* Lab Values* Lab Tests Online <http://www.labtestsonline.org/index.html> What is being tested and why. How the sample is taken.

The meaning of the test results. Lab Values - site A <http://www.bloodbook.com/ranges.html#BLOOD> Lab Values - site B <http://www.contractlaboratory.com/labclass/normalbloodvalues.cfm> Normal values: 2 alternative sites What do these abbreviations mean? CMP or BMP <cmp.htm>, CBC <cbc.htm> Lab test numbers and indications <ClinicLabTestSheet07-APTA.Geri.Listserv.doc> References: Advanced Rehabilitative strategies for the evaluation and treatment of the medically complex geriatric patient. Carole Lewis, Seminar, Summer 1998. *Goodman CC, Snyder TEK. Laboratory Tests and Values in: Goodman CC, Boissonnault, WG, Fuller KS, eds.. Pathology: Implications for the Physical Therapist, 2nd ed. 2003:1174-1197. Retrieved Jan. 16, 2007 from American Physical Therapy Association, Section on Geriatrics, Listserv. http://health.groups.yahoo.com/group/geriatricspt/files/ *Blood sample* *Normal* */Clinical Significance/* Arterial Blood Gases (ABG) PaCO2 = 35-45 mm Hg pH = 7.35-7.45 HCO3 = 22-26 mEq/l SaO2 = 95-99% *Panic Values* for ABGs PaO2: < 40 PaCO2: < 20 or > 70 pH: < 7.2 or > 7.6 HCO3: < 10 or > 40 SaO2: < 60% * See more information regarding CO2 Retention <CO2-retainer.htm>. Degrees of *Hypoxia*: mild: PaO2 of 60-80 mm mod: PaO2 of 40-60 mm severe: PaO2 < 40 mm Hematocrit (Hct) Female: 36-46% Male: 42-52% Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea PaO2 = 80-100 mm Hg

RBC / Whole Blood = ___ % Hemoglobin (Hgb) Female: 12-15 g/dl Male: 14-17 g/dl Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea Chemotherapy: < 10 -- hold aerobic exercise RBC Count Female: 4 -5.5 million/mm3 Male: 4.5 - 6.2 million/mm3 Low values = Anemia: monitor for fatigue, dyspnea, tachycardia, tachypnea High values: In COPD, may indicate *Polycythemia*, a compensation for pulmonary dysfunction that makes blood thicker, and increases risk of CVA, etc. Total WBC Count 5,000 - 10,000 /mm3

> 10,000 indicates systemic infection (more than just local colonization) Chemotherapy : < 5,000: use reverse isolation, see patient in room, careful hygiene, hold aerobic exercise Platelets, Thrombocytes Chemotherapy: * 30,000 ? 50,000: avoid resisted exercise, risk of internal hemorrhage, ambulation OK * < 30,000: bedside, gentle AROM * < 20,000: consult with physician or nurse before activity "Sed Rate", Erythrocyte Sedimentation Rate (ESR) Male: 0-17 mm/hr Female: 1-25 mm/hr 200,000 - 500,000 /mm3

Bad if elevated. Used to diagnose, or follow the course of inflammatory diseases, e.g. rheumatic conditions Alternative calculation of normal value: Female: (age + 10) / 2 Male: age / 2 Creatinine Female: 0.6 - 1.2 mg/dl Male: 0.5 - 1.1 mg/dl Elderly values are lower because of reduced muscle mass measure: *high values are bad*. May indicate nephropathy, end stage renal d. Can occur in brittle diabetics also. Potassium (K) Renal function

3.5 - 5.0 mEq/l

*Low (hypokalemia)* secondary to: vomiting, diarrhea, sweating, or use of loop diuretics e.g. Lasix, furosemide. Also increases the risk of digitalis toxicity. *Result *of low K: ventricular arrhythmias *High (hyperkalemia) *secondary to: overuse of K supplements, renal or endocrine problem. *Result* of high K: ventricular arrhythmias, asystole Calcium (Ca) 8.2 -10.2 mg/dl

*Low (hypocalcemia):* secondary to: abuse of laxatives, renal failure, low dietary calcium or Vit. D intake, excessive magnesium intake. *Result* of low Ca: osteoporosis, muscle spasms / tetany, calcium deposits in tissue; cardiac arrhythmia, asystole *High (hypercalcemia):* secondary to: immobilization, metastatic bone CA; overuse of antacids containing calcium *Result* of high Ca: thirst; polyuria; renal stones; decreased muscle tone and DTRs; tachycardia; cardiac arrhythmia, asystole Sodium (Na) 136 -145 mEq/l

*Low (hyponatremia) *secondary to: fluid loss from diarrhea, vomiting, diaphoresis, diuretic use. *Result* of low Na: postural hypotension, abdominal cramps, headache, fatigue, weakness *High (hypernatremia) *secondary to: dehydration, high salt intake, poor renal function *Result *of high Na: edema, tachycardia *Diabetes* ** *Fasting Blood Glucose (FBG)* Glucose Level Indication 70 to 99 mg/dL Normal fasting glucose 100 to 125 mg/dL Impaired fasting glucose (pre-diabetes) Contributes to the diagnosis of Metabolic Syndrome >126 mg/dL Diabetes *Oral Glucose Tolerance Test (OGTT)* (Sample drawn 2 hours after a 75-gram glucose drink) *Glucose Level * *Indication* < 140 mg/dL Normal glucose tolerance 140 to 200 mg/dL Impaired glucose tolerance (pre-diabetes) Contributes to the diagnosis of Metabolic Syndrome > 200 mg/dL Diabetes

*Conversion tool*for Blood Glucose to HBA1c <https://www.accu-chek.com/us/glucose-monitoring/a1c-calculator.html?utm_source= Google&utm_medium=cpc&utm_term=a1c+converter&utm_campaign=Broad&OVMTC=Broad&site =&creative=5209669947&OVKEY=A1C%2520converter&gclid=CN_BlfqXqKQCFYXV5wodTBSV5g#> *Chart* with comparative values for HBA1c & Blood Glucose <http://www.diabeteschart.org/bloodsugarchart.html> Glycosylated Hemoglobin *HBA1c*, or A1c *4 - 6%* is normal Lab work done at the doctor's office, that gives an average of the last 3 month's blood glucose. The goal for *diabetic* patients it to *keep the value < 7%*

*Pulmonary Function Test (PFT) results: COPD & RLD* *FVC* *FEV1* *FEV1 / FVC* *COPD* Decreased. Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted *RLD* Decreased. Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted Mild: 65-80% of predicted Mod: 50-65% of predicted Severe: < 50% of predicted Normal or increased. 80-100% of predicted -----------------------------------------------------------------------BP - lifespan values <bp-lifespan.pdf> Vital signs - pediatric values <vitals-peds.pdf> */Adult Values/* *Normal* < 120 *PreHypertension* *HTN - Stage 1* *HTN - Stage 2* *SBP* *DBP* < 80 120-139 140-159 > 160 > 100

Decreased. Decreased.

Decreased.

80-89 90-99

- According to the Seventh Report of the Joint National Committee on Detection, Education, and Treatment of High Blood Pressure (JNCVI). 2003

-----------------------------------------------------------------------* Ejection Fraction* (EF), defines degrees of heart failure: * * * * > 55% 40-55% 30-40% < 30% normal mild LV dysfunction moderate LV dysfunction severe LV dysfunction

Ottawa Cardiovascular Centre. (2004). Congestive Heart Failure Survival Kit. Continuing Medical Implementation Inc. Retrieved 7-2-2011. http://www.cvtoolbox.com/downloads/CHF_SurvivalKit.pdf CHF is quantified by an echocardiogram (US) reading of *elevated* EDV (End Diastolic Volume and *decreased *SV (Stroke Volume) -----------------------------------------------------------------------* Rheumatic diseases *and tests with which they may be strongly associated: Bartlett, S. (2006). Clinical Care in the Rheumatic Diseases. (3rd ed.). Association of Rheumatology Health Professionals. American College of Rheumatology. Atlanta : ARHP Rheumatoid factor (RF) RA -70%, Sjogrens -90% (p.44-5) Antinuclear Antibodies: ANA (Fluorescent ANA = FANA) SLE - 99% (p.45) HLA B27: Human Leukocyte Antigens AS - 90%, Reiters - 80% (p.178) ESR Erythrocyte Sedimentation Rate & CRP (C-reactive protein) RA and Polymyalgia Rheumatica Most useful as serial measurements to track the course of the disease, especially when in active inflammation (p.48) Uric Acid Crystals (synovial aspiration) WBC levels Gout or pseudogout (p.44)

* Most indicative of Gout (synovial aspiration) * Normal in RA, but can be elevated during inflammatory phase (p.47-48). * Leukopenia and other hematologic disorders can occur in SLE (p.188) BMI calculator <http://nhlbisupport.com/bmi/> BMI table <bmitable.pdf> Underweight Normal weight Overweight Obesity Morbid Obesity *< 18.5 * *18.5 - 24.9 * *25 - 29.9 * *> 30* *> 40*

-----------------------------------------------------------------------VO2 Max / 3.5 = METs -----------------------------------------------------------------------*

Ankle Brachial Index (ABI): * Clinical application: decisions about use of compression, and use of sharp debridement. Prognostic for wound healing. Ankle SBP / Brachial SBP Must have a doppler US to hear SBP at the dorsalis pedis artery. Cuff goes around calf). For normal persons, leg SBP is higher than brachial SBP. *0.9 *0.7 *0.5 *< 0.5 1.2* 0.9* 0.7 * * Normal Mild arterial disease (intermittent claudication pain) Moderate arterial disease (claudication pain at rest) Severe arterial disease (risk of gangrene)

Falsely high values that are *> 1.2 *may indicate arteriosclerosis (diabetes), because the vessels are calcified and non-compressible by the BP cuff. Referral for other testing would be appropriate. -----------------------------------------------------------------------Diagnostic Imaging for the Physical Therapist <http://www.ptcentral.com/radiology/> by Darryl Hosford & Ken Hurd -----------------------------------------------------------------------University of Missouri School of Health Professions Department of Physical Therapy Last updated December 10, 2011 Contact webmaster <mailto:proste@health.missouri.edu> <Templates/Haynes_Clinical_Practice_2006.pdf>