Vanegas Exam 1: Lab Values

Why do we use lab tests?

1) as a screening tool

2) as a diagnostic tool

3) to monitor medication effectiveness

4) to determine disease progression

5) identify precautions and contraindication

6) modify evaluation and/or intervention approach

we compare a patient's lab values to

normative values (standard scores based on age, gender, diagnosis)

or their baseline (own values)

what are normative values? aka?

standard scores based on age, gender, diagnosis

"reference range"

"expected values"

vital sign values vary according to

1) race

2) sex

3) age

4) other factors

high values are usually identifies with an

H

low values are usually identified with an

L

critical values are identified with

a C or "critical"

when our patient has values outside of the reference range we must

Tailor the session towards those values. What can we do to mobilize the patient without compromising those values?

when a patient has critical values, what happens with tx?

tx is usually deferred --> document

if a patient has abnormal values (H or L) what happens with tx?

-continue with POC

-modify tx (ex: less intense)

-defer tx - "hold"

ways we can modify tx:

- repetitions

-intensity

- amount of resistance

- number/freq of rest breaks

- bedside/sitting/OOB/ standing

when assessing and treating a patient we must

look at the total clinical picture

what does the total clinical picture look like?

1) is it a chronic condition?

2) is it an acute injury?

3) trauma (what is the expected physiological response?)

4) understand the disease process and interpretation of normative values

5) be able to ID p potential risk of adverse event from abnormal value vs potential benefits of tx

A patient has a low platelet count. What should you be aware of with this condition?

they have a high risk for bleeding

A client with low platelet count voices that they would like to engage in ADLs, specifically shaving. What must you be aware of? How can you engage in this activity using precautions?

- high risk for bleeding if cut with razor

- find less sharp razors -- electric...

CBC

complete blood count

most common lab value

CBC

complete blood count

comprehensive blood test that includes:

- red blood cell count (RBC)

- white blood cell count (WBC)

- hemoglobin (Hgb)

- hematocrit (Hct)

- white blood cell differential

- platelet count

Average WBC count

5k-11k

Leukocytosis

increase in the number of white blood cells (more than 11k)

infection, inflammation

leukopenia

Abnormally low white blood cell count (less than 5k)

cancer, transplant patients

WBC critical value

<2k or > 30k

If a client has a WBC of greater than 11k, how should the OT proceed?

- is there a fever?

- no fever proceed with standard precautions

If a client has a WBC of less than 5k, how should the OT proceed?

- fever: no therapy

- less than 500: no therapy

- less than 1000: consul but not therapy recommended

- less than 4000: consult, if okay use neutropenic precautions in addition to std precautions

*if there is no fever you can usually treat the patient

neutropenic precautions

Isolation procedures to protect an immunocompromised patient from infections

average Hgb count for males and females

males: 14-18

females: 13-16

what does a low Hgb signal?

anemia

heart works harder to transport O2

symptoms of low Hgb

patient may get dizzy

what does a high Hgb mean?

- blood is more viscous

-can lead to blood clots

A patient has a Hgb count of 7 g/dl, how should the OT proceed?

super low hemoglobin!

no therapy

A patient has a Hgb count of 8 g/dl, how should the OT proceed?

-consult with Dr.

-BADLs

- no exercise

A patient has a Hgb count of 8-10 g/dl, how should the OT proceed?

- consult with Dr.

-BADLs

- monitor vitals

- exercise usually light to no resistance

A patient has a Hgb count of greater than 20 g/dl, how should the OT proceed?

consult before activity --> they are at a big risk for blood clots

A patient has a low Hgb count and symptomatic, how should the OT proceed?

consult

usually no therapy

what are platelets?

blood components that contribute to the blood-clotting process

normal platelet count

150k-450k

what happens when we have too many platelets?

we are at a higher risk for blood clots

a patient has a low platelet count (less than 150k). what are they at risk for?

difficulty coagulating = bleeding risk

A patient has a platelet count of less than 10k. How should the OT proceed?

-bedrest

-no therapy

-consult because you might be able to do BADLs and AROM

A patient has a platelet count of less than 10k (very low). The doctor clears them for engagement in BADLs. You decide to try out tooth brushing. What precautions might you take to keep the patient safe?

Use a soft tooth brush because if the patient damages their gums they might cut themselves and will not be able to clot the cut due to the low platelet count.

normal glucose levels

70-110 mg/dL

high glucose levels

hyperglycemia

+110 mg/dL

low glucose levels

hypoglycemia

-70 mg/dL

what should we do when we encounter a patient with glucose levels of less than 70 mg/dL?

-low glucose --> hypoglycemia

- quick cab or OJ/apple juice

- check form NPO (nothing by mouth) and swallowing precautions

when a patient has low glucose levels, should we engage them in exercise or not?

exercise lowers our glucose levels, so if the patient already has low glucose level we would not exercise because the glucose levels would keep decreasing

when a patient has high glucose levels, should we engage them in exercise or not?

yes, as long as we allow them to take rests and intake fluid along the process

exercise will help the patient naturally bring the glucose levels down

potassium imbalances can lead to

arrhythmias or cardiac arrest

normal potassium range

3.5-5.0 mEq/L (millequivalents/liter)

If a client presents with abnormal potassium values, what are those values and how should tx continue?

less than 3.5 mEq/L

greater than 5.0 mEq/L

NO THERAPY (general rule_

Hypercholemia

excess K in blood

Nausea, vomiting, Confusion

can lead to cardiac arrest

hypocholemia

low K in blood

muscle weakness

Vomiting, diarrhea, GI sxn

can lead to arrhythmias

You are in the acute care setting and are evaluating a client after being admitted for a right sided stroke, you notice in their chart that they have a history of type II diabetes. Their blood glucose level this morning was at 395 mg/dl (normal range 70-110mg/dl). What would be your course of treatment?

a) Continue with therapy. Provide adequate rest breaks, promote hydration, and communicate any changes with the nursing staff or medical team

b) Defer therapy. Their blood sugar is elevated, and you need clearance from the medical team.

c) Avoid exercising with them since this will trigger the liver to reduce sugar in the blood stream further. Increase their blood glucose level

a) Continue with therapy. Provide adequate rest breaks, promote hydration, and communicate any changes with the nursing staff or medical team

You are in the acute care setting and are evaluating a client who has been newly diagnosed with type II diabetes. Their blood glucose level this morning was at 455 mg/dl (normal range 70-110mg/dl). What would be your course of treatment?

a) Continue with therapy. Provide adequate rest breaks, promote hydration, and communicate any changes with the nursing staff or medical team

b) Defer therapy. their blood sugar is elevated, and you need clearance from the medical team.

c) Avoid exercising with them since this will trigger the liver to reduce sugar in the blood stream further and increasing their glucose level.

b) Defer therapy. their blood sugar is elevated, and you need clearance from the medical team.

Here the correct answer is B as they are newly diagnosed with type II diabetes, and they are in the critical range (<40mg/dl >450mg/dl). Exercising for this client should be avoided as exercise can trigger the release of even more sugar into the blood stream further increasing their blood sugar level.

You are in the acute care setting and notice the clients who's chart you are reviewing had a blood glucose level this morning of 65 mg/dl (normal range 70-110mg/dl). What would be your course of treatment?

a) Continue with therapy. Provide adequate rest breaks, promote hydration, and communicate any changes with the nursing staff or medical team.

b) Defer therapy. Their blood sugar is low, and you need clearance from the medical team.

c) Avoid exercising with them since this will trigger the liver to release sugar in the blood stream further and increase his blood glucose level.

d) Provide a quick absorbable carbohydrate snack (orange juice or apple juice) and ask the nurse to recheck in 15 minutes.

d) Provide a quick absorbable carbohydrate snack (orange juice or apple juice) and ask the nurse to recheck in 15 minutes.

their lab values are 65mg/dl. Per your book <70mg/dl we can give a quick carbohydrate snac

You are in the acute care setting and notice the clients who's chart you are reviewing had a blood glucose level this morning of 35 mg/dl (normal range 70-110mg/dl). He is reporting a headache, shakiness, and blurred vision. What would be your course of treatment?

a) Continue with therapy. Provide adequate rest breaks, promote hydration, and communicate any changes with the nursing staff or medical team.

b) Defer therapy. Their blood sugar is low, and you need clearance from the medical team.

c) Avoid exercising with them since this will trigger the liver to release sugar in the blood stream further and increase their blood glucose level.

d) Provide a quick absorbable carbohydrate snack (orange juice or apple juice) and ask the nurse to recheck in 15 minutes.

b) Defer therapy. Their blood sugar is low, and you need clearance from the medical team.

Their blood glucose level is in the critical range <40mg/dl therefore continuing with therapy would put that patient at risk for diabetic shock.

You are in the acute care setting and notice the clients who's chart you are reviewing had a blood glucose level this morning of 100 mg/dl (normal range 70-110mg/dl). What would be your course of treatment?

a) Continue with therapy. Provide adequate rest breaks, promote hydration, and communicate any changes with the nursing staff or medical team.

b) Defer therapy. Their blood sugar is low, and you need clearance from the medical team.

c) Avoid exercising with them since this will trigger the liver to release sugar in the blood stream further and increase their blood glucose level.

d) Provide a quick absorbable carbohydrate snack (orange juice or apple juice) and ask the nurse to recheck in 15 minutes.

a) Continue with therapy. Provide adequate rest breaks, promote hydration, and communicate any changes with the nursing staff or medical team.