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Exercise and Disease > Cardinal, Pulmonary, Hypertension, Peripheral, Arterial Disease, CVA > Flashcards

Cardinal, Pulmonary, Hypertension, Peripheral, Arterial Disease, CVA Flashcards

1
Q

blood flow blocked

A

Heart Attack; MI

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2
Q

heart stops

A

cardiac arrest

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3
Q

Characteristics of a transplanted heart?

A
  • devernvated
  • higher HR at rest
  • HR reserve is approximately 40-50 ppm
  • Strength training effective
  • be aware of rejection
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4
Q

Low risk cardiac criteria?

A
  • absence of complex ventricular dysrhythmias, angina or other symptoms during ex. testing
  • normal hemodynamics during ex testing
  • fx capacity >7 METS (24)
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5
Q

Moderate risk for cardiac disease?

A
  • presence of agnina (chest pain) or others at high exertion (>7 METS)
  • mild to moderate level of silent ischemia during exercise testing or recovery
  • Functional capacity < 5 METS
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6
Q

if the ST segment is < 2mm from baseline what type of risk is it?

A

-moderate rish

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7
Q

highest risk for cardiac disease?

A
  • complex ventricular dysrhythmias during exercise testing or recovery
  • presence of angina or other symptoms at low exertion <5 METS
  • high level of silent ischemia
  • abnormal hemodynamics
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8
Q

if the ST depression is > 2 mm what risk are they at

A

high risk

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9
Q

1-4 days in hospital

A

Phase I of Cardiac Rehab

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10
Q

goals of Phase I

A
  • progress form self to walking

- 5 METS by discharge (2 flights of stairs)

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11
Q

What should you review during Phase I of cardiac rehab?

A
  • verify orders

- Previous History (lab, coronary artery involvement, risk factor assessment)

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12
Q

Red flag with coronary artery involvement

A

LEFT

also: % blockage, heart damage?, EF%

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13
Q

What makes a patient at higher risk in Phase I?

A
  • poor ventricular function
  • left ventricular failure
  • episode of shock
  • serious arrhythmia
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14
Q

O2 saturation should be:

A

> 90%

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15
Q

Hgb should be:

A

> 12-13 g/dl

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16
Q

When can you do mild PROM, AAROM, AROM and transfers for inpatient cardiac rehab

A
  • pulse rate change 12 bpm or less

- no discomfort

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17
Q

guidelines for hospital/cardiac floor for PT in phase I?

A
  • asymptomatic, RPE <13
  • intensity <120 bpm
  • walk 20-50 ft first visit and progress
  • freq: 2-4x/day, intervals
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18
Q

precautions for median sternotomy?

A
  • 5-8 wks

- look for sternal instability: mvmd of sternum, pain, cracking, or popping

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19
Q

precautions for pacemakers/defib?

A
  • no ROM above 90 degrees for 3 wks

- can lead dislocation

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20
Q

advers responses to inpatient exercise?

A
  • DBO >110 mmHg
  • decrease in SBP >10
  • significant ventricular or atrial dysrhythmias w/ or w/o signs/s
  • second or third heart block
  • S/S of exercise intolerance
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21
Q

Goals of Phase II, Outpatient

A
  • continued education
  • increased aerobic capacity
  • return to work/play
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22
Q

ideal duration for Phase II outpatient

A

2-4 wks up to 6 months

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23
Q

What is the KEY factor in Phase II Exercise Prescription

A

-warm up and cool down

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24
Q

Intensity in Phase II

A

40-80% HRR
RPE 11-16
-below ischemic threshold

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25
Q

Freq of phase II

A

4-7 days/wk; 20-60 minutes/day

-increase time

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26
Q

what to monitor in Phase II

A 
weight
HR Rhythm
BP
PRE
symptoms before, during and after exercise
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27
Q

adding 3-5 lbs may indicate

A

fluid retention

28
Q

when can you start strength training in Phase II?

A
  • 5 wk post MI or 2-3 wks after PTCA
  • no S/S
  • peak of >5 METS exercise capacity
  • below angina threshold
29
Q

1 RM % for U/E strength training phase II

A

30-45% UE, LE 50-60%

30
Q

How often should you strength train during Phase II?

A
  • large muscles
  • 2-4 sets
  • 8-10 exercises
  • 12-15 reps
  • 2-3x/wk
31
Q

RPE scale for Phase II strength training

A

11-14/20, acclimation technique

32
Q

benefits of strength training

A
  • less ischemia during exercise (more blood flow to heart)
  • fewer arrhythmias during exercise
  • higher DBP during exercise
  • RPP similar to aerobic
33
Q

exercise safely below anginla threshold

A

MI

34
Q

40-75% HRR, 3-7 days/wk, 20-40 min, longer warm up and cool down

A

CHF

35
Q

exercise at least 10-20 ppm below point of stimulation

A

Pacemakers and Implantable Cardioverter Difibrillatroes ICD

36
Q

prolonged warm up and cool down

50-75% HRR from exercise test, RPE 11-15, monitor rejection

A

-cardiac transplant

37
Q

intermittent exercise sessions

A

Peripheral vascular disease

38
Q

when can you not do a target HR

A

w/ CABG initially and transplant

39
Q

7 benefits of cardiac rehab

A
  1. decrease mortality by 25%
  2. lower incidence of re-hospitalization
  3. reduced charges per re-hosp.
  4. increased exercise participation, endurance and tolerance
  5. decreased symptoms, stress, cigarettes
  6. improved lipid profile
  7. improvement in psychosocial well being
40
Q 
new onset or change in angina
sever dyspnea, unusual fatigue
light headedness, syncope, near-syncope
high HR, pulse irregularity
musculoskeletal pain
A

important warning signs of cardiac disease

41
Q

Contraindications of exercise

A
  • unstable angina
  • BP >180/110
  • critical aortic stenosis
  • acute infection, fever
  • uncrontrolled arrhythmias
  • uncompensated CHF
  • tachycardia > 120
  • 3rd degree AV block
  • embolism
  • pericarditis, myocardiits, thrombophlebitis
  • ST segment >2mm
  • uncontrolled DM
  • ortho problems
  • metabolic problems
  • systemic illness
42
Q

Reasons to stop exercise

A
  • MI, suspicion
  • mod to severe angina
  • drop in SBP 10 mmHg or more with increased work
  • DBP >110
  • serious arrhythmias
  • signs of poor perfusion
  • unsually or sever SOB
  • CNS symptoms
  • technical problems
  • patients request
43
Q

What medications have effect on exercise blood pressure and heart rate response

A
  • beta blockers
  • digitalis glycosides
  • cannot accuraltey use target heart rate to prescribe medicine
44
Q

Dietary recommendations: fats, cholesterol , sodium

A

Fats: <30 %
Cholesterol: <300 mg/d
sodium: <2-3 grams/day

45
Q

type A personality

A

Anger

  • increased HR, BP, RR, O2 consumption
  • increased muscle tension
  • increased blood flow
    decreased: concentration, decision making skills
46
Q

how many people adhere to cardiac rehab?

A

25-35 %

47
Q

how you enhance adherence?

A
  • clear communication
  • emotional support, reduce fears, and anxieties
  • sensible explanations
  • fit into patient perspective
48
Q

how much can exercise lower BP

A

5-7

49
Q

when do you need to monitor oxygen saturation closely if:

A
  • FEV1 <50% of predicted
  • diffusing capacity <60% of predicted
  • interpret O2 saturation wishing context of pts current status
50
Q

lung disease categories:

A

mild: 75-80%
moderate: 55-75%
severe: below 55%

51
Q

60% of HR range in borg scale

A

12-13

52
Q

what should you do for moderate lung disease?

A
  • increase submax exercise
  • maintain intensity for 20-30 min
  • intensity and HR lower than normal exercise
53
Q

what should you do for severe lung disease?

A
  • symptom based walking speeds
  • interval training with very short exercise bouts
  • continuos monitoring
54
Q

what position is affective in increasing oxygen saturation?

A

prone

55
Q

what position increases oxygenation?

A

sidling on unaffected side

56
Q

what position provides better oxygenation when both lungs are diseased?

A

laying on the right

57
Q

relaxation techniques:

A
  1. jacobsens progressive relaxation
  2. autogenic training
  3. biofeedback
  4. yoga
  5. chest mobs
  6. transcendental meditation
  7. hypnosis
  8. bensons relaxation response
58
Q

freq 3-5 x/wk
standard prescription
20-60 min sessions

A

controlled asthma and COPD

59
Q

optimal work intensity for severe or moderate COPD

A

60-80% peak work rtes
dyspnea scale
intermittent exercise
60-85% HRR

60
Q

paroxysmal tachycardia

A

150-250 bpm

61
Q

flutter

A

250-350 bpm

62
Q

fibrillation

A

350-450 bpm

63
Q

ventricular bigeminy

A

1 normal

1 abnormal

64
Q

ventricular trigeminy

A

2 normal

1 abnormal

65
Q

ventricular quadrigeminy

A

3 normal

1 abnormal

66
Q

saw teeth ekg

A

atrial flutter

Exercise and Disease (12 decks)

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