Exam 1: Lab Values

Lab results can be used as a.....

1) screening tool (inc. WBC? infection?)

2) diagnostic tool (heart attack pt will have inc. troponin lvls)

3) way to monitor medication effectiveness (blood thinners, platelets)

4) way to determine disease progression

What are some implications for OT regarding lab values and treatment?

-OTs should always identify precautions and contraindications in lab values when creating and implementing a tx plan as well as for daily sessions

-OTs should modify evaluation and/or intervention approach depending on pt lab values

What is "reference range" or "expected values"?

-the numeric range of test values for which the general population consistently shows similar results 95% of the time

-provides a baseline to compare individuals to "normal values"

varies by

-race

-sex

-age

What does "H" mean in lab values?

high

can typically continue with POC, modify, or defer tx AFTER CONSULTING DOCTOR (also depends on how high i.e. slightly elevated K+ may lead to cramping but we can closely monitor; use your clinical reasoning!!)

What does "L" mean in lab values?

low

can typically continue with POC, modify, or defer tx AFTER CONSULTING DOCTOR (also depends on how low i.e. slightly dec. K+ may lead to hypotension but we can monitor BP; use your clinical reasoning!!)

What does "C" mean in lab values?

critical

NO therapy, need clearance from doctor

DOCUMENT not able to do therapy bc "x" values were extremely high/low

We can modify our treatment sessions by......

decreasing

-repetitions

-intensity

-amount of resistance

increasing

-number/frequency of breaks

changing from bedside/sitting/OOB/standing

When looking at the total clinical picture of lab values, what should OTs consider when developing and implementing tx plans?

if it is a chronic condition

-some ppl have adapted to their conditions and know how to manage really well

if it is an acute injury

-pts body may have difficulty adjusting to the injury/change in body values

disease process (interpretation of normative values)

T or F: We rely on our clinical reasoning when weighing the potential risk of adverse events from abnormal values vs the potential benefits of tx.

true

example

dec. platelet count = inc. risk for bleeding → if stroke pt who has difficulty w/ coordination wants to work on brushing teeth or shaving we would want to modify tx by using soft bristle toothbrush or electric razor

When looking at a CBC panel, what values are we looking at?

WBCs/leukocytes

neutrophils

hemoglobin

hematocrit

RBCs

platelets

What is the normal range for leukocytes (WBCs)?

5,000-11,000

Noah has a WBC count of 8,000. Is he in normal range?

yes

What is the abnormal range for leukocytes?

greater than 11,000 (leukocytosis)

less than 5,000 (leukopenia)

What is leukocytosis?

abnormally high WBC count (over 11,000)

caused by infection, inflammation, trauma, hemorrhage, burns, drugs, tissue injury, dehydration, pneumonia

Emma, a 45-year-old female, was sent to the hospital for intensive care after sustaining 3rd degree burns in a motorcycle accident. She remains in the hospital for treatment and has now developed an infection from her road burn. She has a WBC of 13,000. Is this range abnormal or critical?

abnormal (elevated)

-leukocytosis

What is leukopenia?

abnormally low WBC count (below 5,000)

caused by immunosuppressed pts, transplant pts, cancer pts, autoimmune diseases, bone marrow disorders, HIV, alcoholism

Jack has an autoimmune disease causing his WBC count to be 3,000. Is this range normal or abnormal?

abnormal (decreased)

leukopenia

What are critical lab values for leukocytes (WBCs)?

less than 2,000

greater than 30,000

Following a car accident, Isa suffered severe blunt trauma to the head causing inflammation and hemorrhaging. She has a WBC count of 32,000. Is this range abnormal or critical?

critical

A patient has a WBC count of greater than 11,000 with a fever. Do we engage in therapy? What range is this?

NO therapy/use caution when exercising????

abnormally high range (leukocytosis)

A patient has a WBC count of less than 5,000 with a fever. Do we engage in therapy? What range is this?

NO therapy

abnormally low range (leukopenia)

A patient has a WBC count of less than 500. Do we engage in therapy? What range is this?

NO therapy

-extremely dangerous, may be fatal

critical range

A patient has a WBC count of less than 1,000. Do we engage in therapy? What range is this?

CONSULT FIRST, therapy is usually not recommended

If physician does clear patient for therapy, avoid exercise, and wear protective equipment.

critical range

A patient has a WBC count of less than 4,000. Do we engage in therapy? What range is this?

CONSULT FIRST, then use neutropenic and standard precautions

-mask, gloves, gown, disinfecting, hand-washing

abnormally low range

A patient has a WBC count of greater than 5,000. Do we engage in therapy? What range is this?

LIGHT exercises, progressing resistance as tolerated

normal

What are neutrophils?

most common type of WBC that play a key role in fighting against infection

↓ neutrophils = neutropenia

-use neutropenic precautions for tx

What is hemoglobin (HgB)?

a protein in red blood cells that carries oxygen throughout the body

What is the normal range for hemoglobin?

Males: 14-18 g/dL

Females: 13-16 g/dL

What is the abnormal range for hemoglobin?

less than 8 g/dL (i.e. 7.5)

8-10 g/dL (i.e. 8.5, 9.5)

greater than 10 g/dL

What is the critical value range for hemoglobin?

less than 7 g/dL

greater than 21 g/dL

What is anemia?

-a decrease in hemoglobin (the oxygen-carrying ability of the blood)

-heart has to work harder to transport O2

-pt's will feel dizzy, lightheaded w/ exercise

due to chronic renal failure, cirrhosis, burns, sickle cell disease, hyperthyroidism, some medications, and certain systemic diseases (e.g., sarcoidosis, systemic lupus erythematosus [SLE], leukemia, or lymphoma).

James has sickle cell disease causing him to be anemic. He often gets dizzy and lightheaded with exercise. James has a _________ in hemoglobin.

decrease

What is polycythemia?

-an increase in hemoglobin, hematocrit, and RBC

-caused by COPD, CHF, dehydration

-can lead to high blood viscosity which can lead to blood clots

Holly is diagnosed with COPD and CHF consequently causing her to have polycythemia. Holly has a _______ in hemoglobin.

increase

A patient has a hemoglobin count of less than 7 g/dl. Do we engage in therapy? What range is this?

NO therapy

-can cause heart failure or death

critical

A patient has a hemoglobin count of less than 8 g/dl (i.e. 7.5). Do we engage in therapy? What range is this?

CONSULT first

then can work on BADLs, but NO exercise

abnormally low

A patient has a hemoglobin count between 8 - 10 g/dl. Do we engage in therapy? What range is this?

CONSULT first

then can work on BADLs and exercise with light to no resistance while monitoring vitals (i.e. using 1-2 lb dumbbells)

abnormal (middle)

A patient has a hemoglobin count of greater than 10 g/dl. Do we engage in therapy? What range is this?

yes; ADLs, functional mobility, resistance exercises as tolerated

abnormal to normal

A patient has a hemoglobin count of greater than 21 g/dl. Do we engage in therapy? What range is this?

CONSULT BEFORE activity

-exercise can lead to increased viscosity and therefore clotting

critical

What is the general rule of hemoglobin levels for therapy for a patient who is symptomatic?

always consult!! will usually result in no therapy

(guidelines are different for everyone tho; use clinical reasoning)

T or F: A patient with low hematocrit and hemoglobin after a recent hip replacement surgery, for example, may be more symptomatic than a person with leukemia. Low hemoglobin and hematocrit symptoms may include weakness, fatigue, tachycardia, dyspnea on exertion (DOE), heart palpitations, and decreased exercise tolerance requiring close monitoring of vitals and rest breaks. When making a clinical decision about treatment, we should consider the patient's total clinical picture and whether the low blood counts are because of an acute or chronic condition; however, we should always consult the doctor first.

true

What are platelets?

-blood components that contribute to the blood-clotting process

What is the normal range for platelets?

150,000 - 400,000/uL

What is the abnormal range for platelets?

greater than 1 million (thrombocytosis)

less than 150,000 (thrombocytopenia)

What is thrombocytosis?

abnormally high platelet count (greater than 1 million)

causes: cancer, inflammation, infection, trauma

Sally has inflammation following a traumatic accident causing her platelet count to be greater than 1 million/uL. What is this called? What range is this?

thrombocytosis

abnormally high range

What is thrombocytopenia?

abnormally low platelet count (less than 150,000)

causes: viral/bacterial infections, anemia, nutritional deficiency, coagulation disorders

Grace is hospitalized due to a bacterial infection causing her platelet count to be less than 150,000/uL. What is this called? What range is this?

thrombocytopenia

abnormally low range

Tor F: With thrombocytopenia (abnormally low platelets), there is increased difficulty in coagulating putting patients at risk for bleeding.

true

What is the critical range for platelets?

less than 20,000

A patient has a platelet count of less than 10,000/uL. Do we engage in therapy? What range is this?

defer therapy

if cleared by dr. then we can work on light BADLs and AROM

i.e. inspecting skin, using a soft-bristle toothbrush and electric razor, gentle wiping, pads instead of tampons

critical range

A patient has a platelet count of 10,000-20,000/μl. Do we engage in therapy? What range is this?

AROM, light exercises; guarded functional mobility

critical range

A patient has a platelet count of 20,000-50,000/μl. Do we engage in therapy? What range is this?

Moderate exercise, including light weights or exercise resistance bands, AROM, ambulation, stationary bicycle, water aerobics, and ADLs as tolerated

abnormally low (50k) to critical (20k)

A patient has a platelet count of 50,000/μl. Do we engage in therapy? What range is this?

Resistive exercise is okay

abnormally low (lower end)

A patient has a platelet count of 50,000-150,000/μl. Do we engage in therapy? What range is this?

Progressive resistive exercises; no restrictions on manual muscle testing. Sexual intercourse, swimming, bicycling on flat ground, and low bench stepping is permissible

abnormally low (50k) to normal (150,000k)

A patient has a platelet count of greater than 150,000/μl. Do we engage in therapy? What range is this?

yes, engage; no activity restrictions

normal range

What is glucose?

amount of sugar in blood; body's main source of energy

What is the normal range of glucose?

70-110 mg/dL

What is the abnormal range for glucose?

less than 60 (hypoglycemia)

greater than 250 (hyperglycemia)

110-200 (pre-diabetes)

greater than 126 (diabetes)

What is hypoglycemia?

abnormally low blood glucose levels (less than 60)

causes: insulin overdose, skipped meals, overexertion in exercise

symptoms: headache, weakness, shaking, clammy, blurred vision, difficulty responding, fainting

T or F: Typically, when a patient has a blood glucose of less than 70 (i.e. 65) mg/dL we will offer them a quick carb such as orange juice or apple juice. However, we should ALWAYS check for swallowing precautions and if patient is NPO.

true

What is hyperglycemia?

abnormally high blood glucose levels (greater than 250 mg/dL)

causes: diabetes, stress

What is severe hyperglycemia? What are the symptoms?

blood glucose of 300-350 mg/dL

acetone breath, increased pulse, nausea, fatigue, weakness, vomiting, dehydration/extreme thirst, COMA

What is the critical range for blood glucose levels?

less than 40 mg/dL

greater than 450 mg/dL

A patient has a blood glucose of less than 100 mg/dL. Do we engage in therapy? What range is this?

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

w/i normal range

A patient has a blood glucose less than 60 mg/dL. Do we engage in therapy? What range is this?

NO exercise (can drop sugar even more)

-overexerting a pt with <60 glucose may lead to a hypoglycemic reaction (i.e., confusion, dizziness, weakness, blurred vision, seizures) or diabetic shock

abnormally low (hypoglycemia)

T or F: Patients with Type 2 diabetes may participate in physical activities and exercises with elevated blood glucose >300 mg/dl if they are asymptomatic and remain adequately hydrated.

true

bc exercise requires use of sugar

offer more rest breaks!!!

A patient has a blood glucose greater than 240 mg/dL. Do we engage in therapy? What range is this?

consult doctor!!

risk of hyperglycemia

What is potassium?

electrolyte important for neuromuscular function and cardiac muscle contraction

What is the normal range for potassium?

3.5-5.0 mEq/L

What is the abnormal range for potassium?

greater than 5.0 mEq/L (hyperkalemia)

less than 3.5 mEq/L (hypokalemia)

What is hyperkalemia?

abnormally high potassium (greater than 5.0)

causes: renal disease/failure, Addison’s disease or excess vitamin D, excessive K+ supplements, diabetic ketoacidosis, hypoxia, acidosis, crush injuries, burns, medications, blood transfusions, or eating foods high in potassium

sy,mptoms: abdominal cramping, nausea, diarrhea, cardiac arrhythmias, cardiac arrest

What is hypokalemia?

abnormally low potassium (less than 3.5)

causes: alkalosis, vomiting, diarrhea, diuretics, Cushing's syndrome

symptoms: muscle weakness, fatigue, leg cramps, paresthesias, disorientation, dizziness, hypotension, decreased strength of cardiac contractions, dysrhythmias, cardiac arrest

What is the critical range for potassium?

less than 3 mEq/L

greater than 6.1 mEq/L

T of F: If potassium levels are <3.2 mEq/L or >5.0 mEq/L, consider deferring therapy because there is an increased risk of arrhythmia or tetany, especially in patients with a cardiac history

true

general rule for K+ = deferring therapy bc of increased risk of cardiac arrest

Exercise may worsen hyperkalemia.

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

correct answer is A

-since the client has a history of type II diabetes they are able to participate in therapy as long as they remain asymptomatic and are adequately hydrated

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

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.

correct answer is D

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

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.

The correct answer is B

-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

The correct answer is A

-the client's lab values are within normal range