PT7130- Lab Values

Most current

In hospital, check _______________________ lab values to determine whether patient is appropriate for PT.

Hold therapy

Delay PT to afternoon or next day d/t patient medical stability (i.e., patient will tolerate PT better s/p blood transfusion).

Tolerance; mobility

Abnormalities in electrolytes and fluids, hematology, ABG's, enzymes, and vitals can impair activity _______________________, cognition, and functional _______________________.

Current

Lab values assist in determining _______________________ patient presentation and clinical observation during examination and treatment.

Guide

Lab values ______________________ intervention appropriatness, intensity, and duration, safety, and effectiveness.

↓

↓ hemoglobin, ____________________ exercise tolerance

Lower

IV rehydration will dilute lab values, so they may appear _______________________ than they are.

MRI

(-) CT scan does not immediately rule out an embolic stroke, so ________________________ may be ordered. → Rules our hemorrhagic stroke

Liver dysfunction

↑ ALT (alanine aminotransferase) or AST (aspartate aminotransferase) indicates _______________________.

14-18 g/dL

Normal hemoglobin values for men.

12-16 g/dL

Normal hemoglobin values for women.

42-52%

Normal hematocrit values for men.

36-48%

Normal hematocrit values for women.

3

Hematocrit is ____________________x hemoglobin.

5,000-10,000/mm³

Normal WBC values.

150,000-400,000/mm³

Normal platelet values.

WBC

Light green in image.

Hemoglobin

Blue in image.

Platelets

Purple in image.

Hematocrit

Burgundy in image.

Symptoms based; signs and symptoms

PT Implications Hematology Value:

__________________________ approach when determining appropriateness for activity, monitor symptoms, collaborate with the interprofessional team. → _________________________ may carry more weight than an isolated lab value in clinical decision making.

Therapy as indicated

Hemoglobin >10 g/dL:

_____________________________

Cardiopulmonary reserve; perfusion; orthostatic hypotension; intolerance

Hemoglobin 8-10 g/dL:

- Anticipate poor _______________________/limited endurance.

- Monitor vitals closely (especially SpO2 for tissue _______________________, may present with __________________________ and tachycardia).

- Examine for pallor, tachycardia, exercise ________________________

May be; blood transfusion

Hemoglobin <7-8 g/dL:

- Therapy _______________________ contraindicated

- Symptoms based approach

- ________________________ probable

- Monitor as described above

Death; likely

Hemoglobin <5-7 g/dL:

- Heart failure and _____________________

- Blood transfusion ______________________

- PT higher likelihood of being contraindicated

Blockage; ischemia

Hemoglobin 20 g/dL:

Increased blood viscosity → Capillary ______________________ and tissue ________________________

Cancer; 300 mL

Low Hemoglobin Considerations:

- Chronic conditions (i.e., CKD, __________________)

- Post-op surgery (~___________________ blood loss = 1.5 unit drop Hg)

- Fluid dilution

Hemodilution

↓ Hg d/t fluid intake.

Hematocrit

Proportion of blood that are RBC; expressed as a percentage.

Light ROM, isometrics

Hematocrit <25%.

Light exercise, SxS based approached

Hematocrit >25%.

>30-35%

Ambulation, resistance as tolerated.

Anemia

Acute blood loss, destruction, or decreased production of RBCs.

Paleness; fatigued; dyspnea; rapid, shallow

Signs and Symptoms of Anemia:

- ______________________ of skin

- Weak

- Listless

- Easily _______________________

- _______________________ on exertion

- ________________________ pulse

Transfusion; vitals; pacing

Indications for Anemia:

- Risk vs. benefit

- Need/timing of ______________________

- Frequent ______________________ monitoring

- Activity _____________________

- Close monitoring

Polycythemia

Myeloproliferative disorders (cancer), hypoxia at tissue level, higher altitudes, heavy tobacco smoking, chronic lung disease, congenital heart defects → Hypoxemia is stimulus.

Blurred; decreased; sensation

Signs and Symptoms of Polycythemia:

- Headache

- Dizziness

- _______________________ vision

- ______________________ mental acuity

- Altered ________________________ in hands/feet (blocked capillaries)

CVA and thrombosis

Polycythemia has increased risk for ________________________ → Pay attention to signs and symptoms of stroke, PE, DVT.

Leukocytosis

WBC > 10,000/mm³

Infection; inflammation; necrosis

Causes of Leukocytosis:

- ______________________

- Leukemia

- PNA

- Neoplasms

- _____________________

- Tissue ______________________

Fever; sore; fatigue

Signs and Symptoms of Leukocytosis:

- ______________________

- Chills

- ______________________ throat

- _______________________

Leukocytopenia

WBC < 5,000/mm³

Bone marrow; autoimmune

Causes of Leukocytopenia:

- _________________________ failure

- Radiation

- Chemotherapy

- HIV

- ________________________ disease

Stiff; sore; fever; ulcers

Signs and Symptoms of Leukocytopenia:

- _____________________ neck

- _____________________ throat

- _____________________/chills

- Headache

- Mouth ____________________

- Frequent infections

Neutropenia

WBC < 1500/mm³

Reverse isolation; mask; flowers

Neutropenia:

- __________________________

- Neutropenic precautions

- Increased risk for infection

- Pt should wear a mask outside of room

- Therapist should wear ________________________

- If therapist sick, do not treat patient

- No fresh fruit/______________________

Platelets

Cytoplasmic fragments of megakaryocytes in bone marrow; function in hemostasis and initiating clotting mechanism.

Thrombocytosis

>400,000/mm³ platelets

Infection; myeloproliferative

Causes of Thrombocytosis:

- __________________________

- Inflammation

- Genetic _______________________ conditions

Thrombosis; bleeding

Risks associated with Thrombocytosis:

- Increased ________________________ formation

- Paradoxical increased risk for _________________________

Weakness; chest; tingling

Signs and Symptoms of Thrombocytosis:

- Headache

- Dizziness

- _______________________

- _______________________ pain

- ________________________ hands/feet

Thrombocytopenia

<150,000/mm³ platelets

Suppression; cytotoxic

Causes of Thrombocytopenia:

- Bone marrow ____________________________

- Leukemia

- _________________________ drugs

Bleeding; resistive; valsalva

Risks associated with Thrombocytopenia:

- Increased risk for ___________________________

- Avoid bumps, bruising

- Avoid ________________________ exercises d/t risk of intramuscular bleeding

- Avoid ________________________

Oral; petechiae

Signs and Symptoms of Thrombocytopenia:

- Bruising

- Epistaxis

- Hematuria

- _______________________ bleeding

- ________________________

AROM; walking

Thrombocytopenia: 20,000-50,000/mm³

- ________________________ exercise with or without resistance

- _________________________ ad lib

Without; spontaneous; prolonged

Thrombocytopenia: <20,000/mm³

- Ther ex ______________________ resistance

- Risk of ________________________ bleeding

- Petechia (small hemorrhage, local, spots)

- Ecchymosis

- ________________________ bleeding time

CNS, GI, or respiratory tract; contraindicated

Thrombocytopenia:

<10,000/mm³ and/or temp >100.5°F

- Risk for spontaneous ______________________________ bleeding

- PT __________________________

Blood transfusions

Replete blood volume, maintain O2 delivery to tissues, maintain proper coagulation. → Typically takes 3-4 hours per unit.

OOB; 15 minutes

Blood Transfusions:

Depending on condition of patient, may defer ________________________ activity. → No contra-indications to therapy, except for the first __________________________ of transfusion.

Transfusion-Related Immunomodulation (TRIM) reactions; circulatory overload

During first 15 minutes minutes of transfusion, observe for signs and symptoms of _________________________ and _________________________ (i.e., CHF exacerbation).

Tachycardia; dyspnea; distended

Signs and Symptoms of Transfusion-Related Immunomodulation (TRIM) Reactions:

- HR: ______________________

- Cough

- Breathing: ________________________

- Crackles

- Headache

- HTN

- _______________________ neck veins

- Fever

- Rash

- Hypotension

Use extreme caution with mobility, fall risk, etc.

Monitor vitals

Jehova's Witnesses

What religion objects to blood transfusions?

Erythropoietin; salvage; normovolaemic haemodilution

Alternatives to Blood Transfusion:

- ___________________________

- Aprotinin

- Cell _______________________

- Tranexamic acid

- Novoseven

- Acute ___________________________

Prothrombin Time (PT)

Examines the function of the extrinsic system in clotting cascade.

Bleeding; clotting

↑ PT, ↑ risk of ________________________. ↓ PT, ↑ risk fo _______________________.

11-13.5 seconds

Normal Prothrombin Time (PT).

International Normalization Ratio (INR)

Used to correct for differences in lab reagents used for test PT time; calculated from PT value.

0.9-1.1

Normal International Normalization Ratio (INR).

Bleeding

↑ INR, ↑ risk of ______________________.

Coumadin (Warfarin)

What drug(s) is/are used for extrinsic system (PT and INR)?

Partial Thromboplastin Time (PTT)

Examines the function of the intrinsic system and common pathways in clotting cascade.

60-70 seconds

Normal Partial Thromboplastin Time (PTT).

Activated Partial Thromboplastin Time (aPTT)

Same as PTT however an activator is used → results available in < 1 hour.

30-40 seconds

Normal Activated Partial Thromboplastin Time (aPTT).

Heparin, Lovenox

What drug(s) is/are used for intrinsic system (PTT and aPTT)?

A-fib

If you have _______________________, you are going to be put on a blood thinner for the rest of your life.

2-3

If patient is on anti-coagulant, INR therapeutic range is __________________________.

Regular; therapeutic range

INR <4.0:

- Perform eval and _________________________ exercise regime

- Do not advance or increase intensity until _________________________ is reached

Resistive; 11

INR 4-5:

- Avoid ______________________ exercise

- Light exercise RPE <___________________

Held; vitamin K; fresh frozen plasma; no

Typically, if INR is >5-6:

- Coumadin is __________________________

- Administration of _________________________ or _________________________

- Perform eval for discharge planning/determine level of function

- _______________________ treatment

Avoid; consult

INR 5-9:

- _______________________ excessive physical activity

- Bed rest

- May do eval only for discharge planning or to determine current level of function

- _______________________ with team

Heart rate; O2 saturation; exertion

Guidlines for Therapy for Patient on Anti-Coagulant:

Monitor blood pressure, ________________________, ________________________, blood counts, physical appearance, level of _______________________, and safety.

Subtherapeutic levels

Coagulation level below goal. INR < 2-3

Clotting

Subtherapeutic INR levels, at risk for ________________________ (forming embolisms).

Supratherapeutic levels

Coagulation level above goal.

Bleeding

Supratherapeutic INR levels, at risk for ___________________________. → Can be reversed with Vit K or Fresh Frozen Plasma.

D-Dimer

Produced by action of plasmin on X-linked fibrin and their presence in the blood confirms that clotting has occurred. → By itself, does not indicate blood clot, but can be used /c signs and symptoms.

0.5 mg/L

Normal D-Dimer value.

Fibrin

D-Dimer is a measurement of _________________________ degradation.

DVT, PE

High levels of D-Dimer associated with ______________________.

Doppler ultrasound

Scan for DVT?

Chest scan, V/Q scan

Scan for PE?

Unlikely; weeks; does not; reduces

Mobilization with Acute DVT:

- Highly _____________________ to mobilize blood clot → More likely to cause another blood clot through immobility!

- Superficial vs. deep venous thrombosis

- Explain risks vs. benefits

- Can remain in LE for ______________________

- Anticoagulation therapy → _______________________ remove existing clot, blood thinner _______________________ risk of another clot

- Education on SxS: PE, DVT, CVA, MI

Chest; breathing; cyanosis

Signs and Symptoms of PE:

- Sudden ___________________ pain

- Cough

- Difficulty ______________________

- Anxiety

- LOC

- Increased RR

- ______________________ of skin

- Lightheadedness

Pumps; TED hose

DVT Prophylaxis:

- Early mobilization

- Ankle ______________________

- ________________________

- Sequential compression devices

- Pharmacological intervention

60%; 2/3; 1/3

Fluid Distribution:

- _____________________ of body weight is made up of water

- Intracellular compartment = ____________________ water in body

- Extracellular compartment = ______________________ water in body → Interstitial spaces (tissue spaces), plasma (vascular compartment), trans-cellular compartment (3rd spaces)

Extracellular

Are lab values intracellular or extracellular?

Ascites

Fluid between the skin and viscera.

Pericardial effusion

Fluid in pericardial space.