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Outcome Measures > Cardiopulm > Flashcards

Cardiopulm Flashcards

1
Q

Major ADLs Addressed in Cardiac Rehab

A

ABCDTT

A- Ambulating

B- Bathing

C- Continence

D- Dressing

T-Toileting

T-Transfers

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2
Q

Phase 1 (Inpatient) Cardiac Rehab

A

The goal for patients typically in ICU is 3-5 days. Then to Cardiac Stepdown unit.

Goals of PT Cardiac Rehab are:

• Activate; Get the patient moving in order to

combat effects of bed rest. (BSChair)

• Educate; Promote lifestyle modifications and

educate about recovery process

• Initiate; Begin process of returning patient

back to independent functioning (ADLS)

  • Physical Therapy Exercise Guidelines:
  • ADL’s, Ambulation, some UE/LE exercises (UE

avoid for CABG – 6-8wks)

• Low Intensity exercise (2-3 METS) -> 5 METS

by DC because 5 METS is what is required to perform ADLs.

  • = 70% of max HR (greater is = high risk rMI)
  • Duration: 5-10 minutes progressing duration

over days (maintain intensity within protocol)

• Frequency: 2-4x per day (ACSM)

*It takes 4-6 weeks to develop effective scar tissue

*MI strength training ACSM guidelines start at 5 weeks. CABG at 8 weeks because of sternal precautions

Contraindications:

  • Exercise Discontinuation Criteria
  • Diastolic blood pressure (DBP) >/= 110
  • Decrease in systolic blood pressure >/=10

mmHg during exercise with increasing

workload (other symptoms don’t matter)

• Significant ventricular or atrial arrhythmias

with or without associated signs or

symptoms

  • Second or third degree heart block*
  • Signs and Symptoms of exercise intolerance

(angina, marked SOB, ECG changes related

to ischemia, >1mm dep)

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3
Q

Nitroglycerin Protocol

A

If symptoms persist, the patient is having a MI. If chest pain EVER worsens, you call EMS! First thing you do: stop the exercise. Second: Wait for 5 min Third: Reassess pain Fourth: If pain is still there, take a 2nd Fifth: Repeat Sixth: If pain is gone, restart at lower instensity. Seventh: After 3 Nitros and 15 min, and pt still have pain, call EMS!!

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4
Q

Phase 2 Cardiac Rehab

A
  • Process (weeks to months)
  • Patients enter a specialized cardiac rehabilitation outpatient program with qualified staff with ability to monitor vitals, EKG, and understand the patient’s medication regimen.
  • Prior to entering Phase II it is recommended that the patient have a symptom-limited ETT at the 4-6 weeks mark.
  • Phase II can begin immediately after phase I but will begin at a exercise prescription determined by the low level GXT
  • Physical Therapy Goals
  • Develop and facilitate a safe and effective formal exercise program
  • Provide supervision and monitoring
  • Return the patient to vocational and recreational activities or modify these activities to fit the patient clinical status
  • Educate on secondary prevention measures (risk factor modification)

Physical Therapy Exercise Guidelines

  • Intensity: Based on exercise test
  • When The Test is Negative
  • Common exercise prescription is 70-85% of

Max HR

  • When The Test is Positive
  • You must keep RPP below ischemic

threshold

  • RPP = SBP x HR
  • Stay >/=10 beats below ischemic threshold

Physical Therapy Exercise Guidelines

  • Type: Aerobic and Strengthening
  • Circuit training is optimal
  • Train large mm groups before

small

• Strengthening @ 5wks post MI

/8 wks CABG

• Duration: 20-60 (5-10 minute warm

up/cool down)

• Frequency: 2-3x week

Exercise Discontinuation Criteria

  • Diastolic blood pressure (DBP) >/= 110
  • Decrease in systolic blood pressure >/=10

mmHg during exercise with increasing

workload (other symptoms don’t matter)

• Significant ventricular or atrial arrhythmias

with or without associated signs or

symptoms

  • Second or third degree heart block*
  • Signs and Symptoms of exercise

intolerance (angina, marked SOB, ECG

changes related to ischemia, >1mm dep)

*D/C Criteria is 9 METS

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5
Q

Phase 3 Cardiac Rehab

A

Process (Indefinitely)

• Patients enter a community based

exercise program, unsupervised,

maintenance

• Prior to entering Phase III the patient

must be able to complete 5 MET’s of

activity without symptoms, have stable

angina, and have medically controlled

arrhythmias during exercise.

  • Physical Therapy Goals
  • Improve and maintain functional

capacity

• Promote self regulation of

exercise programs

• Promote lifelong commitment to

risk factor modification

Physical Therapy Exercise Guidelines

  • Intensity
  • 50-85% of functional capacity
  • Type
  • Aerobic
  • Strengthening
  • Duration:
  • 45-60 minutes (5-10 minute

warm up/cool down)

  • Frequency:
  • 3-5x week (begin following

CDC’s exercise guidelines)

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6
Q

Pulmonary Function Tests

A

Pulmonary tests that measure

lung volumes and capacities and

gas flow rates

  • Lung Volumes (TLC, VC, IRV, ect)
  • FEV1/FVC, FVC
  • Allow us to determine if the

condition is obstructive or

restrictive

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7
Q

PULMONARY FUNCTION TESTS: GAS FLOW RATES

A

• Measure air flow rates during force breathing to provide information about the lung function and severity of lung impairment.

Forced vital capacity (FVC)

• Maximum amount of air that you can actually

move in and out of the lungs (3.5 – 4.5 L)

  • Step one: Exhale deeply
  • Step two: Take a maximum inhalation
  • Step three: Maximally exhale as quickly as possible
  • TELLS US IS THERE A LUNG PROBLEM
  • Reduced in both restrictive and obstructive

conditions

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8
Q

Pulmonary Function Tests: Forced Vital Capacity 1 Sec

A

(FEV1)

• Maximum volume of air that can be

exhaled in one second

  • Why do we care?
  • Tells us information about airflow in the

large airways

• Determine restrictive or obstructive lung

condition

• TELLS US SEVERITY OF LUNG OBSTRUCTION

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9
Q

Forced Expiratory Volume

A

Forced Expiratory Volume

• Can be expressed as a fraction or

percentage (FEV1/FVC or FEV1%)

  • Interpretation
  • FEV1/FVC < .70 = Obstructive

Condition

• FEV1/FVC > .80 = Restrictive

Condition

• FEV1% of greater than 80% indicates

restrictive disease as long as FEV1/FVC is > .70

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10
Q

COPD Gold Stages

A

Stages 1-4, 1 being mild, 4 being severe

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11
Q

Measurements for Obstructive vs. Restrictive Lung Diseases

A

Check Picture

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12
Q

Normal Breath Sound-Tracheal

A
  • Harsh, high-pitched sounds
  • Above supraclavicular notch (1)
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13
Q

Normal Breath Sound- Bronchial

A
  • Loud, high-pitched, tubular sounds
  • Heard during inspiration &

expiration with a pause

• Just above clavicles on each side of

the sternum, over the manubrium (2)

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14
Q

Normal Breath Sound- Bronchovesicular

A

• Softer, tubular sounds heard between the

scapulae

  • Continuous during inspiration & expiration
  • Next to the sternum, & between scapulae (3)
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15
Q

Normal Breath Sound- Vesicular

A

• Low pitched soft sounds heard during

inspiration

• Remainder of lungs (Purple Part)

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16
Q

Abnormal (Adventitious) Breath Sound- Crackles

A

• “popping/crackling” discontinuous

sounds associated w/fluid in alveoli

& airways

• Heard during late inspiration as air

suddenly opens closed airways

• Pulmonary edema, pneumonia,

chronic bronchitis, pulmonary

fibrosis

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17
Q

Abnormal (Adventitious) Breath Sound- Wheezes

A

• continuous whistling,

high pitched noise

• Loudest on expiration,

caused by air forced thru

narrowed airways

• Asthma, bronchiectasis,

bronchitis

18
Q

Abnormal (Adventitious) Breath Sound- Rhonchi

A

• “Gurgling or snore-like”

low pitched type noise,

caused by fluid in large &

medium sized airways

•Bronchitis, Bronchiectasis

pneumonia, CHF

19
Q

Abnormal (Adventitious) Breath Sound- Stridor

A

• Inspiratory, high pitched

wheezing sound due to

tracheal narrowing and/or

disrupted airflow

• Anaphylactic shock, object

lodged in throat

20
Q

Abnormal (Adventitious) Breath Sound- Pleural Friction Rub

A

• Scratching, grating noise

heard during inspiration and

expiration.

• Pleural effusion, pleurisy

(pleuritis), pneumonia

21
Q

Abnormal Breathing Pattern- Cheyne-Stokes Respirations

A

• Breathing characterized by

progressively deeper, and

sometimes faster, breathing

followed by a gradual decrease that

results in a temporary stop in

breathing called an apnea (up to 60

sec)

• CHF, Stroke, TBI, End of life

respirations, opioids

22
Q

Abnormal Breathing Pattern- Kussmaul Respirations

A

• Deep and labored (gasping)

breathing pattern

• Associated with decreased blood

pH caused by

  • DKA (EMS)
  • Metabolic acidosis (ABG question)
  • Carbon monoxide poisoning
23
Q

Abnormal Breathing Pattern- Fremitus

A

• Defined as the vibration that is

produced by the voice or by the

presence of secretions or increased

tissue density in the airways

• Increased fremitus = increased

density in the lung spaces

(consolidation/collapse**)

  • Examples of increased fremitus
  • Pneumonia
  • Tumor or mass
  • Cystic Fibrosis (Mucus plugs)
  • Bronchitis
  • Examples of decreased

fremitus

  • Pneumothorax
  • Hemothorax
  • Pleural Effusion
  • Emphysema
24
Q

Abnormal Breathing Pattern- WHISPERING PETROLILOQUOY

A

While the examiner

auscultates over the lung

fields, the patient is asked to

whisper “one, two, three.

•When consolidation is

present..1,2,3 is heard

clearly

25
Q

Abnormal Breathing Pattern- Egophony

A

Select sound frequencies are

able to pass through

consolidation and tend to

distort the sound of the

vowel “E” so that it is

perceived by the examiner as

“A” or “AAAH.”

26
Q

Abnormal Breathing Pattern- Bronchophony

A

• Select sound frequencies are able to

pass through consolidation and

become louder over areas of

consolidation

• Patient repeats the numbers “99” or

”66”

• If the sound becomes louder over

suspected lung fields, consolidation is

present.

27
Q

A High Frequency Chest Wall Oscillation (HFCWO)

A

vest that is attached to an air pulse

generator which rapidly inflates

and deflates the vest.

  • Moves mucus to large airways
  • Shouldn’t be used with intubated

patients or post op patients

28
Q

FLUTTER VALVE THERAPY/ACAPELLA DEVICE

A

Handheld device that utilizes a

stainless steel ball that vibrates

back and forth, opening and

closing the devices air hole,

pulsing the air back into the

airways.

• Independent use some

children and most

adolescents/adults

29
Q

Pulmonary Intervention Formula

A

Are the secretions stuck?

Vibration and/or Percussion, The Vest, Flutter Device

Does the patient need mobilization and

clearance?

ACBT, Autogenic Drainage

Does the patient just need clearance? If so, how

much assistance can they provide?

Huffing/Coughing, Manually assisted cough, MI/E, suctioning

30
Q

BRONCHO PULMONARY HYGIENE / POSTURAL DRAINAGE

A

Look at picture

31
Q

PERCUSSION

A

• Manual percussion consists of a

rhythmical clapping with cupped hands

over the affected lung segment in PD

positions

  • NPTE Reminders:
  • No percussion with conditions/meds that

create brittle bones, contusions, or blood

thinning

• Percussion is used for mobilizing restricted

mucus not clear

32
Q

Vibration

A

Vibration consists of placing the palmar

aspect of the clinician’s hands in full

contact with the patient’s chest wall. At

the end of a deep inspiration, the clinician

exerts pressure on the patient’s chest wall

and gently oscillates it through the end of

expiration.

  • NPTE Reminders:
  • More gentle than percussion but similar

contraindications because of pressure

provided

33
Q

ACTIVE CYCLE OF BREATHING

A

• Sequence of maneuver used to mobilize

mucus to larger airways and clear

secretions

  • Procedure:
  • Breathing Control (Diaphragmatic Breathing)
  • Thoracic Expansion (Deep Inhalation)
  • Breathing Control
  • Thoracic Expansion (Deep Inhalation)
  • Breathing Control
  • Forced expiration (Huffing)
34
Q

AUTOGENIC DRAINAGE

A

• Sequence of maneuver used to mobilize

mucus to larger airways and clear secretions

  • Procedure:
  • 3 rounds of shallow breathing
  • 3 rounds of medium volume breathing
  • 3 rounds of deep volume breathing
  • NPTE reminder:
  • Difficult to teach <8yo or cognitively impaired
35
Q

Huffing (Clearance)

A

• A deep inspiration

followed by a forced

expiration without glottal

closure. It is often used

in post-op patient who

find it painful to cough

36
Q

MANUAL COSTOPHRENIC ASSIST / MANUAL ABDOMINAL THRUSTS

A

Active-assistive approach where

the therapist places his or her hand

on the child’s abdomen (just below

the diaphragm). The patient takes a

large breath in and holds it for 1 to

3 seconds.

• The patient then attempts to cough

as hard as possible while the

therapist provides compression

with an upward thrust in the

direction of the diaphragm.

37
Q

MECHANICAL INSUFFLATION/EXSUFFLATION

(MIE)

A

• Assisted Coughing Machine

that adds in a high level of

positive pressure followed by

negative pressure to stimulate

a cough

• Typically added with a

manually assisted cough for

more effective removal of

secretion

38
Q

SUCTIONING

A

• Passive elimination of secretions

through using a suctioning tube

within the tracheostomy.

  • NPTE reminders:
  • All active options were exhausted
  • Patient has a tracheostomy
  • Suction tube should be with drawn

using a rotational technique NOT

pistoning

• 5-10 second suction time

39
Q
A
40
Q

Endotracheal suctioning

A

Rotational motion for 5-10 second suction then 10 sec rest. Anything longer makes them hypoxic.

Outcome Measures (8 decks)

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