Practitioners should consider the total clinical picture when deciding whether to terminate therapy, grade down, or place a hold.
Understanding the lab test and potential adverse effects is critical to patient care.
Communicate with appropriate staff such as other therapists, nurses, doctors, and techs as appropriate.
Despite “good” lab values, patients may still experience dizziness and lightheadedness during activities. Therapists must take necessary precautions to minimize the risk of falls (pacing, monitoring vitals, grading activities, bringing a wheelchair, etc.)
Observe any precautions or contraindications throughout your session, e.g. Seizures.
Check out our comprehensive list of Precautions.
Vital Signs
| Pulmonary | Critical Values |
| SaO2 | <88% |
| Respiration Rate | >35 breaths/min |
| PEEP | >10cm H2O |
| FiO2 | >0.6 |
| Cardiovascular | Critical Values |
| MAP | <65 or >120 mmHg |
| Systolic BP | <90 or >200 mmHg |
| Resting HR | <50 bpm or >140bpm |
CBC - Complete Blood Count
| Critical Values | |
| WBC | <5000 (5×109/L) with fever <1500 (1.5×109/L) with neutropenic precautions |
| Hematrocrit | <20% or > 60% (clot) |
| Hemoglobin | <7 gm/dL or > 20g/dL |
| Platelet | <20 ku/L or <10,000/μl if cleared by MD, then light BADLs, AROM |
BMP - Basic Metabolic Panel
| Purpose | Considerations | Critical Values | |
| Na (Sodium) |
Fluid volume in the body, facilitates nerve conduction, neuromuscular function, and glandular secretion | – Impaired cognition – Orthostatic hypotension – History of Seizures |
≤120 mEq/L or >160 mEq/L |
| K (Potassium) |
Neuromuscular function, action potentials, cardiac muscle contraction, and conductivity | – Cardiac issues – Bradycardia – Muscle weakness |
< 2.5 mEq/L or > 5 mEq/L |
| Cl (Chloride) |
Facilitate exchange of O2 and CO2 in RBCs | – Consciousness – Motor function |
<80 or >115 mEq/L |
| HCO3 (Bicarbonate) |
Acid–base balance; works as a pH buffer Byproduct of your metabolism. Blood brings bicarbonate to lungs, and exhaled as carbon dioxide. Excreted/reabsorbed by kidneys. |
None | <10 or >40 mEq/L |
| CO2 (Carbon Dioxide) |
pH level and electrolyte status Waste product of metabolism. Present in blood as bicarbonate. |
Shortness of breath | <10 mEq/L or >40 mEq/L |
| BUN | Excretory function of kidneys and metabolic function of the liver. Indicates renal disorder for dialysis. | Decreased tolerance | >100 mg/dl |
| Cr (Creatine) |
Waste product of muscle metabolism. Filtered out of the body through urination.
Elevated creatinine may indicate a renal disorder; difficulty excreting waste products and require dialysis. |
Decreased tolerance | >4 mg/dl |
| Mg (Magnesium) |
Facilitates transport of proteins, sodium, potassium, and calcium. Important for neuromuscular function and ATP use, and stimulates parathyroid hormone secretion. | – Elevated = Diaphoresis, lethargy, weakness – Depressed = Increased reflexes, tremors, spasticity, seizures |
<1 or >9 mEq/L |
| Ca (Calcium) |
Cell permeability, blood coagulation, muscle contractions, bone and teeth formation. Important for cardiac conductivity. 99% of calcium is stored in bones and teeth. | Impaired cognition | <6 mg/dl (tetany) >13 mg/dl (coma) |
| PO4 (Phosphate) |
Assists with neuromuscular regulation and cellular metabolism. Bone formation. | – Cognition – Muscle Weakness |
<1 mg/dl |
| Glucose | <70 or >200 mg/dL |
Coagulation (DVT & PE)
| NO mobility | Mobilize | Verify with MD | |
| Coumadin (Warfarin) | INR <2* *Hours since last dose |
INR 2-5 | INR > 5 *Increased bleeding!* |
| Low molecular wt. Heparin – Dalteparin – Enoxaparin – Fragmin – Innohep – Tinzaparin– Lovenox – therapeutic dose (mg = pt.’s weight) |
<3 hours | >5 hours | 3-5 hours |
| Fondaparinux (Arixtra) | <2 hours | >3 hours | 2-3 hours |
| Unfractionated Heparin (IV) | <24 hours | >48 hours | 24-48 hours ago |
| Novel oral anticoagulants
– Apixaban |
<2 hours | >3 hours | 2-3 Hours |
| Pending Ultrasound for DVT | IVC Filter in place = Mobilize Otherwise, use Well’s Criteria for DVT Calculator |
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| Pending Ventilation/Perfusion for PE | Well’s Criteria for PE Calculator |
Cardiac Enzymes & Markers
| Purpose | Ranges | |
| Troponin | Proteins specific to cardiac muscle tissue; released with muscle injury or MI | (Prognostic) Troponin I: >1.5 ng/ml Troponin T: >0.1 ng/ml and rising |
| CK-MB | Marker for acute MI or myocardium injury | Reference: 0% – 6% |
| C-Reactive Protein | Produced primarily in the liver in response to an inflammatory process or condition | 0.1–0.3 mg/dL: average risk of future cardiovascular event >0.3 mg/dL: high risk of future cardiovascular even |
| BNP | Hormones secreted by the heart when volume overload is present; differential diagnosis of CHF | Mild heart failure: 100–300 pg/ml Moderate heart failure: 300–700 pg/ml Severe heart failure: >700 pg/ml |
| Myoglobin | Released into the bloodstream during ischemia or in cases of muscle inflammation or trauma | Normal: 0–0.09 mg/ml |
Contraindications:
- Acute MI <2 days
- Acute Infection
- Acute myocarditis / pericarditis
- Pulmonary embolism
- Severe CHF
- Uncontrolled arrhythmias
- Uncontrolled diabetes
Specific Conditions
| Blood transfusion: Defer for at least 30 mins for NSG to monitor for reactions.
Adverse Reactions: headache, fever, chills, tachycardia, hypotension, chest/abdominal pain, flushed face, warmth at vein site. |
| Hemochromatosis: avoid strenuous activity 24 hours after a phlebotomy. |
Units of Measurement
| C | Celsius |
| cc | Cubic centimeter |
| cg | Centigram |
| cm | Centimeter |
| cu | Cubic |
| dl | Deciliter |
| g | Gram |
| IU1 | International Unit |
| ImU | International milliunit |
| IμU | International microunit |
| k | Kilo |
| kg | Kilogram |
| L | Liter |
| mEq | Milliequivalent |
| mEq/L | Milliequivalent per liter |
| mg | Milligram |
| mL | Milliliter |
| mmHg | Milliliter of mercury |
| mmH2O | Millimeter of water |
| mol | Mole |
| mmol | Millimole |
| MOsm | Milliosmole |
| mμ | Millimicron |
| mU | Milliunit |
| mV | Millivolt |
| ng | Nanogram |
| nm | Nanometer |
| nmol | Nanomole |
| Pa | Pascal |
| pg | Picogram |
| pl | Picoliter |
| pm | Picometer |
| pmol | Picomole |
| SI | International System of Units |
| μ | Micron |
| μ³ | Cubic micron |
| μg | Microgram |
| μlU | Microinternational unit |
| μl | Microliter |
| μm³ | Cubic micrometer |
| μmol | Micromole |
| μU | Microunit |
| U | Unit |
Units Conversion Table
| 1 L | 1000 mL |
| 1 mL | 1 cc |
| 1 Tbsp | 15 mL |
| 1 Tbsp | 3 tsp |
| 1 tsp | 5 mL |
| 1 oz | 30 mL |
| 1 oz | 2 Tbsp |
| 1 Kg | 2.2 lb |
| 1 Kg | 1000 g |
| 1 G | 1000 mg |
| 1 mg | 1000mcg |
| 1 in | 2.54 cm |
| 1 ft | 12 in |
| 1 yard | 3 ft |
mL – milliliter, cc – cubic centimeter, Tbsp – tablespoon, tsp – teaspoon, L – liter, oz – ounce, G – gram, Kg – kilogram, mg – milligram, lb – pound, in – inch, cm – centimeter, ft – foot
