Which labs???

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Hello...again. It's been so long that I have had to post a question on here because I have really had it rather easy but I am now in my senior year and taking Med/Surg II. And I need help...right now I am working on a critical thinking case study and I don't know which labs I should assume would be ordered. Here's the scenario:

A 49 year old comes into a rural hospital with C/O indigestion. It's a blizzard and the helicopter can't get out so he will be airlifted for a cardiac catheterization in the am. His current VS are: BP 202/124, 96, 18, 98.2 F. He has male-patten obesity and a barrel chest with a Hx of high-fat food. He is currently receiving IV nitro.

The question wants which of the following labs may be ordered and which significant ones are missing from the list. Would you expect: CBC, EEG in the am (I think so), Chem 7 (yes), PT/PTT (thinking yes), bilirubin every am, UA, STAT 12-lead ECG (yes), Type and crossmatch for 4 units of PRBCs (thinking yes). I am also thinking the other labs would be CK, CK-MB, Myoglobin, Tropinin, and maybe Creatine kinase? Any, any, any help would be greatly appreciated. I have googled, looked in my books, and am now looking in a lab/diagnostic book but if anybody can help me...please?

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Daytonite, can you help me with this please???? Or even point in a good direction???

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Specializes in med/surg, telemetry, IV therapy, mgmt.

I meant to look this up for you, but yesterday. A 49-year old man with indigestion is going to be evaluated for a heart problem first--ALWAYS. Indigestion can be mistaken as a GI p[roblem when it is really a heart problem. Once a heart problem is ruled out, then a GI cause is looked for. In looking through Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span, 7th edition, by Marilynn E. Doenges, Mary Frances Moorhouse and Alice C. Murr and their care plan for Angina and CAD these are the diagnostic studies they have listed (page 64):

  • ECG: Often normal when client at rest or when pain-free; depression of the ST segment or T wave inversion signifies ischemia. Dysrhythmias and heart block may also be preseent. Significant Q waves are consistent with a prior MI.
  • 24-hour ECG monitoring (Holter): Done to see whether pain episodes correlate with or change during exercise or activity. ST depression without pain is highly indicative of ischemia.
  • Exercise or pharmacologic stress electrocqrdiography: Provides more diagnostic information, such as duration and level of activity attained before onset of angina. A markedly positive test is indicative of severe CAD. Note: Studies have shown stress echo studies to be more accurate in some groups than exercise stress testing alone.
  • Cardiac enzymes (troponin I and cardiac troponin T, CPK, CK and CK-MB; LDH and isoenzymes LDy LDz): Usually within normal limits (WNL); elevation indicates myocardial damage.
  • Chest X-ray: Usually normal; however, infiltrates may be present, reflecting cardiac decompensation or pulmonary complications.
  • PCO 2, potassium, and myocardial lactate: May be elevated during anginal attack (all play a role in myocardial ischemia and may perpetrate it).
  • Serum lipids (total lipids, Lipoprotein electrophoresis, and isoenzymes cholesterols [HDL, LDL, VLDL]; triglycerides, phospholipids: May be elevated (CAD risk factor).
  • Echocardiogram: Motion mode (M-mode) or two-dimensional (2-D or cross sectional) electrocardiography helps diagnose cardiomyopathy, HF, pericarditis, and abnormal valvular action that might be cause of chest pain.
  • Nuclear imaging studies(rest or stress scan): Thallium-201: Ischemic regions appear as areas of decreased thallium uptake. MUGA: Evaluates specific and general ventricle performance, regional wall motion, and ejection fraction.
  • Calcium scoring (also called coronary artery calcium scoring): Ultrafast CT scan that measures the amount of calcium in the coronary arteries. Elevated calcium scoring in client with other risk factors (e.g., family history, hypertension, diabetes, hypercholesterolemia) is an indication of some level of coronary artery disease (CAD).
  • Cardiac catheterization with angiography: Definitive test for CAD in clients with known ischemic disease with angina or incapacitating chest pain, in clients with cholesterolemia and familial heart disease who are experiencing chest pain, and in clients with abnormal resting ECGs. Abnormal results are present in valvular disease, altered contractility, ventricular failure, and circulatory abnormalities. Note: Ten percent of clients with unstable angina have normal-appearing coronary arteries.

Labs for GI, if there is something like a gallbladder problem, would be CBC, serum bilirubin, amylase, liver enzymes (AST,ALT, ALP, LDH), prothrombin levels, stool for occult blood, BUN, creatinine and electrolytes.

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Daytonite,

I cannot even begin to tell you what a help this was. This has allowed me to go and re-study these diagnostics and the reasons they are performed. Again you have came to the rescue. I just get so worked up when I am doing these because I don't know a lot of this stuff. I know they say alot of it comes with working on the units/floors but it scares me that I will not be able to properly care for my patients if I don't know these things. Thank you again-you are my Nursing Student Angel. Have a good day :)

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