Lab Values & Blood Disorders
What is the term for low hemoglobin levels?
What is term for glucose below the normal values?
What are the cut-off values for exercise/therapy?
Anemia (no exercise < 8mg/dL)
Hypoglycemia ( no exercis < 70 mg/dL)
(Hyperglycemia > 120 mg/dL, no tx if > 300 mg/dL)
A physical therapist assistant records a patient’s resting blood pressure as 115/79 mm Hg prior to initiating running activities on a treadmill. After five minutes of running at 4.5 miles per hour, what diastolic blood pressure value would be MOST anticipated?
64 mmHg
80 mmHg
84 mmHg
98 mmHg
2. 80 mmHg
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
A physical therapist assistant is treating a patient in the cardiac step-down unit. During the treatment, the IV tubing became hung-up on the edge of the bed without the assistant's awareness. Due to this, the IV became displaced. Which of the following should the assistant do first?
Press the call button to notify nursing staff
Apply pressure to the site to control bleeding
Instruct patient to elevate their arm to control bleeding
Place the patient in Fowler's position to prevent shock
Patient First:
2. Apply pressure to the site to control bleeding
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)
What is the term for elevated potassium levels?
What is the term for elevated sodium levels?
What are normal values?
Hyperkalemia
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 low intensity activity such as a walking program?
5 times/week
(since it is a low intensity, increased frequency is needed to improve endurance. If it was vigorous intensity, 3 days would suffice)
All of the following blood pressure responses would warrant termination of an exercise session in any phase of cardiac rehabilitation, except?
A. A systolic blood pressure higher than 250 mmHg
B. A progressive fall in systolic pressure of 10–15 mm Hg
C. A diastolic blood pressure higher than 110 mmHg
D. An increase in Diastolic blood pressure by 5 mmHg
D. An increase in Diastolic blood pressure by 5 mmHg
All of the following are precautions for patients with a chest tube, except:
The patient cannot roll over the tubing
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
1. The patient cannot roll over the tubing
A physician is showing the therapy team an x-ray of a patient's lungs, and states that the patient’s total lung capacity is significantly increased when compared to established norms. Which medical condition would MOST likely produce this type of result?
Emphysema: is a type of COPD/ obstructive pulmonary disease. Affects the elastic recoil of the alveoli, reduces surface area for oxygen exchange, and increases Total Lung Capacity. This is mainly from the increase in Residual Volume:The amount of air left in your lungs after max exhilation.
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
Which of the following patients would a PTA expect to have the highest maximum oxygen consumption (vo2 max)?
A. 23 y/o male, 210 lbs, 70 in., healthy individual
B. 22 y/o female, 125 lbs, 60 in., with anemia
C. 35 y/o male, 280 lbs, 77 in., with hx of Rotator Cuff Tear (RCT) with Rotator Cuff Repair (RCR)
D. 30 y/o female, 150 lbs, 66 in, with DM I
C. 35 y/o male, 280 lbs, 77 in., with hx of Rotator Cuff Repair
What does Angina indicate, and what should a PTA do if a patient is experiencing moderate angina? What about severe angina?
-Ischemia: reduced blood flow/oxygen to the heart tissue
Moderate: Stop exercise, have patient take nitroglycerin, and/or wait at least 10-15 minutes to see if symptoms resolve
Severe: Terminate session. If symptoms do not resolve in 10 minutes or with nitro, call 911
A physical therapist assistant enters the room of a patient in ICU. The patient’s nurse is placing a line to collect arterial blood gas analysis 4-6 times daily. What type of indwelling line would be used to collect the necessary samples?
Intravenous
Arterial
Central venous
Pulmonary artery
2. Arterial ( see week 5 live slides)
What type of blood does the pulmonary artery carry (venous or arterial)
Describe the movement of ribs 2–7 and the sternum during inspiration
Sternum moves ventrally, ribs move in sagittal plane increasing anterior/posterior diameter
When developing an exercise for a patient with hemophilia, a physical therapist assistant should avoid excessive __________ muscle loading.
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 uses metabolic equivalents (METs) as a method to establish exercise intensity for a 66-year-old patient, 4 weeks post MI, starting this phase of cardiac rehab. What MET level would be the MOST appropriate for the assistant to use given the patient’s anticipated maximal aerobic capacity?
3-5 METs at the start of phase 2
Progress to 9 METs by DC from 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
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?
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: 1.0-1.4 (ankle pressure should be higher than the arm)
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 2-3 METs, progress to 3-5 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 recovering from pneumonia receives a regimen of postural drainage three times a day. What would warrant decreasing the frequency of treatments?
The number of productive secretions decreases