Breathing Exercises

Question 1

Diaphragmatic breathing indicated for who?

Answer 1

post-surgical pts with pain in chest wall or abdomen or restricted mobility.
Pt learning ACB or AD
Dyspnea at rest or with minimal activity
inability to perform ADLs due to dyspnea or inefficient breathing pattern.

Question 2

Diaphragmatic breathing precautions/contraindications

Answer 2

moderate to severe COPD with marked hyperinflation of the lungs without diaphragmatic movement.
Pts with paradoxical breathing patterns or who demonstrate increased inspiratory muscle effort and increased dyspnea during DB.

Question 3

Inspiratory muscle training (IMT) attempts to

Answer 3

strengthen the diaphragm and intercostal muscles

Question 4

Different modes of IMT:

Answer 4

flow resistive breathing and threshold breathing

Question 5

Flow resistive breathing

Answer 5

patient inspires through a mouthpiece and adapter with an adjustable diameter.

Question 6

Threshold breathing

Answer 6

buildup of negative pressure before flow occurs though a valve that opens at a critical pressure. Provides consistent and specific pressure for IMT, regardless of how quickly or slowly patients breath

Question 7

Precautions/contraindications of IMT

Answer 7

clinical signs of inspiratory muscle fatigue: in order:
tachypnea
reduced tidal volume
increased PaCO2
bradypnea and decreased minute ventilation

Question 8

Paced breathing

Answer 8

allows anyone who experiences SOB to become less fearful of activity and exercise

Question 9

Exhale with effort

Answer 9

during activity to prevent a patient from holding their breath

Question 10

Pursed lip breathing

Answer 10

reduces RR, dyspnea, maintains small positive pressure in bronchioles which may help prevent airway collapse in patients with emphysema. Any patient who is short of breath may use this technique.

Question 11

Segmental breathing

Answer 11

localized breathing or thoracic expansion exercises. Intended to improve regional ventilation and prevent and treat pulmonary complications after surgery.

Question 12

Indications for segmental breathing

Answer 12

decreased intrathoracic lung volume
decreased chest wall lung compliance
increased flow resistance from decreased lung volumes
ventilation:perfusion mismatch

Question 13

Expected outcomes for segmental breathing

Answer 13

expand collapsed alveoli via airflow through collateral ventilation channels
assist with secretion removal

Question 14

Indications for incentive spirometer

Answer 14

decreased intrathoracic lung volume
decreased chest wall lung compliance
increased flow resistance from decreased lung volume
ventilation:perfusion mismatch
atelectasis or risk of it due to surgery
restrictive lung defect associated with quadriplegia and/or dysfunctional diaphragm

Question 15

Precautions/contraindications for incentive spirometer

Answer 15

less than 10 mL/kg or inspiratory capacity
patients with severe COPD with increased RR And hyperinflation

Question 15

Forward leaning with arm support optimizes

Answer 15

length-tension relationship of the diaphragm and allows pec minor and major to assist in elevating rib cage during inspiration.

Question 15

Semi-Fowler’s position

Answer 15

supine with HOB elevated to 45 degrees and pillows under knees
used for CHF or other cardiac conditions

Question 16

Clinical contraindications for inpatient and outpatient cardiac rehab

Answer 16

unstable angina
resting SBP >200 mmHg or resting DBP >110 mmHg
orthostatic drop of >20 mmHg with symptoms
critical aortic stenosis
acute systemic illness or fever
uncontrolled atrial/ventricular arrhythmias
third degree heart block without pacemaker
active pericarditis or myocarditis
recent embolism
thrombophlebitis
resting ST segment depression or elevation >2mm
uncompensated HF

Question 17

Inpatient cardiac rehab phase I

Answer 17

AROM
ambulation
self care
average time 3-5 days

Question 18

Discontinue exercise in cardiac rehab phase I if..

Answer 18

HR >130 bpm or >30 beat above resting
DBP>110 mmHg
decrease in SBP >10 mmHg
significant ventricular or atrial dysrhythmia
2nd or 3rd degree heart block
signs or symptoms of angina, marked dsypnea, and ECG changes of suggestive ischemia

Question 19

Exercise in cardiac rehab phase I

Answer 19

active UE and LE exercise can begin 24 hours after bypass and 2 days after infarct.
Progress from sitting to standing (1-4 METS)
progressive, supervised walking (2-3 METS) to walking up and down steps or treadmill walking (3-4 METS)

Question 20

RPE and HR in cardiac rehab phase I

Answer 20

<13
post infarction: HR<120 or <20 above resting
post surgery: <30 above resting

Question 21

Duration and frequency of cardiac rehab phase I

Answer 21

intermittent bouts of 3-5 minutes progressing to 10-15 minutes of continuous activity
first 3 days: 3-4 times per day
after 3 days: 2x/day with increased duration

Question 22

Progression of exercise in cardiac rehab phase I

Answer 22

adequate increase in HR
adequate increase in SBP (10-40 mmHg)

Question 23

Outcomes of inpatient cardiac rehab

Answer 23

walk 5-10 minutes continuously or 1,000 feet four times daily walk up and down a flight of stairs independently

Question 24

Immediate outpatient cardiac rehab (Phase II)

Answer 24

can begin immediately after hospitalization and last up to 12 weeks exercise test with ECG is recommended for patients entering outpatient program and as changes in patients condition warrant

Question 25

Monitoring during outpatient cardiac rehab (phase II)

Answer 25

low risk patients: 6-12 sessions of ECG and BP monitoring and medical supervision moderate to high risk: continuous ECG and BP monitoring and medical supervision usually for 12 sessions.

Question 26

Rating of what on the angina scale is recommended end-point to cease activity during inpatient and outpatient cardiac rehab.

Answer 26

1

Question 27

Individuals who experience angina during activity during cardiac rehab phase II should

Answer 27

discontinue activity immediately and rest in sitting or recumbent position

Question 28

Individuals with medication for angina should be encouraged to use it as directed. If angina is not relieved by termination of activity or by nitro what should you do?

Answer 28

ER

Question 29

Exercise THR for aerobic training should be ___ beat/min below known ischemic or anginal threshold.

Answer 29

> or equal to 10

Question 30

Discontinue exercise during phase II outpatient cardiac rehab if...

Answer 30

plateau or decrease in HR with increase in work SBP plateaus or falls with increase in work or >250 mmHg DBP >115 mmHg ST segment depression >1 mm 2nd or 3rd degree heart block ventricular dysrhythmias angina or other symptoms of CVD insufficiency

Question 31

Aerobic exercise intensity for those in cardiac rehab phase II

Answer 31

without entry exercise test: exercise HR equal to standing RHR +20 bpm with caution

Question 32

Moderate dehydration is considered a loss of how much percent of bodyweight?

Answer 32

6%

Question 33

How much should you drink for each pound lost of body weight?

Answer 33

1 pint

Question 34

Disorientation, dizziness, apathy, headache, nausea, vomiting, hyperventilation, dry skin

Answer 34

heat stroke

Question 35

LBP, elevated HR and RR, wet and pale skin, weakness, dizziness

Answer 35

heat exhaustion

Question 36

decreased HR and RR, pale skin, weakness, vertigo, nausea

Answer 36

heat syncope

Question 37

localized muscle spasms progressing to debilitating muscle cramps

Answer 37

heat cramps

Question 38

Exercise in cold may lower

Answer 38

may lower the angina threshold and increase risk of death or injury in individuals with heart disease.

Question 39

Hypothermia is characterized by

Answer 39

body temp <97 degrees F

Question 40

Duration and frequency of exercise for outpatient cardiac rehab

Answer 40

15-20 minutes of continuous or intermittent exercise during first month. 25-30 minutes during next three or four months 40 min + after 6 months Interval training for those that cannot tolerate exercise continuously 3-5x/week

Question 41

Clinical indications for pulmonary rehab

Answer 41

dyspnea at rest or with exertion hypoxemia hypercapnia reduced exercise tolerance decline in ADLs chronic bronchitis emphysema asthma interstitial lung disease bronchiectasis cystic fibrosis lung cancer chest wall disease neuromuscular disease preop or post op lung ventilator dependency

Question 42

Guidelines for aerobic exercise for pulmonary rehab

Answer 42

>50% peak oxygen consumption determined by exercise test using dyspnea rating at submax level during exercise test 60-80% of peak work rate achieved determined from exercise test RPE of 4-6 on 0-10 scale or 12-16 on 6-20 scale maintain O2 >90%

Question 43

Duration of pulmonary rehab sessions

Answer 43

minimum of 30 minutes accumulated exercise per session interval training for those that cannot exercise continuously 3-5 days per week