A-flutter often presents with a regular but rapid atrial rate (240–400 bpm); ventricular response may be regular or irregular depending on AV block.
Carefully monitor heart rate and rhythm, as patients may suddenly shift into more dangerous rhythms (e.g., atrial fibrillation or rapid ventricular response).
Use ECG or telemetry when possible, especially in acute care settings.
Exercise intensity and progression
Initiate with low to moderate intensity aerobic activity.
Use RPE scales to guide intensity because HR may not accurately reflect exertion, especially if rate-controlled.
Avoid abrupt changes in activity that could increase sympathetic tone and trigger rhythm instability.
Below 90% indicates possible need for supplemental oxygen
Hematological - Complete blood count
Hemoglobin: responsible for transporting oxygen via red blood cells
Male: 14-18
Female: 12-16
Below normal values indicates anemia which increases the risk for blood transfusion
Above normal value indicates polycythemia which increases the risk for clogging of capillaries
Hematocrit: ratio of red blood cells to total volume of blood
Male: 42%-52%
Female: 37%-47%
Below normal values indicates anemia which increases the risk for blood transfusion or need for fluids
Above normal value indicates polycythemia which increases the risk for clogging of capillaries
Platelets: clot forming components of blood
150,000-400,000 mm3
Below 150,000 mm3 indicates thrombocytopenia which increases risk for hemorrhage, bleeding from gums, heavy menstrual bleeding, or blood in uring or stools
Above 400,000 mm3 indicates thrombocytosis which increases risk for DVT development
White blood count: important in immune response to infectious processes
5,000 - 10,000 mm3
Below 5,000 mm3 indicates leukopenia which increases the risk for recurrent infections
Above 10,000 mm3 indicates leukocytosis which increases the risk for inflammation, immune system, or bone marrow disease
Red blood count: cells that carry oxygen from lungs to tissue and are produced within the bone marrow
Male: 4.7-6.1
Female: 4.2-5.4
Below normal values indicates anemia which increases the risk for blood transfusion
Above normal value indicates polycythemia which increases the risk for myocardial infarction and stroke
INR (international normalized ratio): the specific blood test used to measure the time it takes for blood to form a blood clot
0.8 – 1.2: normal range of person non on anticoagulants
Too Low (< 2.0): Blood may clot too easily → risk of thrombosis, stroke, or embolism.
Too High (> 3.0–3.5): Blood is too thin → increased risk of bleeding, especially dangerous in falls or with trauma.
Liver panel
Albumin: protein that assists with moving small molecules such as bilirubin, progesterone, and calcium through body
3-5.5
Lab value that indicates nutritional status in last 12-18 days
Below 3 indicates malnutrition
Will need to increase overall protein intake
Above 55 indicates chronic kidney disease
Pre-albumin: protein that assists with moving small molecules such as bilirubin, progesterone, and calcium through the body.
15-36
Lab value that indicates nutritional status in last 1.9 days
This is the preferred lab value for nutritional status
Below 15 indicates malnutrition
Will need to increase overall protein intake
Above 36 indicates chronic kidney disease
Renal function
Blood urea nitrogen (BUN): Measures the metabolic function of the kidney and excretory function of the kidney
10-20
Below 10 indicates hepatic disease or issues with liver absorption
Above 20 indicates high protein diet, burns- over body covering large surface area due to increased metabolism occurring, septic shock
Creatine kinase: Involved in the supply of energy for muscular contraction
Male: 0.6-1.2
Female: 0.5-1.1
Below normal decreased muscle mass, debilitation
Above normal renal disease, rhabdomyolysis, endocrine dysfunction
Cardiac lab values
Troponin:
Lab value indicates suspected acute coronary ischemic disease
Troponin T: < 0.1
Troponin: < 0.03
Above normal: myocardial injury or myocardial infarction
Arterial blood gases- see further explanation in later chapter 3.3
pH: 7.35- 7.45
Partial pressure of carbon dioxide (PaC02): 32-45
Bicarbonate (HCO3): 22-26
Lipid panel
Low density lipoprotein (LDL - bad cholesterol):
Create plaques and occlusions in blood vessels
Normal <100
Low level indicates decreased protein malabsorption, severe burns
High levels indicates liver or kidney disease
High density lipoprotein (HDL- good cholesterol):
Helps to remove excess cholesterol deposits
Normal: >60 mg/dL
Below 35 mg/dL indicates increased risk for cardiovascular disease
Triglycerides:
Produced in liver and transport fatty tissue
Desirable <150
Above 150 is hypertrilglyceridemia indicates increased risk for hypothyroidism, myocardial infarction, or cardiovascular disease
No specific value- hypotriglyceridemia indicates increased risk for malnutrition
Total cholesterol:
Main lipid associated with cardiovascular disease
<200
200 or higher hypercholesterolemia indicates increased risk for cardiovascular disease
No specific value- hypocholesterolemia indicates increased risk for malnutrition
Ankle brachial index (ABI)
Procedure in which the systolic blood pressure is taken from the brachial artery (brachial) and dorsal pedis and posterior tibialis arteries (ankle) to assess if peripheral arterial disease is present
Ratio of ankle blood pressure over brachial blood pressure
Summary of Results:
1.4 and above:
indicates calcification and vessel hardening
0.9-1.3:
Normal no disease present
0.51-0.89
Venous insufficiency indicated
Lower extremity compression indicated
0.5 and below:
Arterial insufficiency indicated
Lower extremity compression contraindicated
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