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cp interventions 1/22 Flashcards

1
Q

continue to terminal exercise?
• Moderate to severe/increasing angina
• Marked dyspnea

A

stop and stabilize patient

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2
Q

continue to terminal exercise?
• Dizziness, light-headedness, ataxia
• Cyanosis/pallor
• Excessive fatigue

A

stop and stabilize patient

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3
Q

continue to terminal exercise?
• Leg cramps/claudication
• Blunted BP response
• Hypertensive BP response >180 or 110 mmHg

A

stop and stabilize patient

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4
Q

continue to terminal exercise?
• Fall in SBP of 10-15 mmHg
• Significant change in EKG rhythm- ST elevation/depression, looking for changes from baseline

A

stop and stabilize patient

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5
Q

Y/N? indication for cardiac rehab
• Medically stable post-MI
• Stable angina

A

yes, stable

- predictable threshold for angina

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6
Q 
Y/N? indication for cardiac rehab
• CABG
• Stable heart failure
• Heart transplantation 
• Valvular heart surgery
A

yes, stable

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7
Q

Y/N? indication for cardiac rehab

• PAD, CAD

A

yes, stable

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8
Q

normal ejection fraction?

A

~55-85%

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9
Q

Y/N? indication for cardiac rehab

Unstable angina

A

contraindication

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10
Q

Y/N? indication for cardiac rehab
• Uncontrolled hypertension (>180 or >110)
• Orthostatic BP drop of >20 mm Hg with symptoms

A

contraindication

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11
Q

Y/N? indication for cardiac rehab
• Aortic stenosis
• Uncontrolled arrythmias
• Pericarditis/myocarditis

A

contraindication

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12
Q

Y/N? indication for cardiac rehab
• 3rd degree AV block without pacemaker
• Uncontrolled PE/DVT

A

contraindication

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13
Q

6-Minute Walk Test

distance good long-term survival rate

A

> 300meters

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14
Q

calculate exercise intensity

borg scale vs HR

A

borg x 10 = HR

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15
Q

calculate exercise intensity

Rate Pressure Product

A

HR x SBP

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16
Q

Exercise Tolerance Test (ETT)
eg. bruce protocol
+Positive?
-Negative?

A

+Positive= signs of myocardial oxygen supply
inadequate for demand

  • Negative= balanced oxygen supply and demand, eg. cancer patient, nothing bad happening
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17
Q

what phase cardiac rehab?
Divided into 6 subcategory levels, targeting up to 6 MET’s
1. Bedrest 1-1.5 METs
2. Sitting 1.5-2.0 METs
3. Room 2-2.5 METs
4. Hall 2.5-3.0 METs
5. Progressive Hall 3-4 METs 6. Progressive Hall 4-5 METs

A

Phase I—Inpatient, acute stay

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18
Q

what phase cardiac rehab?
• Increase HR 10-20 bpm initially
• No complaints of dizziness, l/h, angina
• <13/20 Borg RPE

A

Phase I—Inpatient, acute stay

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19
Q

what phase cardiac rehab?
• Keep activities <90% of ISCHEMIC RPP (RPP at which ischemic symptoms are noted)
• RPE 11-13 (Light to Somewhat Hard)
• Target 5-9 MET’s

A

II—Outpatient Phase

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20
Q 
what phase cardiac rehab?
• Mode—Large muscle groups, aerobic
• Freq.—3x/week minimum
• Duration—12 weeks
• Warm-up, condition, cool-down 
• 55-90% HR Max
A

II—Outpatient Phase

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21
Q

phase I cardiac rehab
RPE should stay < #?
goal MET?

A

<13/20 borg rpe

6 MET

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22
Q

what phase cardiac rehab?
• Self-regulated
• Maintenance/progression x 6-12 months

A

III-Community Program

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23
Q

Cardiac Rehab Strength Training
target reps?
target RPE?
what muscle groups?

A
  • 12-15 repetitions comfortably
  • 11-13 RPE
  • Large muscle groups
  • Exhalation with exertion
  • Symptom management
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24
Q

what are sternal precautions?

  • lifting weight?
  • scap movement?
  • arm movement?
  • splinting during what?
A
  • UE lifting > 10 pounds
  • Pushing/pulling
  • Scapular adduction
  • UE resistive exercises above 90 degrees
  • No UE assistance with sit to stand
  • Sternal “splinting” with cough, laugh, or sneeze
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25
what term? • Intrathoracic pressure increased against a closed glottis • Collapsed veins reduce BP and HR • Overshoot of ↑ BP and HR
Valsalva
26
medication for angina pectoris (unstable/prinzmetal/constant)? how to administer?
Nitroglycerin (NTG) • Patient brings their own meds • Administer sublingual NTG and monitor 5 min. • Repeat 3x • If no resolution of angina pectoris, send patient to the emergency department
27
normal tidal volume
0.5L, 500mL
28
normal IRV
2.5L, 2500mL
29
normal ERV
1.5L, 1500mL
30
normal RV
1.5L, 1500mL
31
normal IC | what is composed of?
IRV+TV | 3L
32
normal FRC | what is composed of?
ERV+RV | 3L
33
normal VC max inhale followed by max exhale what is composed of?
IRV+TV+ERV | 4.5L
34
normal TLC | what is composed of?
6L
35
term? palpable vibration from lungs full of fluid goal?
Fremitus Patient says a vowel sound eg. tactile fremitus, say "99" Goal is to find where the secretions are
36
what condition? auscultate: Crackles, Rhonchi Tactile Fremitus (say “99”): Increased
Pneumonia
37
what condition? auscultate: Crackles Tactile Fremitus (say “99”): Increased
Pulmonary edema
38
what condition? auscultate: Decreased breath sounds Tactile Fremitus (say “99”): Decreased
Pleural effusion
39
what condition? auscultate: Decreased breath sounds, Rhonchi, Wheezing Tactile Fremitus (say “99”): Decreased
COPD
40
what condition? auscultate: Decreased breath sounds Tactile Fremitus (say “99”): Decreased
Pneumothorax
41
obstructive or restrictive? emphysema asthma
obstructive
42
obstructive or restrictive? brochiecstasis chronic bronchitis
obstructive
43
obstructive or restrictive? | interstitial lung disease
restrictive
44
obstructive or restrictive? | idiopathic pulmonary fibrosis
restrictive
45
obstructive or restrictive? pneumoconiosis sarcoidosis remove part of lung
restrictive
46
obstructive or restrictive? chest wall neuromuscular disease obesity pregnancy
restrictive
47
obstructive lung disease - TLC +/-? - FVC +/-?
TLC normal or increased | FVC normal
48
obstructive lung disease - FEV1? - FEV1/FVC?
FEV1 decreased | FEV1/FVC <0.8
49
restrictive lung disease - TLC +/-? - FVC +/-?
TLC decreased | FVC decreased
50
restrictive lung disease - FEV1? - FEV1/FVC?
FEV1 normal or decreased | FEV1/FVC normal
51
how to perform Manual Secretion Removal
* Postural drainage/ percussion/ shaking * Assisted cough * Tracheal stimulation * Endotracheal suctioning (last resort) • Catheter fed through nose/mouth/stoma
52
``` Exercise Prescription Aerobic - Heart Rate Reserve (HRR) - Intensity? - Duration? ```
* 40-85% Heart Rate Reserve (HRR) * use Karvonen method (HRR = HRmax-HRrest) * Moderate intensity * 20-30 min
53
* Loss of scalenes and intercostal muscles * Epigastric rise * Decreased chest wall expansion
Paradoxical Breathing Pattern
54
EKG - Resting state - Contracting state - Resetting phase
- Resting state is “polarized” - Contracting state is “depolarization” - Resetting phase is “repolarization”
55
ABCDE for obstructive lung disorder
``` asthma brochiecstasis chronic bronchitis dry cough emphysema ```
56
2 reasons to do pursed lip breathing?
``` + back pressure (expand lung alveoli), prevent airway collapse slow RR (increase time for gas exchange) ```
57
where to auscultate aortic valve? pulmonic valve?
aortic - 2nd IC R sternal | pulmonic - 2nd IC L sternal
58
where to auscultate tricuspid? mitral?
tricuspid - 4th L sternal | mitral - 4th L midclavicular
59
ECG big box = s? | how many is 1 sec
0.2sec | 5 big box
60
typical post MI is HR +/-? | what meds?
increased HR | take digitalis, beta blockers to decrease HR

-cardiopulm Npte (17 decks)

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