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Rehabilitation Lab Values Recommendations: A Revisit

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by

Dan Pipal

on 19 May 2014

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Transcript of Rehabilitation Lab Values Recommendations: A Revisit

Where are we now?
Revisit: Baseline Lab Value Recommendations for Inclusion into Rehabilitation Services
Minimum H & H
Where did we begin?
Are we having any issues based on this baseline?
Does anyone feel like we need to make a change?
H & H: <8.0 g/dL & <24.0%
Peak Heart Rate
Previous: 125 beats/minute
Has anyone noticed any issues?
Cardiac cases vs. non-cardiac cases
Heart Rate Resources
Karvonen's Formula
Limitation= difficult to use with Ca++ blocker and beta blocker patients per APTA article
Previous: <8.0 g/dL & <24.0%
Based on Talieh/Fung recommendations
APTA Guideline: <8.0 g/dL & <25.0%
APTA guideline: Not specifically addressed.
Borg Rating of Perceived Exertion (RPE)
220 - Age = Maximum HR
Max HR - Resting HR = Heart Rate Reserve (HRR)
HRR x Training Intensity % + Resting HR = Training HR
Bradycardia
Previous: Ok but monitor and document heart rate change.
Minimum MAP
Previous: Not lower than 60
O2 Saturations
Previous: Not lower than 85% without specific written order.
Have there been any issues with these specific guidlines?
Proposed changes, if any?
No specific APTA guidelines.....
Anticoagulation Guidelines
Coumadin: INR between 2.0 - 3.0
Heparin: anti-Xa factor 0.3 - 0.7
Lovenox: No limitations 3 hours after injection
APTA guidelines did not have a recommendation in the 2008 update but the 2012 issue has documented recommendations. The results are somewhat murky.
Again, has anyone noticed any issues with these guidelines that would negatively impact patient care?
Are there any new medications or suggestions for rehabilitation guideline updates?
Platelets
Previous: No PT with platelet count below 20 K/uL without direct physician order
New APTA guidelines suggest:
Platelets < 10 K/uL and/or temperature >100.5 degrees would prohibit physical therapy
Does anyone have any questions relative to changing this recommendation or any other that we have discussed?
Resources:
Lab Values Interpretation Resources: Update 2012
www.acuteapta.org
Post Stroke Pocket Guide, 2006, Cardiac & Pulmonary Section, http://www.apta.org/ uploadedFiles/APTAorg/Practice_and_Patient_Care/Patient_Care/Physical_Fitness/Members_Only/PocketGuide_PostStroke.pdf#search=%22exercise heart rate%22
Previous resources: John Talieh, MD; Lit Fung, MD; Sanofi, producer of Lovenox (www.lovenox.com)
Full transcript