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 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 exercise program during physical therapy?
Intermittent claudication – incorporate short 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
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)
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
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
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.
Increase the return of blood to the heart and brain as cardiac output and venous return decreases ( prevents fainting)
Enhance the recovery period with the oxidation of metabolic waste and replacement of the energy store.
Prevent myocardial ischemia, arrhythmias, or other cardiovascular complications.
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 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)?
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