< 3.0 meq/L K
K replacement |
|
|
two causes of hypokalemia
|
intracellular shift
body loss |
|
|
symptoms of hypokalemia
|
weakness, cramps, areflexia, cardiovascular problems, urinary retention
|
|
|
which class of drugs can cause hypokalemia
|
insulin
dextrose laxative abuse diurectics (also affect hyperatremia) |
|
|
hyperkalemia
|
>5.0 meq/L
|
|
|
when does treatment for hyperkalemia start and what is it
|
>5.5 meq/L
CaGluconate IV Na Bicarb (K into cells) Kayexelate (binds K in the colon) |
|
|
chloride - intra or extra cell
|
extra cell
(parallels Na elim.) |
|
|
hyperchloremia
|
>110 meq/L
|
|
|
what causes hyperchloremia
|
Cl loading by IV fluides
hypernatremia metabolic acidosis |
|
|
hypochloremia
|
< 90 meq/L
|
|
|
what causes hypocholermia
|
gastric obstruction
protracted or self vomiting |
|
|
how treat hypo or hyperchloremia
|
treat underlying cause
|
|
|
carbon dioxide
|
bicarbonate ion of blood
acid-base balance (but doesn't tell you if in acidosis or alkalosis - pH does that) |
|
|
if you have depressed CO2 you may have one of these 2 things
|
metabolic acidosis
or respiratory alkalosis |
|
|
if you have elevated CO2 you may have one of these two things
|
metabolic alkalosis caused by thiazides or
respiratory acidosis |
|
|
hypoglycemia
|
< 70 mg/dL
|
|
|
what causes hypoglycemia
|
adrenal insufficiency
hypopituitarism hyperinsulinemia starvation |
|
|
drugs that cause hypoglycemia
|
insulin
sulfonylureas beta-blockers salicylates ethanol anabolic steroids |
|
|
signs of hypoglycemia
|
sweating
tremors tachycardia confusion |
|
|
treatment of hypoglycemia
|
glucose admin.
diet |
|
|
hyperglycemia
|
> 126 mg/dL on two separate occasions while fasting
> 200 with 2 hour post-prandial |
|
|
causes of hyperglycemia
|
diabetes, stress, acute pancreatitis, hyperthyroidism, hyperadrenalism (cushing), nutritional support
|
|
|
drugs that can cause hyperglycemia
|
thiazide diuretics
furosemide steroids |
|
|
signs and symptoms of hyperglycemia
|
excessive diuresis and thirst
lethargy coma |
|
|
BUN
|
represents a balance between the rate of urea syntheses in the liver and the rate of excretion by the kidney
|
|
|
4 causes of increased BUN
|
renal insuffieciency
increased protein breakdown GI bleed nutritional support |
|
|
drugs that can cause BUN increase
|
aminoglycosides
amphotericin B vancomycin |
|
|
3 causes for decreased BUN
|
liver damage
malnutrition pregnancy |
|
|
a measure of renal function that is more accurate than BUN
|
serum creatinine
except in patients with decreased muscle mass like elderly and neonate |
|
|
what is approximately equal to creatinine clearance
|
GFR
|
|
|
what are the effects of an increased SCr
|
renal impairment, dehydration, muscle damage
alter drug pharmacokinetics |
|
|
what are the effects of decreased SCr
|
dilution, decreased muscle mass, less food intake
|
|
|
how do you collect urine?
|
1 cup, midstream
refrigerated up to 2 hours bacteria will grow if greater than 2 hours, glucose conc will go down, elements will decompose |
|
|
RBC's in a microscopic urine analysis
|
0-1
otherwise stones, tumors, or glomerulonephritis |
|
|
macroscopic analysis of urine
|
checking color and turbidity
if clear then maybe large numbers of WBC's or RBC's foam my be from proteins or bile acids |
|
|
WBC's in microscopic analysis of urine
|
0-1
or infection |
|
|
Casts in microscopic analysis of urine
|
0
or renal disease (mass of glycoprotein) |
|
|
Crystals in microscopic analysis of urine
|
0
or uric acid (stones- calcium) |
|
|
bacteria in microscopic analysis of urine
|
0
or trace mean urinary tract infection |
|
|
Cells in microscopic analysis of urine
|
0-2
or possible contamination and should be recollected |
|
|
pH in chemical analysis of urine
|
4.5-8 (normal is around 6)
or drugs, foods, diabetes ketoacidosis |
|
|
specific gravity in chemical analysis of urine
|
1.01 -1.025
|
|
|
protein (albumin) in chemical analysis of urine
|
negative to trace (diseases)
|
|
|
glucose and ketones in chemical analysis of urine
|
negative (diseases/nutrition)
|
|
|
nitrites in chemical analysis of urine
|
neg. (infection)
|
|
|
bilirubin, bile in chemical analysis of urine
|
neg. (liver disease or drugs)
|
|
|
4 indicators of hepatocellular injury
|
aspartate aminotransferases (AST)
alanine aminotransferases (ALT) lactate dehydrogenase (LDH) total bilirubin |
|
|
AST normal levels
|
8-42 IU/L
|
|
|
alanine normal levels
|
3-30 IU/L
|
|
|
lactate dehydrogenase normal levels
|
100-225 IU/L (non spei though, because found in many tissues
|
|
|
total bilirubin normal levels
|
.3 - 1.0 mgdL
|
|
|
two most sensitive indicators for liver function and why are two other tests not as sensitive
|
aspartate aminotrans (AST)
Alanine aminotrans (ALT) They are nonspecific for liver |
|
|
7 tests for liver function and normal levels
|
AST 8-42 IU/L
ALT 3-30 IU/L LDH 100-225 IU/L Bilirubin total 0.3-1.0 mg/dL unconjugated bilirubin (insoluble) 0.2-0.7 mg/dL conjugated bilirubin (soluble) 0.1-0.3 mg/dL ammonia 30-70 microgram/dL |
|
|
when are yellow and red flags for liver function tests
|
5 times the upper
10 times the upper |
|
|
four conditions that would effect unconjugated biliruin
|
neonatal jaundice
hemolysis gilberts syndrome criglers syndrome |
|
|
hyperbilirubinermia
|
>50% total with conjugated bilirubin
|
|
|
ammonia
|
form in the GI by bacteria then absorbed by the liver through portal circulation
|
|
|
4 main diagrammatic elements in a complete blood count test
|
platelets
hemoglobin hematocrit WBC |
|
|
indices
|
part of CBC
Mean corpuscular volume (MCV) mean corpuscular hemoglobin (MCH) mean corpuscular hemoglobin concentration (MCHC) |
|
|
what does an RBC count give
|
an indirect measure of Hct and Hgb
|
|
|
D1
|
Crewman departing on same vessel / airline
|
|
|
Hgb defintion and levels for males and females
|
protein that serves as the vehicle for CO2 and O2
Males: 14-18 g/dL. Females: 12.3 – 15.3 g/dL |
|
|
Hct definition and levels for males and females
|
vol. of erythrocytes as % of whole blood
Males: 42-54% Females: 36-48% |
|
|
MCV definition and levels
|
avg. vol. of RBC
most useful 80-96 fL/cell |
|
|
MCH definition and levels
|
amt. of Hgb per RBC
27-33 pg/cell |
|
|
MCHC definition and levels
|
Hgb / Hct
33.4 – 35.5 g/dL |
|
|
normal platelet count
|
150,000 - 450,000 /microL
|
|
|
what does RBC morphology look at
|
size, variations in size, shape, deviations from normal shape (sickle cell anemia)
|
|
|
macrocytic
|
if MCV is greater than 96
B12 or Folic Acid deficiency |
|
|
microcytic
|
if MCV is less than 80
iron deficiency or anemia |
|
|
yellow and red flag for platelet count
|
100,000 for yellow
50,000 for red |
|
|
total WBC levels
|
4.4 - 11.3 x 10^3 cells/mm^3
|
|
|
if WBC is too high then you might have
|
acute infection
intoxication leukemia |
|
|
if WBC is too low then you might have
|
overwhelming or viral infection
drugs chemotherapy anemia |
|
|
5 differentials of WBC
|
neutrophils or polymn granulocytes
lymphocytes monocytes eosinophils basophils |
|
|
neutrophils or polymn granulocytes
|
45-73%
if high then indicator of acute infection |
|
|
lymphocyte levels
|
20-40%
|
|
|
monocyte levels
|
2-8%
|
|
|
eosinophils levels
|
0-4%
|
|
|
basophils levels
|
0-1%
|
|
|
4 things measured in a lipid profile
|
Total Cholesterol (TC)
Triglycerides (TG) Low-Density Lipoprotein (LDL) Cholesterol High-Density Lipoprotein (HDL) Cholesterol |
|
|
primary lipid disorder and three identifiers
|
genetic (type 2A)
high LDL TC>300 TG is normal |
|
|
2 secondary lipid disorders and identifiers
|
caused by disease, meds, or lifestyle
- diabetes mellitus, hypothyroidism, obesity, sedentary lifestyle -- low HDL, high LDL, high TG - acute hepatitis, pregnancy, uremia -- high TG |
|
|
how does alcohol affect the lipid profile
|
increases TG
|
|
|
how do antipsychotics affect the lipid profile
|
increase TG
increase LDL increase TC |
|
|
how do cyclosporines affect the lipid profile
|
increase in TG
increase in LDL |
|
|
how do estrogens affect the lipid profile
|
increase in HDL
increase in TG decrease in LDL |
|
|
how do thiazide diuretics affect the lipid profile
|
increase in TG
increase in LDL |
|
|
how does a high saturated fat diet affect the lipid profile
|
increase in TG
increase in LDL |
|
|
desirable total serum cholesterol
|
< 200 mg/dL
|
|
|
borderline high total serum cholesterol
|
200-239 mg/dL
|
|
|
high total serum cholesterol
|
> 240 mg/dL
|
|
|
normal triglyceride level
|
< 150 mg/dL
|
|
|
borderline high triglyceride level
|
150-199 mg/dL
|
|
|
high triglyceride level
|
200-499 mg/dL
|
|
|
very high triglyceride level
|
> or equal to 500 mg/dL
|
|
|
optimal LDL
|
< 100 mg/dL
|
|
|
near or above optimal LDL
|
100-129 mg/dL
|
|
|
borderline high LDL
|
130-159 mg/dL
|
|
|
high LDL
|
160-189 mg/dL
|
|
|
very high LDL
|
> or equal to 190 mg/dL
|
|
|
low HDL cholesterol
|
< 40 mg/dL
|
|
|
high HDL cholesterol
|
> or equal to 60 mg/dL
|
|
|
when does LDL lead to treatment
|
when it is high
|
|
|
Thyrotropin-Stimulating Hormone (TSH) level
|
0.5-4.7 microIU/L
|
|
|
Free Thyroxine (Free T4) level
|
0.8 – 2.7 ng/dL
|
|
|
Serum Triiodothyronine Resin Uptake (T3 Resin Uptake) level
|
22%-34%
|
|
|
Total serum thyroxine (Total T4) levels
|
4.5 – 10.9 mcg/dL
|
|
|
Total serum triiodothyronince (Total T3) levels
|
60-181 ng/dL
|
|
|
free thyroxine index levels
|
1.0-4.3 units
|
|
|
which is the most sensitive thyroid test
|
TSH
|
|
|
6 tests that make up the thyroid profile
|
TSH
Free T4 T3 resin uptake Total T4 Total T3 Free Thyroxine Index |
|
|
4 signs of hypothyroidism
|
increased TSH
decreased total T4 decreased free T4 decreased total T3 |
|
|
4 signs of hyperthyroidism
|
decreased TSH
increased total T4 increased free T4 increased total T3 |
|
|
TSH level that would create cardiac arrythmias and require aggressive treatment
|
0.1
|
