General Lab Tests for Acute Coronary Syndrome (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 So there's some other general test.

    00:02 These are things that might be considered depending on what's going on with this particular patient.

    00:06 So additional test the team might consider the ABG's arterial blood gases.

    00:12 Now the patient's awake alert the same there's anything indicating to be another problem.

    00:17 These may not be done.

    00:19 But the make consider ABG's a comprehensive metabolic panel or a basic metabolic panel.

    00:25 The comprehensive panel is going to have far more on it than just a basic metabolic panel.

    00:30 Could look at electrolytes and a CBC.

    00:34 Now CBC is a complete blood count because we're looking for things like an anemia or polycythemia.

    00:41 So either low or high red blood cells because these could be indications of some ongoing impaired oxygen carrying ability of the blood if have chronic problems the patient may or may not be aware of it.

    00:53 Sometimes when the patient has had low oxygenation for a long period of time the body will try to compromise by elevating those red cells.

    01:02 Some other underlying issues.

    01:04 So it's always a good idea for a CBC to be run.

    01:08 Now they'll be an inflammatory response to infarcted tissue.

    01:11 So if there is dead tissue, you will see a response or a change in the CBC as evidenced by an inflammatory response.

    01:19 So look at the leucocyte count, anticipate an increase within a couple hours of the event and a peak within two to four days.

    01:27 Does that mean the patient has an infection? No, it's part of of the inflammatory response.

    01:32 That's why it's really important you understand how to look at the results of a CBC and a differential.

    01:39 Now the leucocyte count may remain elevated because likely the inflammatory process will remain ongoing for a couple weeks.

    01:46 So look at the leucocyte count the white cell count expect an increase within two hours because of the MI expected to peak within the first two to four days and it may stay elevated for the first couple of weeks.

    01:59 The hypergycemia we want to watch in all patients after an MI because due to the stress response and the increased release of catecholamines, we expect that blood sugar might tend to rise and we know that elevated glucose is associated with increased complications and poor outcomes after an MI.

    02:18 So whether the patient is diabetic or not keep an eye on their blood sugar because we know that that's usually a sign that they're going to have increased complications and poor outcomes.

    02:28 So we try to keep really good blood sugar control to maintain it within the normal limits.

    02:34 Electrolytes after an MI can also be different.

    02:38 There's a release of epinephrine in that stress response and it causes a rapid influx of these electrolytes out of the bloodstream and into the cells.

    02:47 So you're thinking after an MI got epinephrine catecholamine.

    02:51 It's going to cause the response where these two rapidly and fuse out of the bloodstream and into the cell.

    02:58 Now when they go into the cell If I drew lab work, these levels will be lower we're talking about things like potassium, magnesium and calcium.

    03:08 Now elevated calcium inside the cell damages the membrane.

    03:12 So as its rushing inside the cell because of right, the release of epinephrine in the stress response.

    03:18 It's going to damage the membranes integrity and in a packs its ability for the heart to contract.

    03:24 That's not a good deal.

    03:25 So this mess with our electrolytes is going to impact the heart's ability to contract.

    03:31 On the electrical level because of the shift of calcium.

    03:34 Low sodium, you have to watch for fluid volume status because hyponatremia may be dilutional and a sign of fluid volume overload.

    03:43 Okay so we're thinking about electrolytes.

    03:45 You're going to see these on your BMP whether it's the comprehensive or the basic one.

    03:50 These will be there.

    03:51 So we're talking about the impact of epinephrine because it's released in that stress response the body feels like it's under attack because the heart is taken a hit potassium, magnesium and calcium are going to rush into the cell.

    04:05 Now elevated calcium inside the cell can really damage them even more and it impacts the ability of the heart to contract.

    04:13 So I've got the heart that's damaged maybe in the wall from the infarcted tissue and it's going to impact its ability to be able to contract due to the calcium shift.

    04:23 Now low-sodium.

    04:25 We talked about that once but I wanted to come back around to these because a lot of us are intimidated by electrolytes, but there's no reason for you to be there's always a very logical rationale to why they're moving the direction they're moving.

    04:38 So if you want to pause a minute as we're walking through this just review these in your head to make sure that it's clear before you keep moving with us.

    04:46 That's great in a really good investment in your own brain.

    04:50 Now sodium, low sodium is called hyponatremia.

    04:55 So this can be an indication of fluid volume status to because if it's delutional hyponatremia that may be a sign that the patient is fluid volume overloaded.

    05:05 Well, so what why is that a problem? That's a problem because fluid volume overload might be a sign that the heart can't pump efficiently enough to handle the amount of volume that's on board.

    05:19 So we're going to keep a really close eye on those electrolytes.

    05:24 Now C-reactive protein is a marker that tells us when there's inflammation present when there's inflammation present, CRP is elevated and we know that inflammation plays a role in all of this and the healing process and it may predict a risk for additional plaque formation and acute coronary syndrome.

    05:44 Now why is that? Well we go into detail on some of our other video information about that.

    05:48 So be sure to check those but for now keep in mind atherosclerosis that inflammatory process kind of a chronic inflammatory process.

    05:57 So this may be an indicator not just of what's going on now in the body after the heart attack, but it could be an indication of what's chronically going on in the body and the risk for atherosclerosis.

    06:10 Now erythrocyte sedimentation rate.

    06:12 This increases levels with inflammation and with MI, so we would anticipate if the patients had an MI we would see this rise.

    06:20 Remember it's also elevated inflammation without an MI it elevates within a few days and it might remain elevated for a few weeks.

    06:29 So if the patient has had an MI.

    06:31 I would expect to see this level elevated may take a few days after the event and we'll probably hang out there for a few weeks.

    06:39 So these may be some test that you wouldn't necessarily think about but you can see how each one of them plays a role and putting a piece together in the puzzle of evaluating a patient with an MI.

    About the Lecture

    The lecture General Lab Tests for Acute Coronary Syndrome (Nursing) by Rhonda Lawes, PhD, RN is from the course Acute Coronary Syndrome (Nursing) .

    Included Quiz Questions

    1. An inflammatory response to infarcted tissue
    2. A secondary infection of necrotic tissue
    3. Chronic anemia
    4. Polycythemia vera
    1. Elevated levels are associated with poorer outcomes post-MI
    2. Catecholamine release is associated with profound hypoglycemia
    3. Clients with diabetes are more likely to have cardiac events
    4. Glycemic control is important only in clients with diabetes
    1. Epinephrine release moves them from the bloodstream into the cells
    2. Inflammation shifts them from the cells into the interstitial space
    3. The stress response would cause hypernatremia and poor muscle contraction
    4. Damaged intravascular spaces cannot transport electrolytes

    Author of lecture General Lab Tests for Acute Coronary Syndrome (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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