Cardiac and Pulmonary Rehab Flashcards
During screening a direct accessibility patient, psychosocial or behavioral risk factors are ______ flags and underlying pathologies or biomedical risk factors are _____ flags. Unstable angina is an example of a _____ flag
yellow
red
red
During the anamnesis it is important to find out the patient’s current _____ and _____. Then find out about patient’s ____ level beforehand, their overall ___ situation and then the specific _____ of the patient.
concerns goals activity health complaints
When would you hypothesize dyspnea in a patient that changes with body position?
When would you expect to see swelling in the ankles and wrists?
During a left sided congestive heart failure when an edema forms in the lungs
during a right sided congestive heart failure when venous blood pools in the extremities
When would you use the Borg scale?
To measure the patient’s perceived exertion level
When would you use the 6-minute walk test?
To assess the patient’s aerobic and functional capacity
The patient evaluation consists of ____ instruments followed by an analysis of what?
measurement
the current status
Co-morbidities (for example an infarct that is then followed by congestive heart failure)
Negative contextual factors (Is there a positive support that encourages positive change?)
Expectations
Attainability of goals
Improvement of health status
When creating a treatment plan which two goals are of outmost importance?
The diagnosis must correlate what with what?
- The patient must learn to find his/her own physical limit
- Reducing fear of movement
It must correlate symptoms with objective disorders when considering the results of the aerobic capacity evaluation
What are the 3 objectives that the treatment plan should cover?
- Achieveing secondary prevention
- Acquiring emotional balance
- Learning to cope with heart disease in a functional manner
What are the general effects of cardiac treatment?
Less angina pectoris better psychological functioning better social functioning reduction of risk factors more active lifestyle
Name 5 effects of aerobic training
increases heart pump output volume
increases heart minute volume during maximum-intensity exercise
increases blood volume and hemoglobin level
increases artery-vein oxygen differential
lowers blood pressure
increases VO2-max
increases anaerobic threshold
increases maximum respiratory minute volume
increases ventilation
increases lung diffusion capacity
increases lung volume and capacity
Lowers heart rate
Name 3 effects of strength training
functional hypertrophy increased mitochondrial numbers (mitochondrial hypertrophy) increased capillary circulation increase in muscle enzymes increased energy-rich phosphate level
What is the type of treatment for cardiac patients? TIFT
Type= Aerobic (HIIT or endurance) Intensity= 55-90% of HR-max (should be able to still have a conversation during this intensity) Frequency= 3-5 times a week Time= 20-60min
Is HIIT or endurance training better for stable cardiac patients?
How do you apply it?
HIIT
an interval of high intensity followed by a shorter interval of low intensity training
intensity is determined by HR-max
What would be the type of treatment for relaxation? TIFT
Type= progressive muscle relaxation or mindfulness (breathing) Intensity= Low Frequency= 3 times a day (high) Time= 5-15 minutes
How do you calculate exercise intensity?
First find the max heart rate: 220-age or 208-(0.7xage) then find heart rate reserve: Hrmax-HRrest=HRR then calculate minimal required HR: HRrest+40% of HRR Then calculate threshold HR: HRrest+75% of HRR
What are the components of a re-evaluation?
- Information= process and results
- Advice= continue or terminate treatment
- Aftercare= Maintaining healthy lifestyle
What is the difference between arterial and venous vascular disease concerning the following: type of pain presence of edema presence of pulse types of sores and their locations
arterial: intermittent claudication pain No edema No pulse of very weak pulse No drainage round and smooth sores that are black usually on the toes and feet
Venous: Dull, aching, pain lower leg edema pulse present drainage sores with irregular borders that are yellow usually around the ankles
What the steps of the diagnostic process
- Anamnesis
- Evaluation
- Differential diagnosis
- .co-morbidities
- Indication for physiotherapy
- Treatment plan
When screening for intermittent claudication which symptoms are relevant?
intermittent muscle discomfort with exercise
patient experience fatigue, aching, cramping
discomfort is released by short-term rest
foot ulcers and limb pain
How do you functionally assess for peripheral vascular disease using a treadmill?
patient walks on treadmill at a speed of 3.2km/hr with an increasing incline of 2% every 2 minutes up to a maximum of 10% for a duration of max 30 min
What are possible differential diagnosis for intermittent claudication?
Spinal canal stenosis diabetic neuropathies osteoarthritis chronic venous insufficiency chronic compartment syndrome Bakers cyst
What are possible co-morbidities of intermittent claudication?
Diabetes mellitus COPD chronic heart failure angina pectoris CVA Chronic arthritis hip and knee joint complaints feet problems
What is the classification used to diagnose severity of intermittent claudication?
What is stage 2b?
Fontaine
Intermittent claudication symptoms start at less than 200m of walking distance
What are possible treatment goals?
Reduce limb symptoms Improve exercise capacity Prevent/lessen physical disability Reduce the occurrence of cardiovascular events Increase problem insight Increase pain free walking distance Increase pain tolerance Overcome fear for exertion
