Lab Values & Blood Disorders
What is the associated diagnosis for a patient with low hemoglobin levels?
What are the cut-off values for exercise/therapy?
Anemia (no exercise < 8mg/dL)
A patient with peripheral arterial disease (PAD) reports pain and cramping in the calf muscles after walking short distances, which is relieved by rest. What is the most likely cause of this symptom, and how should you modify the patient’s walking program during physical therapy?
Intermittent claudication – incorporate shorter and more frequent bouts of walking with rest breaks
A patient is one-day post-myocardial infarction. The patient's blood pressure changes from 100/75 mmHg to 78/70 mmHg when transitioning from supine to sitting. What is the physical therapist assistant's best course of action?
Maintain sitting and have the patient do ankle pumps
When working with a patient with an IV line: If the IV becomes displaced, what is the first step the PTA should take?
Patient First:
1. Apply pressure to the site to control bleeding
2. Instruct patient to elevate their arm to control bleeding
3. Press the call button to notify nursing staff
1. Describe the movement of ribs 2–7 and the sternum during inspiration
2. Which ribs form costovertebral joints?
3. Which ribs for costotransverse joints?
1. Sternum moves ventrally, ribs move in sagittal plane increasing anterior/posterior diameter
2. Ribs 1-10
3. Ribs 1-12
What is the term for elevated potassium levels? and for Sodium?
What are the cut-off values for PT treatment?
Hyperkalemia and Hypernatremia
Potassium: Potassium levels below 3.2 mEq/L or above 5.1 mEq/L may contraindicate physical therapy intervention because of the possibility of arrhythmia and tetany.
Sodium: Adult: <120 or >160 mEq/L. Needed to maintain homeostasis. Can lead to impaired cellular and neurological function.
What frequency of exercise would be the MOST desirable to improve cardiovascular endurance through a moderate intensity activity such as a walking program (3- 5.9 METs)?
5 times/week
Chap 7: Ther-Ex: 30 minutes of moderate intensity activity (3 to 5.9 MET level) 5 days/week or 20 minutes of vigorous intensity activity (greater than or equal to 6 METs) 3 days/week...Generally speaking, the greater the intensity of the exercise, the shorter the duration needed for adaptation, and the lower the intensity of exercise, the longer the duration needed.
A PTA is treating a patient that is 5 days s/p CABG x3. You notice he tries to get out of bed by rolling on his side, pulls up using the bed rail, scoots to the edge of his bed, stands up, and tries to put on his coat. Which of these activities are of concern and why?
Sternal precautions: pulling up on the rails, and reaching behind to put a coat on
What are precautions for patients with a chest tube?
The collection box must be upright at all times
Do not place a gait belt over the chest tube site
Always keep the chest tube drainage system below chest level
Better to roll towards the tube, than away from it
A PTA performs postural drainage to the posterior basal segments of the lower lobes. During the treatment session, the patient suddenly reports dizziness and mild dyspnea. What action should the assistant take FIRST?
Elevate the head of the bed (and position the patient into supine)
A PTA is treating a 25 year old patient with history of a stroke, a genetic blood disorder, and a R THA. The PTA reviews the medical record and sees a Hgb of 9 mg/dL. What blood disorder does this patient most likely have, and what should the PTA educate this patient on?
Sickle Cell Anemia
Educate on pain management, hydration, and mobility
A cool down period should last ____ minutes because it allows the body to:_____________
Should last 5-10 minutes ( pg 263 of the Ther-Ex book)
It prevents pooling of the blood in the extremities by continuing to use the muscles to maintain venous return.
Maintains the return of blood to the heart and brain as cardiac output and venous return decreases ( prevents fainting)
Enhances the recovery period with the oxidation of metabolic waste and replacement of the energy store.
What does Angina indicate, and what should a PTA do if a patient is experiencing stable angina?
-Ischemia: reduced blood flow/oxygen to the heart tissue
Light to moderate angina: 1+ or 2+ on Angina scale. Stop exercise, Take patient's HR and BP, and have patient take nitroglycerin if they have it. Modify exercise after symptoms have resolved. If symptoms continue to worsen OR do not resolve in 10-15 minutes call 911
Moderately severe or worsening: 3+ (Preinfarction pain), 4+ (Infarction pain): Terminate therapy session, take vitals, call 911.
A patient’s nurse is placing a line to perform a ABG analysis 4-6 times daily. What type of indwelling line would be used to collect the necessary samples?
Intravenous, Arterial, Central venous, or Pulmonary artery?
Arterial.
What type of blood does the pulmonary artery carry (venous or arterial)?
A PTA is to treat a patient for secretion removal (including vibration, postural drainage, and percussion) of the posterior segments of the upper lobes lungs.
1. What is the order of the techniques the PTA will perform?
2. What position will the patient be placed in?
1. Postural drainage with percussion ( how many minutes?), followed by vibration ( done with what phase of ventilation, and how many times?)
2. The patient will be placed in sitting, and instructed to lean forward over a pillow ( about 30 degrees): Chap 12 of O'Sullivan
1. A patient with hemophilia presents with osteoporosis and overgrowth of epiphysis; no erosions; no narrowing of cartilage space. What stage of the Arnold–Hilgartner Hemophilic Arthropathy is this patient in?
2. When developing an exercise for a patient with hemophilia, a physical therapist assistant should avoid excessive __________ muscle loading.
1. Stage II( Review page 348 of the Goodman Patho book)
2. Eccentric
While reviewing the patient's medical record before gait training, the physical therapist assistant notes that the patient is experiencing increased shortness of breath and the physician has just written an order for a ventilation-perfusion scan. What is the MOST appropriate response now for the assistant?
Withhold treatment and contact the supervising physical therapist.
What is a VQ scan? also called a Ventilation (V) Perfusion (Q) scan, is made up of two scans that examine air flow and blood flow in your lungs. A mismatch between the ventilation and perfusion scans could indicate a blockage or PE.
A physical therapist assistant is establishing exercise intensity for a 66-year-old patient, 4 weeks post MI, who is just starting this phase of cardiac rehab. What intensity levels would be the MOST appropriate for the assistant to use given the patient’s anticipated maximal aerobic capacity?
RPE: Moderate, 5-7
Borg: 12-16
Target heart rate: 40% ( starting) - 80% of HRR ( using the karvonen/ exercise HR formula)
3-5 METs at the start of phase 2
A PTA is treating a patient with retained secretions. What are some mechanical options the PTA has to help the patient clear secretions?
A patient with congestive heart failure is to undergo postural drainage of the left lower lobe. What is the MOST appropriate strategy to modify the patient's position to prevent additional complications from heart failure?
Sidelying on the right with the bed flat (Trendelenburg position contraindicated for patients with decompensated CHF, due to fluid overload on the heart)
A physical therapist assistant checks a patient's medical record prior to a scheduled physical therapy session. The medical record indicates that this morning, the patient's white blood cell count is below the normal range. What is this patient at risk of?
Increased risk of infection/ susceptibility to infectious disease
A physical therapist assistant assesses a patient's Ankle Brachial Index. For which medical condition(s) would this type of assessment be MOST essential?
What is the ABI, and what is a normal finding?
Bonus: What is an elevated lab value that could be related and of concern? and what dietary education could you provide a patient with an abnormal ABI?
Intermittent claudication( typically caused by peripheral artery disease (PAD), atherosclerotic changes), where the arteries in the legs become narrowed or blocked. This reduces blood flow (ischemia) to the muscles, causing pain when they exert themselves
Normal ABI: .95-1.19
Bonus: Cholesterol - dietary education: eggs, high fat meats, fried food, dairy
A 50 year old patient is 2 days s/p CABG x 2, is now medically stable, and cleared for initiating cardiac rehab. What should a PTA educate this patient on? (safety, METs, precautions)
Therapeutic focus: Patient education on self-monitoring and CV risk education
Intensity: Begin at 1-2 METs, progress to 3-4 METs by discharge. RPE: light, 1-4, Borg: <12
Vitals: Post Cardiac Surgery: max HR increases no more +30 bpm above resting
Restrictions: Lifting restrictions, Sternal precautions, No isometrics (due to Valsalva)
When taking BP, what is the recommended rate to release air from the bladder of the cuff?
2-3 mmHg/ sec
A patient with worsening emphysema has been monitored by his pulmonologist for the past 20 years.
What lung volumes and which capacities would be the most affected by this condition?
Emphysema = obstructive disease
This is a flow issue, with difficulty for getting the air out of alveoli that have lost their elastic recoil.
You would expect to see the residual volume (dead air space) increase the most, which would increase the Functional residual capacity the most.