Multisystem Assessment and Laboratory Investigations



Multisystem Assessment and Laboratory Investigations


Elizabeth Dean



Key Terms











The purpose of this chapter is to describe the rationale for multisystem assessment in the patient managed for cardiovascular and pulmonary dysfunction and to discuss some common laboratory tests related to multisystem assessment. The bases of tests that assess the function of the following organ systems are presented: blood, pulmonary, cardiac, peripheral vascular, kidney, endocrine, liver, and immune systems. The normal ranges are given for common laboratory tests and investigations. The information in this chapter is supplemental to the elements of the cardiovascular and pulmonary assessments and related laboratory investigations described in other chapters of Part II.


The oxygen transport system affects and is affected by virtually every organ system in the body. The signs and symptoms of systemic disease can mimic other conditions, including cardiovascular and pulmonary dysfunction, which is treated by physical therapists. Therefore the physical therapist must be able to differentiate among these presentations to determine what treatment, if any, is indicated, and what treatments may be contraindicated. Knowledge of multisystem function helps to confirm a diagnosis, as well as to predict a patient’s response to treatment and his or her recovery and prognosis. In addition, this information is crucial in guiding clinical decision making, that is, refining and modifying treatment prescription. These abilities have become increasingly important in this era of professional accountability and with the advent of direct patient access.



Rationale for Multisystem Assessment


The cardiovascular and pulmonary systems support cellular respiration and life. Thus every system and every cell in the body is affected by the adequacy of oxygen transport, which is dependent on cardiovascular and pulmonary function. In addition, these systems are affected by virtually every other system in the body. The cardiovascular and pulmonary physical therapist, therefore, needs thorough knowledge of multisystem function and of the interdependence of the organ systems, as well as the ability to assess multisystem function and to integrate this information into a comprehensive and progressive treatment plan.


The lungs and heart are anatomically and physiologically interdependent, and they function as a unit to transport oxygen via the peripheral circulation so as to perfuse and nourish tissues. Tissue homeostasis is dependent on the adequacy of the anatomy and physiology of the blood. The adequacy of peripheral perfusion determines the adequacy of the function of all organ systems in the body. Therefore knowledge of the failure of the various organ systems can reflect impaired oxygen transport or may identify a threat to oxygen transport.


The elements of laboratory evaluation and testing, as well as the normal values, have been compiled from the following sources: Dean (1999)1; Fischbach (2004)2; Hall (2010)3; Jacobs et al (2001)4; Le Fever Kee (2000)5; Pagana and Pagana (2002)6; and Wallach (2000)7.



Elements of Multisystem Assessment


Blood


Some common blood tests are listed in Table 13-1, along with their normal values.



Table 13-1


Common Tests of Multisystem Function and Their Normal Values: Blood Tests




























































































































































































Test US Unit SI Unit
Red blood cell count (RBC)    
 Men 4.4-6.2 million/µL 4.5-6.2 × 1012/L
 Women 4.0-5.5 million/µL 4.0-5.5 × 1012/L
Hemoglobin (Hgb)    
 Men 13.6-18 g/dL 8.44-11.17 mmol/L
 Women 12-16 g/dL 7.45-9.9 mmol/L
Hemoglobin A1c <6%  
Hematocrit (Hct)    
 Men 39%-51% 0.39-0.59
 Women 35%-47% 0.35-0.47
Platelet count 150,000-400,000/mm3 150-400 × 109/L
Prothrombin time (PT) 10-15 seconds 10-15 seconds
Partial thromboplastin time (PTT) <70 seconds <70 seconds
White blood cell count (WBCC)*    
 Men 4500-11,000/µL 4.5 × 11.0 × 109/L
 Women 4500-11,000/µL 4.5 × 11.0 × 109/L
Erythrocyte sedimentation rate (ESR)    
 Men 15-20 mm/hr  
 Women 20-30 mm/hr  
Proteins    
 Albumin 3.5-5.0 g/dL 35-50 g/L
 Alpha1 globulin 0.1-0.4 g/dL 1.0-4.0 g/L
 Alpha2 globulin 5.0-10 g/dL 0.5-1.0 g/L
 Beta globulin 7.0-12 g/dL 0.7-1-2 g/L
 Gamma globulin 8.0-16 g/dL 0.8-1.6 g/L
 Fibrinogen 200-400 mg/dL 2.2-4.0 g/L
Lactate    
 Venous 0.5-2.2 mEq/L 0.5-2.2 mmol/L
 Arterial 0.5-1.6 mEq/L 0.5-1.6 mmol/L
Electrolytes (blood)    
 Sodium (Na+) 136-145 mEq/L 136-145 mmol/L
 Potassium (K+) 3.5-5.3 mEq/L 3.5-5.0 mmol/L
Calcium (Ca2+)†    
 Total 8.2-10.7 mg/dL 2.10-2.70 mmol/L
 Ionized 4.45-5.30 mg /dL 1.10-1.30 mmol/L
 Chloride (Cl−) 95-108 mEq/L 95-108 mmol/L
Cholesterol total    
 Men ≤40 years 124-270 mg/dL 3.21-699 mmol/L
 Men >40 years 151-277 mg/dL 3.91-7.17 mmol/L
 Women ≤40 years 122-242 mg/dL 3.16-6.27 mmol/L
 Women >40 years 147-303 mg/dL 3.81-7.85 mmol/L
Creatine kinase (total)    
 Men 20-200 international units/L 20-200 international units/L
 Women 20-180 international units/L 20-180 international units/L
C reactive protein Normal: <0.8 mg/L
Low risk: <1.00 mg/L
Average risk: 1.00-3.00 mg/L
High risk: >3.00 mg/L		  

Related posts:

  1. Pulmonary Function Tests
  2. Respiratory and Cardiovascular Drug Actions
  3. Epidemiology as a Basis for Informing Contemporary Physical Therapy Practice
  4. Individuals with Acute Surgical Conditions

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Jun 11, 2016 | Posted by in RESPIRATORY | Comments Off on Multisystem Assessment and Laboratory Investigations

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