Procedural interventions: Exercise Rx, Airway Clearance, Breathing Exercises, Cardiac Rehab

Question 1

Using the Karvonen Formula, how do you determine the lower Target Heart Rate (THR) zone?

Answer 1

Lower THR = [(HRmax - HRrest) x 40%] + HRrest

Question 2

Using the Karvonen Formula, how do you determine the upper Target Heart Rate (THR) zone?

Answer 2

Upper THR = [(HRmax - HRrest) x 85%] + HRrest

Question 3

How do you determine duration for aerobic exercise prescription?

Answer 3

Low intensity: > or = 30 mins

High intensity: 20 mins

Question 4

What is the frequency for aerobic exercise prescription?

Answer 4

3 - 5 days per week

Question 5

What is the Active Cycle of Breathing Technique

Answer 5

3 phases

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

Question 6

What is Autogenic Breathing?

Answer 6

3 phases

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

Question 7

What is directed cough?

Answer 7

max inhale
2-3 sec breath hold
sharp cough 2-3x

Question 8

What is huff coughing?

Answer 8

Inhale deeply

cough saying “Ha, Ha, Ha”

Question 9

What is high frequency airway oscillation, Acapella or Flutter?

Answer 9

Combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in airways

Question 10

What is Postural Drainage?

Answer 10

positioning patient so gravity helps remove secretions

Question 11

What is Percussion?

Answer 11

Rhythmic clapping or cupping over thorax

Question 12

What is Vibration for airway clearance?

Answer 12

Flat hand, quick vibrations during exhale

Question 13

What is Shaking for airway clearance?

Answer 13

Flat hand, large oscillations during exhale

Question 14

What is a PFELX?

Answer 14

Inspiratory Muscle Trainer

- turn dial to regulate resistance

Question 15

What population would benefit from Pursed Lip Breathing (PLB)?

Answer 15

Emphysema - prevent airway collapse

Question 16

What positions are best to relieve Dyspnea?

Answer 16

Reverse Trendelenburg Position
- Supine, head above trunk and LEs

Semi-Fowler’s Position

• Supine, HOB elevated 45 deg, pillow under the knees
• *Also good for CHF and other cardiac issues**

Question 17

Where does Phase I of Cardiac Rehab take place?

Answer 17

Inpatient

Question 18

What parameters determine exercise prescription in Phase I Cardiac Rehab?

Answer 18

Heart Rate and RPE scale

Question 19

What are the criteria to discontinue exercise in Phase I of Cardiac Rehab?

Answer 19

• 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

Question 20

What are the typical METs in Phase I of Cardiac Rehab?

Answer 20

2-3 METs: supervised level walking

3-4 METs: up and down hill steps or treadmil walking

Question 21

What is the RPE for Phase I of Cardiac Rehab?

Answer 21

RPE < 13 (6-20 scale)

• Post surgery: < 30 bpm over resting HR
• Post MI: < 120 bpm or 20 bpm over resting

Question 22

What is the exercise frequency for Phase I of Cardiac Rehab?

Answer 22

First 3 days: 3-4x/day

After 3 days: 2x/day (longer sessions)

Question 23

What are the expected outcomes of Phase I of Cardiac Rehab?

Answer 23

• 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

Question 24

What the session duration during Phase I of Cardiac Rehab?

Answer 24

10 - 15 mins of continuous activity

Question 25

How long does Phase I of Cardiac Rehab last?

Answer 25

3-5 days

Question 26

Where does Phase II of Cardiac Rehab take place?

Answer 26

Immediate Outpatient (after release from inpatient)

Question 27

How long does Phase II of Cardiac Rehab last?

Answer 27

Immediately after discharge up to 12 weeks

Question 28

How many session is ECG and BP monitored on patients in Phase II of Cardiac Rehab?

Answer 28

6 to 12 sessions (> 12 for high risk)

Question 29

What are the criteria to discontinue exercise in Phase II of Cardiac Rehab?

Answer 29

• 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

Question 30

How do you determine intensity in Phase II of Cardiac Rehab?

Answer 30

HR, METs and RPE

• HR: rest + 20 bpm
• METs: calculated as a %
• RPE: specific to mode of exercise

Question 31

What is the session duration in Phase II of Cardiac Rehab?

Answer 31

First month: 15-20 mins
Next 3-4 months: 25-30 mins
After 6 months: 40+ mins

Question 32

What is the frequency in Phase II of Cardiac Rehab?

Answer 32

3-5 days/week

Question 33

What are the expected outcomes of Phase II Cardiac Rehab?

Answer 33

• Promote active lifestyle
• Inc fxn capacity
• Improve symptoms