Unit 3: Vitals and Lab Values Across the Lifespan Flashcards
1
Q
Blood Pressure
A
- Adult
- Pediatric
- Symptoms
- Possible Treatment
- Clinical Implications
2
Q
Adult (Blood Pressure)
A
Normal Range: <120/80 mm/Hg Hypertension: >140/90 mm/Hg Hypotension <90/60 mm/Hg *hypotension is relative to the patients age Hypertensive Crisis: 180/120 mm/Hg
3
Q
Pediatric (Blood Pressure)
A
Neonate: 60-90/20-60 mm/Hg Infant: 87-105/53-66 mm/Hg Toddler: 95-105/53-66 mm/Hg Preschooler: 95-110/56-70 mm/Hg School-Aged Child: 97-112/57-71. mm/Hg Adolescent: 112-128/66-80 mm/Hg
4
Q
Hypotension Symptoms
A
- Weakness
- Sleepiness
- Blurred Vision
- Confusion
- Syncope
- Light-Headedness
5
Q
Hypertension Symptoms
A
- Fatigue
- Confusion
- Chest Pain
- Visual Changes
6
Q
Possible Treatments for Hypotension
A
- IV fluids, blood products, antibiotics or medications that increase BP
- Thromboembolic deterrent stockings (TED hose) used to increase blood flow velocity
- Sequential compression devices to reduce venous stasis
- Increased sodium intake
- Abdominal Binders
- Elevation of lower extremities
7
Q
Possible Treatments for Hypertension
A
- Lifestyle modifications
- Medication
- Diuretics to remove fluid
8
Q
Clinical Implications of Hypotension
A
- Always check patients BP in supine before therapy
- Proceed carefully with functional mobility, rechecking BP and reported symptoms after changes in positions
- If the patient’s BP drops more than 20 mm/Hg systolic and more than 10 mm/Hg diastolic, elevate his/her lower extremities and observe for signs of relief. If patient. is still symptomatic, return to supine. If symptoms subside, continue with mobility carefully, checking BP frequently
- Low blood pressure is not always a contraindication for therapy, but you should be in communication with the care team
9
Q
Clinical Implications of Hypertension
A
- Can have devasting effects on the brain and other organs
- Activity may be contraindicated if someone is in a hypertensive crisis
- Always be in communication with the care team
10
Q
Heart Rate
A
- Heart Rate (adult)
- Heart Rate (pediatric)
- Clinical Implications for adults
11
Q
Adult Heart Rate
A
Normal Range: (Resting): 60-100 BPM (athletes may have lower resting heart rate)
Abnormal Range
-Bradycardia: <60 BPM
-Tachycardia: >100 BPM
Max HR: 220-age (ex. If your patient is 40 years old, HR=180 (220-40)
12
Q
Pediatric Heart Rate
A
Newborn to 3 months: 85-200
3 months-2 years: 100-190
2-10 years: 60-140
>10 years: 60-100
13
Q
Clinical Implications for Adults w Abnormal HR
A
Abnormal heart rates and rhythms can cause the following symptoms: fatigue, dizziness, fainting, shortness of breath, chest pain, and cardiac arrest.
-The OT should monitor their patient for significant changes in rate or rhythm with activity.
For example, a swift increase in heart rate with minimal activity may indicate poor activity tolerance.
-Tachycardia may require a rest break to bring the heart rate down after activity and before continuing with the therapy session.
-If there is a change of rhythm (i.e., atrial fibrillation or runs of ventricular tachycardia) during the session, the RN should be notified, and the therapist may be advised to discontinue services.
14
Q
Respiratory Rate
A
- Normal Respiratory Rate (adult)
- Normal Respiratory Rate (pediatric)
15
Q
Adult Normal Respiratory Rate
A
Normal Range: 12-20 breaths per minute
Tachypnea: >20 breaths per minute
Bradypnea: <12 breaths per minute
16
Q
Pediatric Normal Respiratory Rate
A
Infant: 30-60 Toddler: 24-40 Preschooler: 22-34 School-Aged Child: 18-30 Adolescent: 12-16
17
Q
Oxygen Saturation
A
-Oxygen saturation and clinical implications
18
Q
Purpose of Oxygen Saturation
A
Percentage of oxygen carried by hemoglobin, measured noninvasively with a pulse oximetry probe. Provides information on oxygenation status.
19
Q
Oxygen Saturation Normal and Abnormal Ranges
A
Normal Range: 97%–99%
-Closely monitor patients between 90-96%
Abnormal Range: <90%
20
Q
Clinical Implications for Oxygen Saturation
A
Monitor oxygen demands and modify activities when needed to keep oxygen within appropriate parameters. Note: Physicians may set individual parameters below 90% for select patients. Oxygen saturation less than 84% reflects a greatly reduced oxyhemoglobin saturation. If untreated, it can eventually lead to respiratory failure. Deep breathing and upright positioning assist with oxygenation and carbon dioxide removal.
21
Q
Purpose of Measuring Glucose
A
Measure of blood sugar levels
22
Q
Normal Range for Glucose
A
70–110 mg/dl (fasting)
23
Q
Abnormal Range for Glucose
A
Hypoglycemia: <70 mg/dl Hyperglycemia: >250 mg/dl Prediabetes: >110-200 mg/dl Diabetes: >126 Critical Values: <60 mg/dl, >300–350 mg/dl
24
Q
Hypoglycemia
A
<70 mg/dl
25
Causes and Symptoms of Hypoglycemia
-Cause: Insulin overdose, insulinoma, skipped meals, or overexertion in exercise.
Symptoms = headache, weakness, shakiness, clamminess, impaired muscle control, blurred vision, or difficulty responding to commands.
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Clinical Implications for Hypoglycemia
- Defer therapy if the patient is symptomatic and needs carbohydrates.
- Avoid exercise before meal time and after insulin because both can result in reduced blood sugar levels
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Hyperglycemia
>250 mg/dl
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Causes and Symptoms of Hyperglycemia
- Diabetes mellitus or stress
| - Acetone breath, rapid pulse, nausea, vomiting, weakness, dehydration, coma.
29
Clinical Implications of Hyperglycemia
Defer therapy for patients with blood glucose >300 mg/dl until levels have been stabilized.
30
Purpose of Measuring Leukocytes (White Blood Cells)
Indicates immune system status, infection, or inflammation.
31
Normal and Abnormal Ranges for Leukocytes (White Blood Cells)
Normal: 5,000-11,000/mm3
Leukocytosis: >11,000/mm3
Leukopenia: <5,000/ mm3
Critical Values: <2,000/ mm3 or >30,000/mm3
32
Clinical Implications for Leukocytes (White Blood Cells)
< 500/mm3: Extremely dangerous, may be fatal.
<1,000/mm3: Defer therapy.
<4,000/mm3: Neutropenic precautions observed. Includes strict hand washing; wearing a gown, gloves, and face mask; and disinfecting any equipment brought into the room. Reverse isolation observed.
<5,000/mm3: Consider deferring therapy, as patients are at an increased risk of infection. Think about the risk vs. benefit of your services.
>5,000/mm3: Light or resistive exercise (as tolerated).
11,000 /mm3 with fever: Use caution when exercising.
33
Purpose of Measuring Hemoglobin
Measures blood’s capacity to carry oxygen
34
Normal and Abnormal Ranges for Hemoglobin
Normal Range: Males: 13–18 g/dl, Females: 12–16 g/dl
Abnormal Range: <8 g/dl: may indicate a need for a transfusion
Critical Values: <5 g/dl: may result in heart failure or death
35
Clinical Implications of Hemoglobin
-Low hemoglobin indicates that the heart must work harder to ensure sufficient oxygen can be transported to the rest of the body. Symptoms of low hemoglobin and hematocrit include weakness, fatigue, tachycardia, dyspnea on exertion, heart palpitations, and decreased exercise tolerance
<8 g/dl: If a patient is going to have a blood transfusion due to low hemoglobin, consider deferring therapy until after the transfusion, if able.
8–10 g/dl: Light exercise is appropriate but vitals should be loosely monitored as patient may have poor activity tolerance.
10 g/dl: Resistive exercise can be incorporated into the plan of care.
35
Hemoglobin Clinical Implications
-Low hemoglobin indicates that the heart must work harder to ensure sufficient oxygen can be transported to the rest of the body. Symptoms of low hemoglobin and hematocrit include weakness, fatigue, tachycardia, dyspnea on exertion, heart palpitations, and decreased exercise tolerance
<8 g/dl: If a patient is going to have a blood transfusion due to low hemoglobin, consider deferring therapy until after the transfusion, if able.
8–10 g/dl: Light exercise is appropriate but vitals should be loosely monitored as patient may have poor activity tolerance.
10 g/dl: Resistive exercise can be incorporated into the plan of care.
36
Purpose of Measuring Platelets
Responsible for clotting blood by forming platelet plugs.
37
Normal and Abnormal Ranges for Platelets
Normal Ranges: 150,000–400,000/µl
Abnormal Range: Thrombocytosis: >1 million/µl, Thrombocytopenia: <150,000/µl
Critical Values: <20,000/µl
38
Clinical Implications for Platelets
Patients with thrombocytopenia are at risk for bleeding easily from mucosal surfaces, including gums, nose, GI tract, respiratory tract, and uterus. Patients are also at a higher risk for bruising and bleeding under the skin and for post-surgery bleeding, including into the central nervous system and GI
<20,000/µl: Consider deferring therapy; may exhibit spontaneous bleeding, skin bruising, or prolonged bleeding time—no aggressive teeth brushing.
20,000- 50,000/µl: Light AROM, light ADLs, and ambulation OK.
<50,000/µl: No resistive exercise; ambulation and ADLs OK.
50,000/µl: Resistive exercise OK.
39
- P wave: Arterial depolarization; electrical impulse travels through the atria
- PR interval: AV conduction time; impulse travels from the atria to the AV node, and down the bundle branches, to where the ventricles contract
- QRS complex: Ventricular depolarization; impulse travels through the ventricles
- ST segment: Early repolarization; the ST segment should be at baseline. If elevated or depressed, could be a sign of MI or ischemia.
- T wave: Ventricular repolarization; ventricles return to their resting state
39
.
- P wave: Arterial depolarization; electrical impulse travels through the atria
- PR interval: AV conduction time; impulse travels from the atria to the AV node, and down the bundle branches, to where the ventricles contract
- QRS complex: Ventricular depolarization; impulse travels through the ventricles
- ST segment: Early repolarization; the ST segment should be at baseline. If elevated or depressed, could be a sign of MI or ischemia.
- T wave: Ventricular repolarization; ventricles return to their resting state
40
Normal Sinus Rhythm
Typical rhythm for a healthy individual.
41
Normal Sinus Rhythm
Typical rhythm for a healthy individual.
42
Tachycardia
Sinus rhythm with an elevated rate of impulses, typically a rate greater than 100 BPM. Clinical Implication: Tachycardia may require a rest break to bring the heart rate down after activity and before continuing with the therapy session. A swift increase in heart rate with minimal activity may indicate poor activity tolerance.
43
Bradycardia
Sinus rhythm with a slower than normal rate, generally below 60 BPM. Clinical Implication: If the heart is not pumping fast enough, it may not get enough oxygen to brain and other organs. This can cause dizziness, fatigue, shortness of breath.
44
Atrial fibrillation
Irregular and often rapid heart rate caused by the atria beating chaotically and irregularly—out of coordination with the two ventricles. Can be episodic or develop and stay permanently. Clinical Implication: Symptoms may include heart palpitations, shortness of breath, and weakness. Chronic A-fib is not a contraindication for therapy however if a patient changes from normal sinus rhythm to A-fib during OT activity, stop activity and inform the care team before deciding to continue.
45
Jerry Smith is a previously independent, obese 45-year-old male admitted to the general medicine floor with pancreatitis and high risk for sepsis. He lives at home with his wife and was found at home in the shower after he “blacked out” and couldn’t get up. Per the wife’s report, he has been feeling more and more weak and lethargic during the past few weeks. You receive a referral that states “Occupational therapy eval & treat.” Upon review of the patient’s chart, you see the following vitals trend:
Temp: 100.94 degrees farenheit
BP: 95/62
Resting HR: 162
What is significant about these vitals? Is this patient appropriate to be seen? Why or why not?
The patient may not be appropriate to be seen; proceed with caution
-The patient has a fever, is hypotensive, and tachycardic. These are all signs of potential sepsis, or generalized infection in the body. It is advised to talk to the medical team and most likely hold therapy services until vitals stabilize.
46
You are a home health therapist seeing Gabriela Lopez. She is a 77-year-old woman with advanced type 2 diabetes. Her daughter reports that she typically is able to independently test her glucose levels and administer insulin as needed. Upon your arrival to the home, Gabriela says she has been feeling tired all morning. She checks her glucose levels and finds them to be 33 mg/dL. What is the appropriate clinical action?
The patient is not appropriate to be seen at this time.
-Normal resting glucose levels are 70–110 mg/dL. This client is hypoglycemic and symptomatic. You should encourage the patient to drink juice and notify her nurse or primary care doctor. Initiating therapy without any additional nutrients may make glucose levels fall even lowe
47
Patient is a 69-year-old male, one day post-THA, with a known history of dysrhythmias. While standing at the sink completing grooming tasks with the OT, she goes into ventricular tachycardia (evidenced by EKG telemetry). What is the appropriate clinical action?
Discontinue therapy and notify the medical staff immediately.
-Any abnormal change in heart rhythm during activity should result in the immediate discontinuation or pause of therapy. The medical staff should be alerted
48
A toddler you are seeing in the pediatric inpatient unit is acting sleepier than usual. Their blood pressure is 85/50. In interacting with them they seem confused and fatigued. You were planning to get them up for some active play and to work on dressing. Should you proceed with therapy?
Do not proceed with treatment. Notify the nursing staff that the child is showing signs of hypotension and needs to be evaluated further. Wait for nursing to inform you whether you can proceed with in bed treatments.
-Changes in vital signs, with resulting symptoms, should not be ignored. Getting the child up could cause syncope.
49
A female patient has a hemoglobin level of 15 g/dl. She is complaining of increased fatigue and feeling sore, stating she had a long session of therapy yesterday and didn’t sleep well. Should you proceed with therapy or notify nursing that there is a problem with her hemoglobin?
Continue with therapy, and discuss the client's sleep habits and ways to alleviate soreness after exercise.
-This person's hemoglobin is within normal limits. Her fatigue is likely due to a lack of sleep and soreness and is not a symptom of low hemoglobin. You may proceed with therapy.
