Flashcards in Procedural interventions: Exercise Rx, Airway Clearance, Breathing Exercises, Cardiac Rehab Deck (33)
Using the Karvonen Formula, how do you determine the lower Target Heart Rate (THR) zone?
Lower THR = [(HRmax - HRrest) x 40%] + HRrest
Using the Karvonen Formula, how do you determine the upper Target Heart Rate (THR) zone?
Upper THR = [(HRmax - HRrest) x 85%] + HRrest
How do you determine duration for aerobic exercise prescription?
Low intensity: > or = 30 mins
High intensity: 20 mins
What is the frequency for aerobic exercise prescription?
3 - 5 days per week
What is the Active Cycle of Breathing Technique
1. Breathing Control: 5-10 seconds relaxed breathing
2. Thoracic Expansion Exercise: 3-4 deep slow breaths
3. Forced Expiratory Technique: 1-2 huffs at mid to low lung volumes
What is Autogenic Breathing?
1. Unsticking phase: slow breathe in, 3 sec hold, exhale into expiratory reserve vol
2. Collecting Phase: breathe at tidal vol with intermittent holds
3. Evacuating phase: deep inspirations, breath holding, huff cough
What is directed cough?
2-3 sec breath hold
sharp cough 2-3x
What is huff coughing?
cough saying "Ha, Ha, Ha"
What is high frequency airway oscillation, Acapella or Flutter?
Combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in airways
What is Postural Drainage?
positioning patient so gravity helps remove secretions
What is Percussion?
Rhythmic clapping or cupping over thorax
What is Vibration for airway clearance?
Flat hand, quick vibrations during exhale
What is Shaking for airway clearance?
Flat hand, large oscillations during exhale
What is a PFELX?
Inspiratory Muscle Trainer
- turn dial to regulate resistance
What population would benefit from Pursed Lip Breathing (PLB)?
Emphysema - prevent airway collapse
What positions are best to relieve Dyspnea?
Reverse Trendelenburg Position
- Supine, head above trunk and LEs
- Supine, HOB elevated 45 deg, pillow under the knees
**Also good for CHF and other cardiac issues**
Where does Phase I of Cardiac Rehab take place?
What parameters determine exercise prescription in Phase I Cardiac Rehab?
Heart Rate and RPE scale
What are the criteria to discontinue exercise in Phase I of Cardiac Rehab?
- HR >130 bpm or > 30 bpm or resting
- DBP > or = 110 mm Hg
- Dec in SBP > 10 mm Hg
- Significant ventricular or atrial dysrhythmias
- 2nd or 3rd degree heart block
- Signs or symptoms including angina, marked dyspnea, and ECG changes suggestive of ischemia
What are the typical METs in Phase I of Cardiac Rehab?
2-3 METs: supervised level walking
3-4 METs: up and down hill steps or treadmil walking
What is the RPE for Phase I of Cardiac Rehab?
RPE < 13 (6-20 scale)
- Post surgery: < 30 bpm over resting HR
- Post MI: < 120 bpm or 20 bpm over resting
What is the exercise frequency for Phase I of Cardiac Rehab?
First 3 days: 3-4x/day
After 3 days: 2x/day (longer sessions)
What are the expected outcomes of Phase I of Cardiac Rehab?
- Walk 5 to 10 mins continuously (or 1000 feet) 4x daily
- Walk up and down 1 flight of stairs independently
- Know safe HR and RPE limits
- Know abnormal signs and symptoms
What the session duration during Phase I of Cardiac Rehab?
10 - 15 mins of continuous activity
How long does Phase I of Cardiac Rehab last?
Where does Phase II of Cardiac Rehab take place?
Immediate Outpatient (after release from inpatient)
How long does Phase II of Cardiac Rehab last?
Immediately after discharge up to 12 weeks
How many session is ECG and BP monitored on patients in Phase II of Cardiac Rehab?
6 to 12 sessions (> 12 for high risk)
What are the criteria to discontinue exercise in Phase II of Cardiac Rehab?
- Plateau or dec in HR with inc work
- SBP plateaus or falls with inc in work or > 250 mm Hg
- DBP > 115 mm Hg
- ST segment depression > 1 mm
- 2nd or 3rd degree heart block
- Ventricular Dysrhythmias
- Angina or other symptoms of cardiovascular insufficiency