5.4 Other Systems Quick-Hit (Endocrine, GI, GU, Hematology)
Key Takeaways
- Blood glucose below 70 mg/dL is hypoglycemia; if the patient is alert, deliver about 15 grams of fast-acting carbohydrate, retest in 15 minutes, and hold exertion until levels stabilize.
- PTAs should avoid scheduling vigorous exercise at peak insulin action and should not have a patient inject insulin into a muscle that is about to be heavily exercised.
- Hyperthyroidism presents with heat intolerance, weight loss, and tachycardia; hypothyroidism presents with cold intolerance, fatigue, and bradycardia — both alter exercise tolerance and require PT communication.
- Internal pelvic floor examination is outside PTA scope; PTAs may deliver external surface biofeedback, behavioral education, and therapeutic exercise inside a PT-written pelvic health plan of care.
- Sickle cell pain crisis is managed by stopping exertion, supporting hydration and oxygenation, keeping the patient warm, and immediately involving the supervising PT or medical team.
Diabetes And Exercise
Patients with diabetes mellitus need careful glucose monitoring around physical therapy sessions. The PTA's contribution is recognizing when not to exercise and how to respond when glucose values fall outside safe windows.
- Hypoglycemia — Blood glucose below 70 mg/dL. Signs include shakiness, sweating, tachycardia, hunger, confusion, and pallor. If the patient is alert and able to swallow, follow the 15-15 rule: deliver about 15 grams of fast-acting carbohydrate (4 oz juice, glucose tablets), wait 15 minutes, and retest. Repeat until the value is above 70 mg/dL, then provide a small protein/carbohydrate snack and report the episode to the supervising PT.
- Hyperglycemia — Pre-exercise glucose above 250 mg/dL with ketones, or above 300 mg/dL regardless of ketones, generally warrants holding vigorous exercise and notifying the supervising PT or nursing staff.
- Insulin timing — Avoid scheduling strenuous activity at peak insulin action; this is the highest-risk window for hypoglycemia. Do not have the patient inject insulin into a muscle that is about to be heavily exercised because uptake will be accelerated.
- Foot care — Inspect feet every visit. Diabetic neuropathy lets small wounds progress unnoticed, which links this section to Wagner grading from earlier in the chapter.
Thyroid Disorders
| Disorder | Common Findings | PT/PTA Implication |
|---|---|---|
| Hyperthyroidism (e.g., Graves disease) | Heat intolerance, weight loss, anxiety, tremor, tachycardia, exophthalmos | Monitor heart rate closely; progress intensity slowly; watch for arrhythmia and fatigue |
| Hypothyroidism (e.g., Hashimoto) | Cold intolerance, weight gain, fatigue, bradycardia, dry skin, proximal muscle weakness | Expect lower exercise tolerance; allow longer warm-ups and rests; report worsening fatigue |
Untreated thyroid storm or myxedema coma are emergencies — stop therapy and call for medical help.
Gastrointestinal And Genitourinary Considerations
The GI and GU domains contribute a small share of items (each in the 0-4 range on the FSBPT outline), but a few high-yield rules show up repeatedly.
- Reflux — Avoid prolonged supine positioning right after meals; favor head-of-bed elevation and upright exercise positions when symptomatic.
- Bowel and bladder programs — PTAs reinforce timed voiding, fluid scheduling, fiber intake, and transfer mechanics inside a PT-written plan.
- Pelvic floor rehabilitation scope — Internal vaginal or rectal examination, internal biofeedback placement, and intra-cavity electrical stimulation are PT-only interventions in most jurisdictions. The PTA may deliver external surface biofeedback, behavioral education, posture and breathing strategies, and external therapeutic exercise as long as the supervising PT has documented this in the plan of care and the state practice act allows it.
- Urinary catheters and ostomies — Position drainage bags below the bladder, manage stoma sites carefully, and avoid traction on lines during transfers.
Hematology Quick Hits
- Anemia — Hemoglobin and hematocrit drop reduces oxygen-carrying capacity. Expect lower exercise tolerance, fatigue, and pallor. Follow institutional lab-value guidelines for therapy hold thresholds and report symptomatic patients.
- Thrombocytopenia — Low platelet counts (often below 20,000/microL) restrict resistive exercise and contact activities because of bleeding risk. Aerobic, light activity may still be appropriate per the plan of care.
- Sickle cell disease and crisis — A vaso-occlusive crisis presents as severe musculoskeletal or abdominal pain, often with dehydration, cold exposure, or exertion as triggers. Response: stop exertion, support hydration and oxygenation, keep the patient warm, and immediately notify the supervising PT or medical team. Compression therapy is not used to treat a sickle crisis.
- Deep Vein Thrombosis (DVT) — Suspected acute DVT (new unilateral calf swelling, warmth, tenderness) requires holding lower-extremity exercise and reporting; mobilization resumes only after the medical team has cleared it and anticoagulation is established.
Bone Health And BLT Precautions
Osteoporosis treatment crosses into Integumentary review because precautions overlap with post-operative spinal protocols. PTAs reinforce BLT precautions — no Bending forward, no Lifting more than the prescribed limit (often 5 to 10 pounds), and no Twisting — when the supervising PT has prescribed them after vertebral fracture, kyphoplasty, or lumbar surgery. Education includes hip-hinge mechanics, log rolling, and avoidance of spinal flexion exercises in patients with significant vertebral osteoporosis.
Forty minutes into a gait-training session, a patient with Type 1 diabetes becomes pale, diaphoretic, and shaky. The patient is alert and reports feeling 'wobbly.' A fingerstick reads 58 mg/dL. The patient can swallow safely. What is the most appropriate immediate PTA action?
A supervising PT writes a pelvic-health plan of care for a patient with stress urinary incontinence. Which intervention falls within typical PTA scope of practice?