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Exam 1 Flashcards

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1
Q

What is the genetic theory of aging?

A

Apoptosis

Limit to cell division

Cell damage from free radicals, poor nutrition, or hydration

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2
Q

What is the nongenetic theory of aging?

A

Environmental factors damage DNA

Genetic mutation

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3
Q

What are free radicals?

A

Comes from processed foods and other sources

Cause overall cell damage

Could cause cancer

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4
Q

How are free radicals combated?

A

Antioxidants

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5
Q

What does acceleration of cell death lead to?

A

Parkinson’s and Alzheimer’s

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6
Q

What happens to cartilage as you age?

A

Decreased hydration = increase fibrotic tissue = stiffness

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7
Q

How do you treat aging cartilage?

A

WB activities

Maintain strength of muscles around jt to decrease stress

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8
Q

When does muscle mass decrease?

A

Between ages 60-90

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9
Q

What causes change to occur in muscles?

A

Decreased activity level and disuse

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10
Q

How much muscle is lost per year during aging?

A

1.5%

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11
Q

What occurs physiologically to muscles as you age?

A

Decrease in motor units

Decrease speed of muscle, contraction, and movement

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12
Q

How to treat aging muscles?

A

Strength can still be increased and maintained

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13
Q

What causes a decrease in skeletal mass?

A

Decrease levels of vitamin D3 = less calcium absorbed

Imbalance b/t ostoblast and osteoclast

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14
Q

How to treat loss of bone mass?

A

WB exercise

PRE to improve bone strength

Fall prevention

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15
Q

What occurs to fat composition as we age?

A

Increases at mid life and then decreases

Moves from under skin to hips in women and abs in thighs

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16
Q

What occurs in the neuro system as you age?

A

Atrophy of nerve cells in cerebral cortex (loss of mass)

Decrease cerebral blood flow and energy metabolism

Delayed nerve conduction

Neuronal loss and atrophy

More degeneration of motor function

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17
Q

What effects on movement does an aging neuro system?

A

Speed and coordination decrease

Slow recruitment of motor neurons = loss of strength

Reaction and movement time are increased

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18
Q

How to treat aging neuro system?

A

Increase physical activity

Allow for increase reaction and movement time

Allow for memory limitation = one-step commands

Provide adequate explanation

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19
Q

What occurs to vision as you age?

A

Decline in acuity, presbyopia, increase sensitivity to light, loss of color discrimination, cataracts, glaucoma, senile MD, and diabetic retinopathy

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20
Q

How to treat vision aging?

A

Wear glasses

Work in appropriate light

Provide sensory cues

Safety education

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21
Q

How to treat hearing loss?

A

Hearing aids

Minimize auditory distractions

Speak slow and clearly

Face patient

Use nonverbal communication

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22
Q

What occurs to the vestibular system as you age?

A

Degeneration of otoconia

Diminished vestibuloccular reflex

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23
Q

How to treat the vestibular system during aging?

A

More dependent on balance

Decreased ankle strategy and increased postural sway

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24
Q

What occurs to the somatosensory system when you age?

A

Decline in sensitivity to touch, temp, vibration, loss of joint receptor sensitivity, and pain threshold increases

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25
How to treat an aging somatosensory system?
Allow extra time for response Use touch communication Give extra feedback through sensation Teach compensatory strategies to prevent falls AD
26
What happens to your cognitive abilities as you age?
Decline intellectual abilities Perceptual speed decreases Short term memory
27
How to treat cognitive changes as you age?
Mass practice Decrease pace Memory tools Increase physical activity Provide written instruction
28
What changes occur to the CV system with aging?
Slight increase in heart size Heart will increase CO by increasing SV Loss of pacemaker cells in SA BV thicken
29
What are some precautions to starting exercise in those with an aging CV system?
Avoid quick changes in position Avoid exercise after meal MHR decreased
30
Why does the heart increase as you age?
Heart works harder = muscles increase
31
Why should you avoid exercising after a meal?
Blood flow is going to GI system instead of the rest of the body
32
What occurs to the pulmonary system as you age?
Chest wall thickens = increased kyphosis Loss of elastic recoil Less effective O2 uptake Pulmonary BV thicken Decrease lung capacity
33
How to treat a decreased pulmonary system function?
Increased vent cost of work at high intensity exercise Impaired cough Individualized exercise program essential Aerobic training Increase daily activity
34
What occurs to the integumentary system as you age?
Dermis thins Decreased vascularity Decreased sweating Skin grows and heals more slowly Decreased sensitivity to touch
35
What happens to the GI system as you age?
Decreased salivation, taste, and smell along with inadequate chewing Reduced motility and control of lower esophageal sphincter and stomach Reduced ability for absorption of nutrients in small intestine
36
What is a negative effect of inadequate chewing?
Poor nutrition
37
What is the recommended PT for someone with osteoporosis?
Promoting WB - Walking 30 min/day - Stair climbing - Weight belts Postural training and balance - Postural re-ed - Stretching - Balance ex - Tai Chi - Gait training Safety education/fall prevention
38
What is Paget's Disease?
Metabolic bone disease characterized by increased bone resorption and excessive, unorganized new bone formation
39
What PT interventions are involved in Paget's Disease?
Encourage regular CV and strengthening activity Postural exercises WB exercises Coordination and balance work AVOID high impact
40
Who is at high risk for fractures?
Elderly due to decreased bone density, age, co-morbid disease, dementia, and psychotropic meds
41
Where are the most common areas for the elderly to fracture their bones?
Hip Vertebral compressions
42
What are the risks of fractures in the elderly?
Heal slower Complications such as ulcers, pneumonia, etc
43
What is OA?
Non-inflammatory progressive degenerative process affecting the articular cartilage of the synovial jts
44
What are characteristics of OA?
Bony spurs Capsular thickening
45
What is the tx for OA?
Reduce pain and maintain ROM Balance training Aerobic conditioning and wt reduction Aquatic therapy ADs
46
What is RA?
CT disease that results in inflammation of synovial membrane, release of proteolytic enzymes, and jt damage
47
Where are the inflammatory changes in RA?
Tendon sheaths
48
How do you treat RA?
Decrease pain Increase/maintain ROM Jt protection Resistance exercise Exercise ADL Gait
49
What is included in jt protection principles?
Respect fatigue Conserve energy Use good posture Avoid increase in pain Maintain jt alignment
50
What is the definition of delerium?
Fluctuating attention state causing temp confusion and loss of mental function, disorientation to place and time
51
What is the definition of dementia?
Loss of intellectual functions and memory causing dysfunction in daily living
52
What problems are caused from immobility?
``` Pressure sores Contractures Bone loss Muscular atrophy Deconditioning CV issues ```
53
What interventions occur in PT for someone who is immobile?
Work toward goals Focus on optimum function and progression of ADLs Prevent further complications
54
What age increases fall risk?
65 and older
55
How to intervene falls and instability?
Determine fall risk Eliminate fall risk Increase functional mobility Provide sensory compensation strategies Balance and gait training Functional training Safety education Environmental modification
56
What does nutritional deficiency do to the elderly?
Sensory impairments Mobility Fine motor skills Memory and cognitive skills Psychosocial
57
How to advance dynamic balance activities in the elderly?
Controlled reaching in sitting and standing Leaning in all directions while sitting and standing Sitting postural control with external disturbances WS activities in all directions Stooping and bending Reaching and lifting Standing on high density foam Walk in sturdy shoes Walk barefoot Vary amb surfaces Ramps Stairs Directional changes
58
What is normal gait speed?
140-160 cm/sec
59
What is aging gait speed?
118-125 cm/sec
60
What is normal stride length?
150-160 cm/sec
61
What is aging stride length?
126-140 cm/sec
62
What is normal stride width?
8-10 cm
63
What is aging stride width?
Wider
64
What is normal gait swing-to-stance ratio?
40:60
65
What is aging gait swing-to-stance ratio?
30:70
66
What is normal walking cycle duration?
1 sec free walking
67
What is aging gait walking cycle duration?
1.25 sec free walking
68
What is normal cadence?
110 steps/min free walking 132 steps/min fast walking
69
What is aging cadence?
Decreases
70
What is normal age foot clearance?
1-2 cm
71
What is aging foot clearance?
Decrease or increase depending on pathology
72
What is normal heel strike and push-off?
Present
73
What is aging normal heel strike and push-off?
Frequently decreased
74
What is the definition of cadence?
Steps per min
75
What is the definition of gait speed?
Distance over time
76
What are the types of dementia?
Alzheimer's Lewy Body dementia Vascular dementia
77
What is stage one Alzheimer's disease?
No impairment
78
What is stage two Alzheimer's disease?
Very mild decline Person may feel as though they have memory lapses, forgetting familiar words or the location of everyday objects
79
What is stage three Alzheimer's disease?
Mild cognitive decline Friends, family, or co-workers begin to notice memory deficits
80
What is stage four Alzheimer's disease?
Mod cog decline (mild or early-stage) Medical interview is conducted to make a clear diagnosis
81
What is stage 5 of Alzheimer's disease?
Moderate severe Gaps in memory are more noticeable Begin to need help with day to day activities Unable to recall personal info such as address, phone number, etc Confused on the date Need help choosing clothing Still remember significant details about themselves and family Do not need assist to toilet or eat
82
What is stage 6 Alzheimer's disease?
Severe cognitive decline Memory continues to worsen and personality changes may take place Need extensive help with ADLs Can remember own name, but cannot remember personal hx, can distinguish between familiar or unfamiliar faces, forget caregiver/spouse's name Need help to dress or make mistakes trying Changes in sleep patterns Need help in toileting Trouble controlling bowel and bladder Major personality changes - may be suspicious, delusional, compulsive Tend to wander or become lost
83
What is stage 7 of Alzheimer's Disease?
Very severe cognitive decline (severe or late stage) Final stage of disease Individual loses ability to respond to environment or to carry on a convo. Eventually loses control of movement May say words or phrases Need help with personal care including eating and toileting May lose ability to smile or sit up without support Reflexes become abnormal, muscles grow rigid, and trouble swallowing
84
What are treatment options for someone with Alzheimer's?
Meet where individual is at that day physically and cognitively Dementia is more than forgetfulness - affects processing, sequencing, problem solving, critical thinking, and learning abilities Need more time for tasks and demonstration. Simple instruction
85
What are helpful tips when working with someone with Alzheimer's disease?
Agree rather than argue Divert rather than reason Distract rather than shame Reassure rather than lecture Reinforce rather than force Encourage rather than condescend Reminisce instead of remember Never say "I told you so", instead repeat and regroup Never say "You can't", instead say "let's do this"
86
What are examples of environmental barriers?
Obstacles that impede the individual from functioning normal such as, safety hazards, access problems, home design difficulties, and workplace design difficulties
87
Who regulates the requirements for public and commercial building accessibility guidelines?
ADA
88
How do therapists evaluate the environment?
Accessibility, safety, function, and usability (circle and connect to one another)
89
What does it mean to have an accessible environment?
Assess identifiable barriers that could impact an individual Make recommendations of realistic changes to make a space more accessible and accommodating to the patient's need at home, work, or other buildings
90
What does it mean to have a usable environment?
Preparing the pt and their support system to their return home after a major injury. Help to determine whether other services may be needed
91
How do therapists benefit the function of an environment?
Determines need for AD, other adaptive equipment or assistive technology
92
What are the 5 main areas of the environment to assess?
Assistive or adaptive devices Safety devices Structural alterations Modifications or altered location of environmental objects - IE. disabling stoves, placing locks on door handles, remove throw rugs, moving furniture Task modification - IE. Visual/auditory/sensory cuing, work simplification, energy conservation, and joint preservation techniques
93
What are tips for accessibility at the route of entry to a home?
Most accessible - fewer stairs, closest to driveway, etc Walkways should be smooth, well lit, and covered Steps should be no greater than 7 inches high with a depth of 11 inches (non-slip surface) Handrails should be the ht of min of 34 inches and max 38 inches Ramp should have a min grade of 1 inch in height and 12 inches in depth. Minimum width should be 36 inches and non-slip surface
94
What are tips of accessibility to an entrance for a w/c?
Large enough platform to allow the pt to enter and rest if need be Door swinging out should be 5 feet x 5 feet Door swinging in should be 3 feet deep x 5 feet wide
95
What are other tips for accessibility at an entrance?
Door locks should be accessible (look at height) Door handle should be easy to turn Adaptation to door to so pt can (I) open and close Remote/automatic doors Raised threshold should be removed
96
What should the doorway width be for someone who is in a w/c?
32-34 inches
97
How to make furniture arrangement to make space more accessible?
Move furniture to the walls Place rubber suction cups under legs of sofas and chairs Remove coffee tables, foot stools, and wires (prevent falls) Clear passageway from one room to the next Living room chairs should have double armrests, firm seating, and upright back (90-90-90) Remove rocking chairs and other unstable furniture
98
What are common ideas of electrical controls for accessibility?
Wall switches and electrical outlets Change overhead toggle switches to a rocker or sensor device Use high wattage lightbulbs to last longer and be brighter Use timers to turn on/off lights Touch pad dimmer switches to activate the lamps
99
What are common ideas for accessible flooring?
Non-slip and level - Any coverings should be tacked down - Short-pile carpet Refinish any unlevel flooring Covered furniture or bright colored tape to ID uneven areas Remove rugs Matte finish to floors to reduce glare Edge the room with tape
100
What are tips for accessible doors?
Raised thresholds should be removed - if they cannot be removed then add wedges to improve transition Widen doorways to at least 32 inches Increase door clearance - IE. pocket doors, remove wood strips on doorframes, use offset hinges, or change door to a curtain Door handle accessibility
101
Tips to make windows more accessible?
Use film on windows to reduce glare Heavy drapes can be used to absorb background noise Can install remote opening/closing systems for window coverings
102
What are some tips to make stairs more accessible?
Stairwells should have handrails - Make sure there is enough light - Handrail should extend 12 inches past the top and bottom of the stairs Keep stairs free of obstacles - Use bag to carry things up and down stairs Use tape or lights to designate edge of stairs for those with vision impairments Motorized stair lift
103
What are some tips to make heating units more accessible?
Screen off or insulated pipes (help with those with sensation issues) Adaptation for heating controls Keep away combustible material Make sure there are smoke detectors and CO detectors
104
What are some tips in the bedroom accessibility?
Stationary and positioned to allow a lot of room to move Height of bed that can be raised or lowered Mattress should be firm - can add wood board below the mattress Make sure bedside table is near them Lower closet bar
105
What are tips of accessibility for the bathroom?
Transferring into a chair with wheels once they get to the bathroom that fits and use LE to propel Elevate toilet Grab bars - Toilet - 36 inches from floor - Length of grab bars on side of wall 42-54 inches - Length of grab bars on the back wall 24-36 inches - Bath - 33-36 inches from the floor of tub Tub transfer bench Collapsible seat to attach to shower wall Non-skid strips on the floor of the tub Detachable showerhead
106
What are tips of accessibility for the kitchen?
Height of counter should be less than 31 inches and depth of at least 24 inches Make sure pt can reach faucet at the sink Small carts with casters can help to move things around the kitchen Check height of table Make sure objects in cabinets are reachable Use electric, not gas stoves Dishwashers should be elevated by 6 inches from the floor and should be front loading
107
What is cardiovascular disease?
CAD/CHD pathological process of atherosclerosis specifically of the coronary arteries
108
What are sx/sx of CVD?
Vascular dysfunction Arrhythmias HTN CAD leads to CVA and PVD
109
What race is at more risk for heart disease?
African Americans American Indians Mexican Americans
110
What is the pericardium of the heart?
Sac surrounding the heart Double walled - Outer layer is fibrous and dense (parietal) - Inner layer is thin (visercal)
111
What is the epicardium of the heart?
Inner layer of pericardium
112
What is the myocardium of the heart?
Muscle Largest portion
113
What is the endocardium of the heart?
Smooth lining of the inner surface and cavities of the heart Continuous with the heart valves and endothelium of blood vessels
114
What is between the two two layers of the pericardium?
Pericardial fluid - help layers to slide across one another
115
What is pericarditis?
Inflammation and/or infection of the pericardium
116
What is cardiac tamponade?
Excessive fluid in pericardial space causing compression of the heart
117
What are cardiomyopathies?
Alterations of the muscular wall of the heart
118
What is the cycle of blood through the heart?
Enters through the SVC and IVC --> R atrium --> tricuspid valve --> R ventricle --> R AV valve --> Pulmonary Aa --> lungs --> Pulmonary veins (4) --> L atrium --> Mitral valve --> L ventricle --> L AV valve --> Aorta --> Body
119
What is the definition of systole?
Ventricular contraction Systole end volume is when there is about 50 mL of blood left in the ventricle
120
What is the definition of diastole?
Ventricular relaxation Diastole end volume is when there is about 120 mL of blood left in the ventricles
121
When does atrial contraction occur?
Last third of diastole and is complete with ventricular filling
122
Where do the arteries of the heart arise from?
Aorta
123
When does blood flow to the myocardium?
During diastole
124
What does the right coronary artery supply?
R atrium. R ventricle, inferior wall of L ventricle, AV node, and bundle of His
125
What does the left coronary artery supply?
Most of the L ventricle
126
What does the left anterior descending artery supply?
L ventricle and interventricular septum
127
What does the circumflex artery supply?
Lateral and inferior walls of the L ventricle and portions of L atrium
128
Where does the coronary sinus receive blood?
Heart and empties into the R atrium
129
Where is the SA node located in the heart?
Located in the junction of SVC and R atrium
130
What is the function of the SA node?
Pacemaker of the heart Innervation affects HR and strength of contraction
131
Where is the AV node located?
Junction of R atrium and R ventricle
132
What does the AV node merge with?
Bundle of His
133
What is the process of conduction in the heart?
SA node --> spread to both atria (contract together) --> stim AV node --> transmit down bundle of His to Purkinje fibers --> impulse spread throughout ventricles (contract together)
134
What does heart muscle fibers have more of?
Mitochondria
135
What is the definition of stroke volume (SV)?
Amount of blood ejected w/ each contraction
136
How much blood is ejected during SV?
~70 mL
137
What is the definition of cardiac output (CO)?
Volume of blood discharged from the L/R ventricle per min
138
How much blood is ejected from the ventricles in CO?
~4-6 L/min
139
What is ejection fraction (EF)?
Percentage of blood emptied from ventricle during systole
140
What is a normal EF?
55-75%
141
How to calculate CO?
HR x SV
142
When does the size of arteries change size?
Triggered by sympathetic activity (vasoconstrict/vasodilate)
143
What are capillaries?
Minute BV that connect end of arteries (arterioles) with the beginning of veins (venules)
144
What is the function of capillaries?
Exchange of nutrients and fluids b/t blood and tissue
145
Which vessel has a larger capacity than the other?
Veins
146
What do veins rely on to move blood?
Movement of surrounding muscles Gravity Respiration Compliancy of R heart
147
When does venous reflux occur?
When vein valves do not function
148
What occurs in the body during sympathetic stimulation (fight or flight)?
Increase HR and force of myocardial contraction and myocardial metabolism Coronary artery vasodilation Skin and peripheral vascularization = vasoconstricted
149
Where do the signals of fight or flight come from?
Medulla oblongata Release of epi and NE
150
What are beta-adrengeric agents?
Drugs to stimulate sympathetic activity by either acting as epi and NE or stimulate their release
151
What are the functions of adrenergic drugs?
``` Increase BP Vasoconstrict Open airways Increase HR Stop bleeding ```
152
What conditions are adrenergic drugs given?
Cardiac arrest Shock Asthma attack Allergic reaction
153
What are some examples of adrenergic drugs?
Bronchodilators (Albuterol) Vasopressors (Ephedrine, epinephrine, and dopamine) Cardiac stimulants
154
What are beta-adrenergic blocking agents?
Drugs that decrease sympathetic activity by binding to beta-adrenoreceptors to prevent epi and NE from binding
155
What are beta-blockers used for?
Following MI - increase survival rates
156
What are examples of beta-blockers drugs?
End in -olol
157
How is the parasympathetic nervous system innervated?
Control of medulla oblongata by the vagus nerve (release of ACh)
158
What are the effects of the PNS on the body?
Slow rate and force of myocardial contraction | Vasoconstriction
159
What are baroreceptors?
Main mechanism controlling HR
160
Where are baroreceptors located?
Aortic walls or aortic arch | Carotid sinus
161
What is the circulatory reflex?
Respond to change in BP Increase BP as a result of PNS and decrease rate and force of contraction Decreased BP results in SNS stimulation = increase HR, BP and vasoconstrict peripheral BV Increase atrial pressure causes reflex acceleration of HR
162
What are chemoreceptors?
Sensitive to changes in blood chemicals such as oxygen, carbon dioxide, and lactic acid
163
What change in blood chemicals cause the heart rate to increase?
Increase CO2 Decrease O2 Decrease pH
164
Where are chemoreceptors located?
Carotid body
165
How does temp affect HR?
Increase in temp = increase HR | Decrease in temp = decrease in HR
166
What are potential effects of hyperkalemia?
Tachycardia | Potential cardiac arrest
167
What are potential effects of hypokalemia?
Hypotension | Arrhythmias that may progress to V-fib
168
What are potential effects of hypercalcemia?
HTN Signs of heart block Cardiac arrest
169
What are potential effects of hypocalcemia?
Arrhythmias | Hypotension
170
What are potential effects of hypernatremia?
HTN Tachycardia Pitting edema
171
What are potential effects of hyponatremia?
Hypotension | Tachycardia
172
What is the correlation between peripheral resistance and arterial blood vol/pressure?
Direct linear correlation Increased peripheral resistance = increased arterial blood volume and pressure Decreased peripheral resistance = decreased arterial blood volume and pressure
173
What influences peripheral resistance?
Viscosity and diameter of BV/ arterial blood volume
174
What happens to BP if the diameter of BV decreases?
BP increase
175
What are risk factors of CV disease?
``` Hypercholesterolemia HTN Smoking Impaired fasting glucose Obesity Sedentary life Family hx PMH Environment - fam support and education Social habits - smoking and diet Past and present level of activity ```
176
What level of HDL should your blood be at to decrease risk of CV disease?
>60 mg/dL
177
What is the relationship between HR and external workload?
Direct linear correlation
178
Where should you listen for heart sounds?
Aortic valve Pulmonic valve Tricuspid valve Mitral valve
179
What is the "lub" in lub/dub?
Closure of mitral and tricuspid valves
180
What is the "dub" in lub/dub?
Closure of aortic and pulmonic valves
181
What are some irregular sounds of the heart?
Murmur/bruit
182
What is the P-wave?
Atrial depolarization
183
What is the P-R interval?
Time required for impulse to travel through atria through the conduction system to Purkinje fibers
184
What is the QRS wave?
Ventricular depolarization
185
What is the ST segment?
Beginning of ventricular repolarization
186
What is the T wave?
Ventricular repolarization
187
What is the QT interval?
Time for electrical systole
188
What are ventricular arrhythmias?
Ectopic (excitable group of cells) focus in the ventricles
189
What are atrial arrhythmias?
Ectopic focus in the atria
190
What are atrioventricular blocks?
Abnormal delays or failure to conduct through normal conducting system
191
What are some causes of arrhythmias?
``` Conditions of myocardium Electrolyte imbalance Acidosis or alkalosis Hypoxemia Hypotension Emotional stress Drugs Alcohol Caffeine ```
192
What is an ectopic pacemaker or ectopic focus?
Group of excitable cells that cause premature heartbeats outside a normally functioning SA node
193
What is ventricular fibrillation?
Pulseless, emergency situation Perform CPR and defibrillation Meds to treat
194
What is premature ventricular contractions (PVC)?
Premature beat arising from the ventricle Larger and quick QRS
195
What is ventricular tachycardia?
Run of 3 or more PVCs occurring sequentially HR = 150-200 bpm
196
What is atrial fibrillation?
P-waves are abnormal or not identifiable Tachycardia and atrial flutter
197
What is the normal BP for 1-12 mon/old?
90/60 mmHg
198
What is the normal BP for 1-5 y/o?
95/65 mmHg
199
What is the normal BP for 6-13 y/o?
105/70 mmHg
200
What is the normal BP for 14-19 y/o?
117/77 mmHg
201
What is the normal BP for adults?
Less than 120/80 mmHg
202
What is the ankle/brachial index used for?
Used for PAD
203
How do you perform ABI?
``` First take BP in both UE Find pedal pulse Use US over pulse - will hear swish until you find pulse Pump up BP cuff until pulse disappears Deflate until beat is heard again ```
204
How do you calculate ABI?
Ankle systolic pressure divided by the highest UE systolic pressure
205
What is normal ABI?
Greater than or equal to 1
206
What is the value of minimal arterial disease ABI?
0.9-1.0
207
What is the value of significant arterial disease ABI?
0.5-0.89
208
What is the value of severe arterial disease ABI?
Less than 0.5
209
What is the value of BP for pre-HTN?
120-139 mmHg/80-89 mmHg
210
What is the value of BP for stage I HTN?
140-159 mmHg/90-99 mmHg
211
What is normal to see in BP with exercise?
Systolic should increase by 10% increments of max HR, systolic increase 12-15 mmHg (less will occur in hypotensive situation), and won't see much change in diastolic
212
What is dyspnea?
SOB
213
What does +1 mean on dyspnea scale?
Noticeable to pt but not observer
214
What does +2 on dyspnea scale mean?
Some difficulty and noticeable to observer
215
What does +3 mean on dyspnea scale?
Moderate difficulty, but can continue
216
What does +4 mean on dyspnea scale?
Severe difficult and pt cannot continue Does not necessarily mean pt cannot do therapy, it may just mean a particular exercise is too much
217
What is the definition of hypoxemia?
Abnormally low oxygen in blood
218
What is the definition of hypoxia?
Low oxygen levels in tissues
219
When should you terminate exercise based on O2 sats?
Below 90% for those who are healthy 86% for those with chronic lung disease
220
How to assess ischemic cardiac pain (angina or MI)?
Diffuse, retrosternal or tightness, achiness Associated with dyspnea, sweating, indigestion, dizziness, syncope, and anxiety
221
How to describe angina?
Sudden or gradual onset of chest pain Occurs with rest or activity Precipitated with physical/emotional stress or hot/cold temp
222
How is angina treated?
Rest and nitroglycerin
223
How do you describe MI pain?
Sudden onset Last more than 30 min Not relieved by meds
224
Where is angina typically felt?
May present as heaviness in shoulder, jaw, arm, elbow, or back between scap
225
What is diaphoresis?
Excess sweating with decrease CO
226
What should be looked at prior to d/c?
Look for diaphoresis Check arterial pulses Observe skin color Palpate skin temp Observe skin changes Observe pain, cramping, and fatigue during exercise and relieved by rest (associated with PVD) Observe/measure edema
227
What does rubor mean?
Dependent redness with PVD
228
How to test for rubor?
Testing arterial insufficiency Locate peripheral vein on foot and puffiness of vein Raise leg to 45-degree angle and hold for 1-3 min Lower LE and bring pt back up to dependent position Vein should go back to normal puffiness w/in 15 sec and normal color in about 30 sec
229
What is abnormal rubor?
Deep redness and takes longer to get back to normal
230
What is the percussion test of the peripheral venous system used for?
Determines competence of greater saphenous vein
231
How is the percussion test of the peripheral venous system done?
Stand and palpate one segment of vein while percussing about 20 cm above
232
What represents an abnormal precussive test of peripheral venous system?
Pulse wave felt in the hand that is lower
233
What is the Trendelenburg test for peripheral venous circulation used for?
Determine competence of communicating veins and saphenous system Determines valvular incompetence in a pt with varicose veins
234
How to perform a peripheral venous Trendelenberg test?
Supine with legs elevated about 60 degrees Tourniquet on proximal thigh Pt asked to stand Note if vein fills back in a normal pattern within 30 sec
235
What is a doppler US used for?
Listening for pulse sound of the peripheral venous system
236
What is the definition of rubor of dependency?
Check color changes in the skin during elevation of foot followed by dependency Pallor will develop in elevated position with insufficiency
237
What is the definition of venous filling time?
Check time necessary to refill veins after emptying
238
What is the procedure of venous filling time?
Pt supine - leg elevated about 60-degrees for 1 min, then back to dependent position Note time for refill
239
How to perform an examination for intermittent claudication?
Exercise induced pain or cramping in legs that is absent at rest
240
Where is intermittent claudication most commonly felt?
Calf, buttock, hip, thigh, or foot
241
What will a chest X-ray show?
Abnormal lung fields, cardiac shape and size, and aneurysm
242
What will an ECG/EKG show?
Examine HR, rhythm, conduction delays, and coronary perfusion
243
What will myocardial perfusion imaging show?
Diagnose and evaluate ischemic heart disease and MI
244
What does an echocardiogram show?
US test to visual internal structures
245
What does a cardiac cath show?
Used to diagnose and treat some heart conditions
246
What is another name for cardiac cath?
Swan Ganz Cath
247
What is an Exercise Tolerance Test?
Pt hooked up to EKG and monitored throughout workout
248
What is Thromboangiitis?
AKA Buerger's Disease Occlusion of small arteries and veins
249
What is diabetic angiopathy?
Elevation of blood glucose with associated atherosclerosis
250
What is Raynaud's disease?
Episodic spasms of small arteries
251
What are varicose veins?
Distended, swollen superficial veins
252
What are common rehab guidelines for arterial disease?
Risk factor modification Avoid excessive strain and protect extremities from injury and extreme temps Bed rest may be needed with gangrene, ulcerations, acute arterial disease Exercise training for those with PVD LE exercise Medical treatment
253
What should be considered with an exercise training program for PVD pts?
Use interval training Walking program - 40-70% VO2 max for 3-7 days/wk Exercise to point of pain NMB might be necessary Proper fitting shoes
254
What are important LE exercises to perform in those with arterial disease?
Ankle pumps Resistive calf exercises are most effective to increase blood flow
255
What kind of meds might someone with arterial disease be on?
Meds to decrease blood viscosity and thrombus formation Vasodilators Calcium channel blockers
256
What are common sx/sx of DVT?
Early stages are often asymptomatic Dull ache, pain, tenderness in calf, edema, and fever
257
What acute tx is done for someone with acute DVT?
Bed rest until signs of inflammation have subsided Elevate extremity Exercise contraindicated Amb is permitted with stockings after tenderness and swelling resolve
258
What are rehab guidelines for someone with venous insufficiency?
Varies by severity Focus on "muscle pump" - Ankle pumps and foot circles - Periodic elevation - Use cycle ergometry - Early amb is IMPORTANT Compression stockings Manual lymphatic drainage Exercise including ROM Intermittent pneumatic compression Skin care edu
259
What is CAD?
Narrowing of coronary arteries due to atherosclerosis, which may lead to myocardial ischemia
260
What are the risk factors for atherosclerosis?
``` Age Sex Race Fam hx of CAD Smoking High BP High chol Obesity Sedentary lifestyle Stress ```
261
What are syndromes of CAD?
Angina MI CHF Sudden death
262
What are meds used to manage CAD?
``` Nitroglycerin Beta adrenergic/beta blockers Ca Channel blockers Antiarrhythmics Antihypertensive Digitalis Diuretics Aspirin ```
263
What is the fxn of nitroglycerin?
Peripheral vasodilation
264
What is the fxn of beta adrenergic, beta blockers?
Reduce HR and contractility Reduce BP
265
What is the fxn of Ca channel blockers?
Inhibit Ca flow Reduce HR Dilate coronary arteries Reduce BP
266
What is the fxn of antiarrhythmics?
Restore normal heart rhythm
267
What is the fxn of digitalis?
Increase contractility and decrease HR
268
What is the fxn of aspirin?
Decrease platelet aggregation
269
What should the activity restriction include in someone who has had a recent acute MI or CHF?
Usually activity is performed within the first 24 hr or until pt is stable for 24 hours
270
When is thrombolytic therapy used?
Acute MI to dissolve clot
271
What is a Percutaneous Transluminal Coronary Angioplasty (PTCA)?
Surgical dilation of BV with balloon
272
What are intravascular stents?
Wire mesh placed after an angioplasty to prevent BV from closing
273
What is a Coronary Artery Bypass Graft (CABG)?
Surgical circumvention of an obstruction in a coronary artery using another BV (usually saphenous)
274
What is transplantation?
Used in end stage only Typical problems with rejection and immunosuppression
275
What is the effect of prolonged HTN?
Decreased elasticity of arterioles = increased peripheral vascular resistance
276
What are some symptoms that can be included in HTN?
Usually asymptomatic Can include: - HA - Vertigo - Flushed face - Blurred vision - Increase nocturnal urination - Increase BP
277
What are risk factors to HTN?
``` Sedentary lifestyle Smoking Increased chol Alcohol abuse High Na DM ```
278
What are PT considerations with HTN?
Pt education Aerobic conditioning - Emphasize LE - Monitor VS - Intensity 65-70% MHR - 3x/wk - Watch for med side effects
279
What is CHF?
Inability of heart to effectively pump enough blood to supply the bodily needs
280
Where is the main failure in CHF?
L ventricle - complication d/t HTN and ischemia
281
What is the 1st phase of CHF?
L ventricle enlarges to hold more blood Fibers become stretched so far they cannot pump Blood accumulates in lungs (SOB)
282
What is 2nd phase of CHF?
Sympathetic system stimulates increased pumping and increased HR Hypertrophy of heart = increased demand of coronary arteries
283
What is the 3rd phase of CHF?
Kidneys stim to retain fluid to increase blood volume = increase edema and place increased load on the heart
284
What is the 4th phase of CHF?
Mild to severe fluid overload leads to heart failure
285
What are sx/sx of CHF?
Dyspnea Fatigue Mm weakness
286
What meds are used in CHF?
Decrease heart workload Increase Mm contraction Improve renal blood flow ACE inhibitors Vasodilators Diuretics Beta blockers
287
What surgery may be performed on a pt with CHF?
CABG Heart valve reconstruction Cardiac transplant
288
What are some PT indications with someone who has CHF?
Improve physiological response to exercise and improve physical abilities in every day activities Exercise to increase peripheral endurance and respiratory mm training Avoid exercise right after eating or meds No resistnace training Monitor RPE, BP, O2
289
What is the target heart rate of someone with CHF?
Below 115 bpm
290
What is the criteria to start exercise on someone who has CHF?
Medically stable Exercise capacity > 3 METS Exercise induced ischemia and arrhythmias are poor prognostic indicators
291
What are some cardiac rehab indicators?
``` Medically stable Stable angina CABG PTCA Compensated CHF Cardiomyopathy Heart transplant Valve/pacemaker insertion PAD CAD ```
292
What is compensated CHF?
Chronic form of CHF that is under control with meds
293
What is the opposite of compensated CHF?
Decompensated
294
What are normal responses to exercise?
Increase in VO2, CO, HR, Systolic BP, and RR Diastolic should not inc/dec more than 10 mmHg Decrease in total peripheral resistance
295
What are contraindications to cardiac rehab?
``` Unstable angina Systolic > 200 mmHg or diastolic > 110 mmHg Acute illness Uncontrolled arrhythmias Uncontrolled sinus tachycardia > 100 bpm Uncompensated CHF Recent embolism Thrombophlebitis Uncontrolled diabetes ```
296
What is the definition of unstable angina?
Inability of heart to pump blood adequately to meet the demands of the body
297
What is compensated heart failure?
Reduction of CO during initial stage of heart failure and triggers structural/functional changes in cardiac tissue Often asymptomatic
298
What is decompensated heart failure?
Adaptive changes fail to maintain desired CO Become symptomatic
299
When should someone be stopped during cardiac rehab?
``` Persistent dyspnea Dizziness/confusion Onset of angina Leg claudication Excessive fatigue, pallor, or cold sweat Ataxia Bone/jt pain Nausea/vomiting Systolic BP does not rise or decrease Systolic > 200 mmHg or diastolic > 110 mmHg Significant change in ECG ```
300
What is an Exercise Tolerance Test (ETT)?
Determines safe exercise levels w/o sx Sets level to just below onset of sx Use 12 lead EKG and face mask
301
What is the goal of ETT?
Determine presence of ischemia Determine functional aerobic capacity
302
What does a positive ETT mean?
Point reached where O2 demands of myocardium exceeds supply
303
What does a negative ETT mean?
O2 supply was adequate for myocardium needs
304
What equipment is ETT tested on?
Treadmill or cycle ergometry Step tests
305
What are metabolic equivalents (METs)?
Measurement of estimated energy expenditure O2 cost of the body to do activity Measured in L/min or kcal or O2/kg/min
306
What does 1 MET mean?
Basic O2 requirement at rest
307
What does 5 METs mean?
5x the O2 requirement needed at rest
308
What does VO2 mean?
O2 consumption of the body
309
What does VO2 max mean?
Max O2 consumption
310
How many METs are required to promote endurance?
3-4
311
How many METs are mean to safely resume most daily activities?
5
312
What are the exercise Rx variables?
Type (mode) Intensity Duration Frequency
313
How is intensity determined?
ETT within 40-85% Use HR, RPE, and METs to determine
314
Is HR the best determinant of intensity?
No Beta/Ca blockers, pacemakers, and Valsalva can all affect HR
315
What does an RPE of 10-11 mean?
Fairly light Equate to 45-50% of HR range
316
What does an RPE of 12-13 mean?
Somewhat hard Equates to 60% of HR range
317
What does an RPE of 16 mean?
Hard Equates to 85% of HR range
318
What should duration be in cardiac rehab?
5-10 min warm up and cool down Condition for 15-60 min Avg for mod intensity is about 20-30 min
319
Which should be increased first duration or intensity?
Duration
320
What determines frequency during cardiac activity?
Lower intensity and duration would equal a greater frequency
321
When can an individual be progressed in cardiac rehab?
HR is lower than target RPE is lower than previously Sx of ischemia do not appear Increase duration first, then intensity Rate of progression can depend on age, health, functional capacity, goals, and preferences
322
When should you reduce the level of activity/exercise in a cardiac rehab pt?
Acute illness Acute injury Increase edema, unstable angina Change in meds Environmental stressors
323
What is phase 1 of cardiac rehab?
In patient - length of stay for uncomplicated MI
324
What are the goals of phase 1 cardiac rehab?
Activity guidelines of 3-5 METs at D/C Exercise guidelines Pt and fam education HEP
325
What are the activity guidelines for phase 1 cardiac rehab?
Initiate independent ADLs early on Counteract effects of bed rest Reduce anxiety and depression Provide medical surveillance Provide stamina to go home
326
What is involved with exercise guidelines post MI in phase 1 cardiac rehab?
First 24 hr - bedrest, bed mobs, ankle pumps, and breathing exercise Once stable for 24 hr - sit EOB, sit OOB x 30 min several times per day, LE exercise Gradual increase in am to 5 min a few times a day ADLs - selected arm and leg exercise, progress amb to 10 min several times per day Activity to go home - stairs RPE in light range with HR increase of 10-20 bpm, constant monitoring of vitals and pt response
327
What is involved in the exercise guidelines post-PTCA?
May amb comfortably after surgery Avoid aerobic training for 2 weeks post-op Exercise script based on post-op ETT results
328
What is involved in the exercise guidelines post-CABG?
Sternal/intercostal incision precautions for 4-6 weeks LE incision Address soft tissue impairments Address posture and scap retraction UE ROM if cleared Energy conservation First 2 days hold pillow, hold pillow to sneeze or cough Avoid reaching behind or lifting/pushing more than 10#
329
When should post-MI increase amb?
Goal 20-30 min 1-2x/day at 4-6 weeks
330
What occurs in phase 2 cardiac rehab?
Improve function Progress toward full ADLs, hobbies, and work Risk factor modification and lifestyle change Encourage energy conservation
331
What are the exercise guidelines for phase 2?
~36 visits Duration - 30-60 min (5-10 min warmup) Mode - walking and/or cycle/arm ergometer and strength training Submax intensity Strength training - Begin at 3 weeks of cardiac rehab, 5 weeks post MI, and 8 weeks post CABG - Begin with bands and light weights - Progress to mod loads
332
What is phase 3 cardiac rehab?
Community exercise
333
What are the goals of phase 3 cardiac rehab?
Improve functional capacity Promote self-regulation of exercise program Promote life-long commitment to risk-factor mod
334
What are the exercise guidelines of phase 3 cardiac rehab?
Entry - 5 METs, stable angina, controlled arrhythmias during exercise Progress to self-regulated exercise
335
What is the criteria for exercise of CHF?
Medically stable >3 METS Exercise training - Prolonged warm up and cool down - Low intensity - Increased duration - Maintain HR below 115 bpm - Monitor RPE - fairly light - Avoid isos - May do light resistance
336
What is a class I CHF?
Mild No symptoms up to 6.5 METs
337
What is class II CHF?
Mild Dyspnea, fatigue, angina with activity at 5.6 METs
338
What is class III CHF?
Moderate Limited up to 3 METs by dyspnea, fatigue, angina
339
What is class IV CHF?
Severe Symptoms present even at rest 1.5 METs cause discomfort
340
What is important to remember in someone with a pacemaker?
Should know the HR set limit Use RPE ST segment changes may be common Avoid UE aerobic and strengthening exercise after implant Contraindicated with electromagnetic signals
341
How does poorly controlled blood glucose affect the body?
``` CV disease Renal disease Neuropathy PVD Ulcers Autonomic dysfunction ```
342
How to test exercise limits with someone who has diabetes?
May need to use submax ETT With PVD and peripheral neuropathy = may need to use UBE
343
How to train someone with diabetes?
Exercise Rx Monitor for hypoglycemia Proper footwear Jogging/jarring activities are contraindicated
344
What is the intensity of exercise in someone with pulmonary disease?
60-95% of VO2 max when spaced and rest periods Use warm up and cool downs Emphasize controlled breathing Use THR range and dyspnea scale Use RPE
345
How to determine duration of exercise with pulmonary disease?
Within THR at least 20-30 min (continuous or with rest) Increase duration first during progression Shorten breaks
346
How to determine frequency of exercise with pulmonary disease?
3-5x/week if 20-30 min of exercise can be achieved Increased frequency if duration is shorter or for pt with low functional abilities
347
What PT interventions are used with someone who has pulmonary disease?
``` Stretching Posture Strength Training -Increase R with aerobic exercise -Wt train Progression -Increase intensity once 20 min of continuous exercise is tolerated ``` Pt education HEP
348
Dementia vs AD
Dementia is a degenerative syndrome characterized by deficits of memory, language, and mood. AD is a form of dementia AD is the earliest manifestation of loss of short-term memory
349
What are other types of dementia?
Vascular dementia - more abrupt onset and is caused by physical insult of high BP, diabetes, and stroke PD - dementia is present in late stages
350
When do people typically start to develop AD?
~60 y/o
351
What are common changes in advanced AD?
``` Psychosis Aggression Profound personality change Judgement loss Personal care neglect Physical illness ```
352
What neurotransmitter is affected in AD?
ACh ACh loss = loss of memory
353
What neurotransmitters affect changes in mood, behavior, and aggression in those with AD?
NE, GABA, and serotonin
354
What medications can help slow the progression of AD?
ACh replacement (Aceytl cholinesterase inhibitors - Aricept, Exelon, Namenda) Antidepressants and antianxiety meds
355
What are PT implications of someone with AD?
Target and treat generalized weakness and abnormal movements Fall prevention/balance Treat underlying decreased proprioception Change environment and decrease obstacles Structed exercise program Short and simple exercises Use group therapy
356
What is catatonic schizophrenia?
Motor disturbances with rigid posture Pt remain aware during episodes Episodes consist of uncontrolled movements Med regulations
357
What is paranoid schizophrenia?
Delusions of grandeur Delusions of persecution May believe that they possess power
358
What is disorganized schizophrenia?
Usually progressive and irreversible Inappropriate emotional response Mumbled talking
359
What medical treatments are there for schizophrenia
Meds to replace dopamine Psychosocial tx in combination with
360
What are PT indications with someone who has schizophrenia?
Try to keep the pt from social environment Work in closed environment
361
What are some PT implications for someone with depression?
Reassure and redirect the patients direction to positivity Actively listen without judgement Offer encouragement PLISSIT -Permission - acknowledge presence of depression and allow the person to feel what they are feeling Limited info - acknowledge and validate how the person is feeling Specific suggestions - have person seek out social contact everyday Intensive Therapy - Get therapy from trained professional
362
What is mania?
Constantly active Impulsive Unrealistic Elation and self-confident Disagreement with pt may result in aggression Very few pt with mania are diagnosed
363
When does bipolar manifest?
Late adolescence or early adulthood
364
What are some common side effects of bipolar meds (IE. lithium)?
Hand tremors Increased thirst Increased urination Vomit and diarrhea Wt gain Impaired memory Poor concentration and drowsiness Mm weakness Decreased thyroid function
365
What do meds for anxiety typically target?
Increase effects of GABA - there is potential for addiction
366
What is borderline personality disorder?
Often occurs in women with abandonment issues Unstable mood characterized by crisis and anger, alternating with depression Vulnerable to brief psychotic episodes, substance abuse, and eating disorders
367
What are PT implications for someone with personality disorder?
Focus on physical needs Remind yourself that you are not there to satisfy all needs of the pt Remain professional Document troublesome exchanges Do not try to be their friend Do not take any client's response personal Do not allow emotions to take over documentation
368
What are somatoform disorders?
Classified based on physical symptoms present in each disorder Primarily in women Complains of sx but now physiologic basis Sx usually lead to meds and medical visits Sx can alter pt life Resemble hypochondrosis
369
What is conversion disorder?
Physical complaints of neurological basis but no underlying cause Paralysis most common finding Other findings may include deafness/blindness Freud believes this is a mental anxiety that is transformed into physical sx Diagnosis can be made once testing is done to cross off negative physical ailments
370
What are PT implications for someone with somatoform disorders?
Keep accurate records of findings Assess regularly Mention progress frequently Focus on what you can change and avoid what you can't Praise strengths Do not tell them it is in their head Do not confront the obvious contraindications
371
What is psychogenic amnesia?
Develop when a person unconsciously dissociates one part of mind from the rest No physical cause Forgets all aspects of the past

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