Can someone help me figure out why my pts Labs were abnormal?

Marie_LPN, RN, LPN, RN · Jun 4, 2006

Plavis

Plavix?

EMTandNurse2B · Jun 4, 2006

Oh and does anyone know what choncondritis is? I can't find it in any of my books or on the internet. My patient said it was something from her past cardiac surgeries that got infected?

Does she mean Costochondritis? This is an inflammation of the rib cartilage.

And I was confused about the neuropathy that she has? She doesn't hvae diabetes? And I always associated neuropathy with diabetes, SO I guess I was wrong?

Neuropathy can be caused by a whole host of things other than diabetes. Lead poisoning, pernicious anemia, and heredity are just a couple of examples. You might want to consider looking up some other causes and then asking your patient if she had/has one of the other factors that could cause it.

I hope this helps!

RN_Jen · Jun 4, 2006

Synthroid can interfere w/labs, increasing CPK, LDH, AST, PBI, and blood glucose.

Lopressor, Diovan, Plavix, and Imdur can all cause increased AST; Lopressor can also cause increased ALK PHOS.

Is she on coumadin? If she is, then I believe an INR of 1.0 just means it isn't at a therapuetic level.

I was taught to always look at the drugs to see if they could be causing abnormal labs. Hope this helps.

papawjohn · Jun 4, 2006

Hey LUV2!!!

Naturally no one can exactly and precisely answer all those questions on this forum. If we could open the chart together and then interview the Pt, chat with MDs about these questions and do all those kinda things, maybe we STILL couldn't answer all those questions. For example, it is not unusual for the very first chemistry drawn in the ER to have an elevated Glucose. Can't prove it, but I assume (like you do) that it's a stress-mediated thing.

It's also fairly common for a cardiac Pt to have a slightly elevated CPK but negative ISO-ENZYMES. In this person's case, I'd make an effort to look at the ISO's and if no MI is found, relate the CPK to the inflamation of costoconditis.

The LYMPHs are a breakdown of the WBCs. Everytime I try to get my head around the different 'meanings' of the different types of WBCs I find I have to go WAY back into Anatomy and Physiology which I don't want to do right now. Short answer: 1. The thing you're looking at in the breakdown of Polys, Eeos, and Lymphs is the age of the WBC and the number is a percentage. So the Lymphs (I think, fully matured amoeba-like phagcytes?) are 19% of this Pt's WBCs and are associated with bacterial infection. (ATTENTION!! YOU SHOULD DOUBLE CHECK THIS BEFORE TAKING IT TO YOUR INSTRUCTOR!!) 2. Chronic inflamation can alter the immune system numbers.

So, in the absence of any other signs of infection (hint: check the UA and CXRay) I think you'd be reasonable in putting the elevated Lymphs off onto the costocondritis, too.

The liver enzymes are almost certainly NOT related to past heart-caths. The contrast medium is nephro-toxic (actually--on the periodic chart, it's a metal) but does not affect the liver. So you might see an increase in BUN and Creatinine after 'X-Ray dye' is used, but hopefully very briefly.

More likely your Pt's ALT/AST, etc are chronic due to atherosclerosis of small arteries. Which would also result in neuropathies.

Good on you for noticing and asking about these kinds of things. Keep on looking and asking!!!

Papaw John

luv2shopp85 · Jun 4, 2006

Plavix?

yes plavix... sorry had a typo

luv2shopp85 · Jun 4, 2006

Does she mean Costochondritis? This is an inflammation of the rib cartilage.
Neuropathy can be caused by a whole host of things other than diabetes. Lead poisoning, pernicious anemia, and heredity are just a couple of examples. You might want to consider looking up some other causes and then asking your patient if she had/has one of the other factors that could cause it.
I hope this helps!

Alright I think it may have been costochondritis which she was referring too. I lookd it up on the wikipedia and the s/s and all that seemed to fit. I could have sworn she told me it was choncondritis. Maybe she had the name wrong?

I'm not sure about the neuropathy. This was my patient last Tuesday and I'm sure she's been discharaged home by now so I dont really have any way of figuring out why she had the neuropathy.

chrispicritah · Jun 5, 2006

Okay I need some help filling out my lab paper work from my patient that I had this week.
Here is the past medical history: HTN, Hypothyroidism, Asthma, CABG, GERD, Arthritis, Choncondritis, Neuropahty, CAD, Cardiac Cath 4 times, Unstable Angina( just diagnosed with this). No smoking or alcohol.
Came in with chest pain and R/O MI... whcih was ruled out.
s/s on admission .....chest pain, nausea, chills, fever, SOB, vomitting
Pts meds:Protonix, Advair 500, Salmeterol, Lopressor, Diovan, Synthroid, Flunisolide, Neurontin, Plavis, Imdur.
Soo here is the lab work that is abnormal:
LYMPH 19 , increased
INR 1.0 Decreased
Glucose 153 Increase
ALK PHOS 160 Incrase
AST/SGOT 66 Increase
CPK 148 Increase
Here is hwat I Have figured out so far:
Lymphs increased from a possible dietary deficiency, esp because patient is on multi vitamins since coming to the hospital.
Glucose increased from stress?
AST/SGOT increased from past cardiac operations, and 4 cardiac caths
CPK increased ... from cardiac ischemia?
I can't really figure out the other ones and the reasons why they would be abnormal.
Oh and does anyone know what choncondritis is? I can't find it in any of my books or on the internet. My patient said it was something from her past cardiac surgeries that got infected?
And I was confused about the neuropathy that she has? She doesn't hvae diabetes? And I always associated neuropathy with diabetes, SO I guess I was wrong?

CK goes up with a heart attack

liver enzymes go up because of the drugs, some people are diabetics and don't know it, because it "hides".

chondritis is an inflammation in the ribs, they call it costochondritis.

good luck

cc

soon to retire june 30 2006:balloons:

after 22 years