Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BACPR > Viva for Case Study > Flashcards

Viva for Case Study Flashcards

Prepare for 30 minute Viva (86 cards)

Start Studying
1
Q

What is the primary cardiac diagnosis in the case study?

A

STEMI (ST Elevation Myocardial Infarction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What major artery was treated during the cardiac event?

A

The left anterior descending artery (LAD), treated with PPCI and stent insertion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does PPCI stand for and what does it involve?

A

Primary Percutaneous Coronary Intervention — an emergency angioplasty to open a blocked coronary artery using a balloon and stent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What complication was diagnosed post-STEMI?

A

Heart failure, NYHA Class II.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What investigation confirmed the diagnosis of heart failure?

A

Echocardiogram on 23/3/24 showing an ejection fraction of 33%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does an ejection fraction of 33% indicate?

A

Severely reduced left ventricular function, increasing the risk of symptoms and cardiac complications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What symptom history led up to the STEMI diagnosis?

A

Chest pain during gym activity misattributed to indigestion, followed by shortness of breath and fatigue. On return to the gym days later, symptoms worsened with hot, clammy feeling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How was the diagnosis of STEMI confirmed in hospital?

A

ECG confirmed ST elevation and troponin levels were elevated, indicating myocardial infarction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What was the patient’s cardiac risk profile at the time of event?

A

Obesity (BMI 34), Type 2 Diabetes, hyperlipidaemia, ex-smoker, family history (father had MI at 58).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What cardiac rehabilitation phase I care was given in hospital?

A

ECG and angiogram, PPCI to LAD, echocardiogram, diagnosis confirmed and discussed, education on medication and risk factors, BHF resources provided.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What medication change occurred during Phase II follow-up?

A

Losartan dose was increased to manage breathlessness from heart failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What follow-up support was provided in Phase II?

A

Nurse contact via GP surgery, written medication guidance, advice on side effects, and dietary advice for cholesterol reduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is the patient considered high risk in this case study?

A

Because he has heart failure (NYHA Class II) and a severely reduced ejection fraction of 33%, indicating poor left ventricular function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does a low ejection fraction (33%) impact exercise prescription?

A

It reflects reduced cardiac output and increased risk of arrhythmia. A sudden increase in workload is ill-advised, so a cautious, progressive approach is needed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are key supervision requirements for this patient in Phase III?

A

High staff-to-patient ratio (1:3–1:5), with trained cardiac rehab professionals. Close monitoring of symptoms and workload is essential.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When can the patient transition to Phase IV home exercise?

A

After consistent, symptom-free participation in Phase III and demonstrated ability to self-monitor safely.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is RPE monitoring preferred over heart rate for this patient?

A

Because beta blockers lower heart rate response, making RPE and the talk test more reliable for judging exercise intensity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should be avoided in this patient’s exercise sessions?

A

Sudden workload increases, isometric holds, breath-holding, extreme temperatures, and excessive postural changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are key signs to monitor for during exercise in heart failure patients?

A

Breathlessness, chest pain, dizziness, fatigue, palpitations, ankle oedema, and unusual BP responses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is extended warm-up and cool-down essential in this case?

A

To prevent hypotension, venous pooling, and cardiac strain. They also support safe transitions into and out of exercise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What aerobic prescription is recommended for this patient?

A

Start with 3 × 5-minute bouts at RPE 9–11, progressing to 30 minutes continuous at RPE 11–13.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When should resistance training begin in this case?

A

Only after aerobic tolerance is established. Start with light resistance, 1–2 sets of 10–12 reps, avoiding isometric or breath-holding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the purpose of Aspirin and Ticagrelor in cardiac rehab patients?

A

They are antiplatelet agents used to reduce the risk of clot formation post-STEMI and stenting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the exercise implications of taking Aspirin and Ticagrelor?
Increased risk of bruising and bleeding. Avoid contact activities and monitor for signs of unusual bleeding.
26
What do beta blockers do in cardiac patients?
They reduce heart rate, blood pressure, and myocardial oxygen demand.
27
What are the exercise implications of beta blockers?
Blunted heart rate response to exercise; RPE and the talk test should be used instead of heart rate monitoring.
28
What is the role of an Angiotensin II Receptor Blocker (ARBs) like Losartan?
They reduce blood pressure and protect the heart in heart failure by blocking angiotensin II.
29
What are the exercise implications of ARBs?
Monitor for dizziness or hypotension, especially during transitions and after exercise.
30
What do diuretics do in heart failure management?
They reduce fluid overload by promoting urine output.
31
What are exercise considerations for patients on diuretics?
Risk of dehydration and electrolyte imbalance; monitor hydration status and symptoms of fatigue or cramping.
32
What is the function of GTN spray or tablets?
Used to relieve angina by dilating coronary arteries.
33
What are the exercise implications of GTN?
Ensure the patient carries GTN during exercise. Watch for hypotension and dizziness post-use.
34
What is the role of statins in cardiac patients?
They lower LDL cholesterol and reduce cardiovascular risk.
35
What are the exercise-related side effects of statins?
May cause muscle aches or weakness; report unexplained muscle pain or fatigue.
36
What do SGLT2 inhibitors do in diabetes and heart failure?
They reduce blood glucose and have additional benefits in heart failure by reducing fluid load.
37
What are the exercise considerations for SGLT2 inhibitors?
Monitor for dehydration and urinary frequency. May increase risk of low blood sugar if combined with other meds.
38
What does Metformin do and why is it relevant?
It improves insulin sensitivity and lowers blood glucose. Though not a cardiac drug, it's central to diabetes management.
39
What are the exercise considerations for Metformin?
Generally safe with low risk of hypoglycaemia unless used with other glucose-lowering agents. Monitor hydration and GI comfort.
40
What staff-to-patient ratio was used and was it appropriate?
1:5 ratio. Acceptable if patients are pre-screened, known to staff, and the environment is controlled.
41
What was a strength of the 10-minute warm-up?
Gradual increase in range of motion and speed, with both joint mobilisation and pulse-raising activities.
42
What were the main criticisms of the warm-up?
Too short—should be 15 minutes. Upper body mobilisation should follow lower body to activate the muscle pump first. RPE was too high at 11 (should be 9–10). Static stretching too early increases risk of venous pooling and BP drop.
43
What was positive about the cool-down?
Correct length (10 minutes) and included an education section.
44
What were the critiques of the cool-down?
Needs gradual tapering with mobility, not just walking. Static stretches should come after full 10-minute dynamic cool-down to allow BP and HR to stabilise.
45
How was the main conditioning component structured and what were the strengths?
25 minutes total using 5 × 1-minute CV stations plus AR. Time and structure appropriate, combo OK, feet moving maintained circulation, no supine work, shuttle walk is evidence-based.
46
What were the critiques of the conditioning structure?
AR would be better interspersed with CV. Current structure may cause fatigue and reduce safety.
47
Why might the Half Star movement be unsuitable for this patient?
Overhead arm actions may excessively increase cardiac load, especially if performed early. Arms should stay below shoulder height.
48
What are the concerns with Hamstring Curl, Lunges, Knee Raises, and Upright Row?
HSC: watch for balance; use chair. Lunges: forward preferred over reverse due to fall/knee strain risk. Knee raises increase intra-abdominal pressure. Upright rows may raise BP via neck tension—low row is safer.
49
Why was the monitoring setup not ideal?
Exercise instructor monitored CV while the nurse monitored AR. It would be more appropriate for the nurse to supervise CV due to clinical risk.
50
What measures were used to monitor intensity?
RPE of 12 achieved, THRR range 98–108 bpm, and a pulse oximeter was used.
51
What are the pros and cons of the monitoring methods used?
RPE and THRR are suitable for EF and HF risks. Over-reliance on pulse oximeter may interrupt muscle/respiratory pump and reduce autonomy—best used when symptomatic.
52
What is the goal of the Phase IV programme for this patient?
To build sustainable, independent exercise habits that maintain cardiovascular health and improve quality of life.
53
What aerobic exercise structure was prescribed for Phase IV?
Progressive structure starting with short bouts and building toward 30 minutes of continuous aerobic activity at RPE 11–13, 5x/week.
54
What type of resistance training was included in Phase IV?
Home-based, light resistance exercises using bands and dumbbells, performed 2–3x/week with gradual progression in reps and sets.
55
Why is pacing and progression crucial in this patient's Phase IV plan?
Due to reduced ejection fraction and heart failure diagnosis, sudden increases in workload could provoke symptoms or decompensation.
56
How was individualisation achieved in the Phase IV prescription?
Programme matched functional capacity, personal goals, comorbidities (diabetes, obesity), and risk level, with a home-based format.
57
What are key psychosocial considerations in this patient’s recovery?
Fear of another heart event, low self-efficacy, body image concerns, and disrupted routines may affect confidence and adherence.
58
What strategies support psychosocial well-being in Phase IV?
Encouraging small wins, involving family, using success-focused language, and reconnecting the patient with enjoyable activities.
59
How does the Phase IV programme rebuild confidence and motivation?
By allowing the patient to progress safely and independently, restoring a sense of control, dignity, and identity post-MI.
60
What does the calculated training heart rate range (THRR) of 94–111 bpm indicate for this patient?
It reflects a low training threshold appropriate for his severely impaired cardiac function (EF 33%). Even light to moderate activity puts a load on his heart.
61
Why is a lower THRR suitable for this patient?
Because of his heart failure and reduced ejection fraction, his cardiac reserve is limited. Lower intensity allows safe progression without provoking symptoms.
62
What is a 're-warm' in the context of exercise?
A short period of gentle movement following a break or after early low-intensity warm-up, used to safely raise heart rate again before the main conditioning.
63
Why is a re-warm important for this patient?
It prevents sudden cardiovascular load by gradually increasing intensity, supporting venous return and reducing risk of postural hypotension.
64
What makes a resistance programme 'functional'?
It includes movements that mirror daily activities (e.g. sit-to-stand, step-ups), improving strength, balance, and independence.
65
Why should resistance load progress only when 15 reps are comfortable?
Comfortable completion of 15 reps indicates the muscles can handle the current load safely and are ready for gradual progression.
66
Why is a 10-minute warm-up important before resistance or aerobic training?
It gradually raises heart rate, increases circulation, warms muscles, and reduces injury risk.
67
Why include joint mobilisation in the warm-up?
To increase range of motion, prepare the joints for activity, and support coordination and postural control.
68
Why are pulse raisers included in warm-up?
To gradually stimulate the cardiovascular system and prepare the heart for increased activity levels.
69
Why is a 10-minute cool-down included after resistance training?
To allow a gradual return to resting heart rate, support venous return, and reduce risk of post-exercise hypotension.
70
What is included in the resistance training cool-down?
Rhythmic movements with decreasing pace and range of motion, followed by static stretching, breath work, and mindfulness.
71
Why include breath work and mindfulness after exercise?
To support parasympathetic activation, reduce stress, and enhance emotional recovery and body awareness.
72
What can happen if the cool-down is too short?
Increased risk of dizziness, venous pooling, abrupt blood pressure drops, and delayed recovery.
73
Why is RPE preferred over heart rate monitoring in this patient?
Because beta blockers blunt heart rate response, making RPE a more reliable indicator of effort.
74
What RPE range was prescribed for this patient and why?
RPE 11–13 (light to moderate) was chosen to ensure safe exertion for a patient with heart failure and EF 33%.
75
Why is the talk test useful in this case?
It provides a simple, practical method to assess exercise intensity and encourages autonomy in self-monitoring.
76
How does the prescribed RPE support independence and confidence?
It empowers the patient to listen to their body, reduces over-reliance on equipment, and builds self-efficacy.
77
What does a THRR of 94–111 bpm indicate in this patient?
A low-intensity target appropriate for his limited cardiac reserve, supporting safety and gradual cardiovascular adaptation.
78
What are the risks of using THR alone in heart failure patients?
It may lead to under- or overtraining due to medication effects on HR. Symptoms and perceived exertion are more accurate.
79
How does the group exercise programme follow the FITT principle?
It includes structured Frequency (2–3x/week), Intensity (RPE 11–13), Time (progressing to 30 mins CV), and Type (aerobic and resistance mix).
80
What are the components of the group exercise session?
Warm-up, re-warm, aerobic endurance training (AET), active recovery (AR), cool-down, and relaxation/stretching.
81
What is the purpose of the re-warm in group sessions?
To safely re-activate cardiovascular and muscular systems before entering higher intensity activity, especially after rest or education breaks.
82
How is the programme individualised for the case study patient?
Progresses from Level 2, considers EF 33%, uses RPE and talk test for monitoring, includes safe alternatives for exercises with joint or balance risk.
83
How does the programme reflect the patient’s Phase III progression?
It builds on 3×5-minute CV bouts by increasing to longer intervals and reducing AR, matching the patient’s developing capacity.
84
How does the group programme address functional limitations?
Exercises are low-impact, support balance, avoid supine work, and include chair-based modifications when needed.
85
What safety features are built into the group circuit?
Safe movement sequencing, visible RPE charts, instructor supervision, and clear guidance on breathing and pacing.
86
How is cardiovascular workload progressed in the group setting?
By increasing duration of CV bouts, reducing rest periods, and encouraging sustained effort within RPE 11–13.

BACPR (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions