Differential Diagnosis for Physical Therapy: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary 122
with extremity elevated, rubor with dependence, dry, hairless appearance Ankle–Brachial Index (ABI) Assessment • Systolic blood pressure ankle divided by systolic BP arm • Normal value: 0.90 to 1.3 • Normally, systolic pressure in the legs is 10% to 20% higher than in the arms • Peripheral artery disease: 1.0 or below Vascular Claudication During treadmill walking test, look for the following signs and symptoms: • Pain increases with activity • Halts with rest, even standing • Neurogenic: Impacted by position change regardless of exercise Cardiovascular Red Flag Presentation Deep Vein Thrombosis (DVT) • Signs and symptoms: calf pain, tenderness, warmth, symptoms increased with standing/walking and alleviated with rest/elevation, recent surgery, pregnancy, trauma, or prolonged bed rest, Homan’s sign • Clinical decision rule: Wells ○ Tenderness: Assessed by firm palpation in center of posterior calf, popliteal space, and along area of femoral vein in the anterior thigh and groin ○ Swelling: Measured 10 cm below tibial tuberosity ○ ≤0 = probability of peripheral DVT of 3% (95% confidence ) ○ 1 or 2 = probability of PDVT of 17% (95% CI = 12%–23%) ○ ≥3 = probability of PDVT of 75% (95% CI = 63%–84%) • Palpitation in any person with history of unexplained sudden death in the family requires medical evaluation • Anyone who cannot climb a single flight of stairs without feeling moderately to severely winded or who awakens at night Cardiovascular System Screen Guidelines for physician referral:
with orthopnea should be evaluated by a physician • Fainting without any warning may be a sign of heart valve or arrhythmia problems • Cardiac clients should be sent back to their physician under the following conditions: ○ Nitroglycerin tablets do not relieve anginal pain ○ Pattern of angina changes noted ○ Client has abnormally severe chest pain with nausea and vomiting ○ Anginal pain is not relieved by rest ○ Client develops progressively worse dyspnea ○ Individual with coronary artery stent experiences chest pain ○ Client demonstrates a difference of more than 40 mmHg in pulse pressure SCREENING FOR IMMUNE DISORDERS The Immune Response • Antigen: Foreign substances composed of proteins, polysaccharides, or both (glycoproteins) • Activate immune system (IS) to produce antibodies: Usually IS ignores self-cells • Once IS recognizes invader (antigen), it develops a specific response (antibody) to it and stores that response in memory cells for future reference ○ Primary response: First exposure to antigen ○ Secondary response: Repeat exposure to same antigen (memory cells) Organs of the Immune System • Primary organs ○ Bone marrow: All cells in IS derived from undifferentiated stem cells of the bone marrow ○ Thymus: Develops T cells, where immature cells turn into killer cells, helper cells, or suppressor cells • Secondary organs
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