Cardinal, Pulmonary, Hypertension, Peripheral, Arterial Disease, CVA Flashcards
1
Q
blood flow blocked
A
Heart Attack; MI
2
Q
heart stops
A
cardiac arrest
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
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)
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
6
Q
if the ST segment is < 2mm from baseline what type of risk is it?
A
-moderate rish
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
8
Q
if the ST depression is > 2 mm what risk are they at
A
high risk
9
Q
1-4 days in hospital
A
Phase I of Cardiac Rehab
10
Q
goals of Phase I
A
- progress form self to walking
- 5 METS by discharge (2 flights of stairs)
11
Q
What should you review during Phase I of cardiac rehab?
A
- verify orders
- Previous History (lab, coronary artery involvement, risk factor assessment)
12
Q
Red flag with coronary artery involvement
A
LEFT
also: % blockage, heart damage?, EF%
13
Q
What makes a patient at higher risk in Phase I?
A
- poor ventricular function
- left ventricular failure
- episode of shock
- serious arrhythmia
14
Q
O2 saturation should be:
A
> 90%
15
Q
Hgb should be:
A
> 12-13 g/dl
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
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
18
Q
precautions for median sternotomy?
A
- 5-8 wks
- look for sternal instability: mvmd of sternum, pain, cracking, or popping
19
Q
precautions for pacemakers/defib?
A
- no ROM above 90 degrees for 3 wks
- can lead dislocation
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
21
Q
Goals of Phase II, Outpatient
A
- continued education
- increased aerobic capacity
- return to work/play
22
Q
ideal duration for Phase II outpatient
A
2-4 wks up to 6 months
23
Q
What is the KEY factor in Phase II Exercise Prescription
A
-warm up and cool down
24
Q
Intensity in Phase II
A
40-80% HRR
RPE 11-16
-below ischemic threshold
25
Freq of phase II
4-7 days/wk; 20-60 minutes/day
| -increase time
26
what to monitor in Phase II
```
weight
HR Rhythm
BP
PRE
symptoms before, during and after exercise
```
27
adding 3-5 lbs may indicate
fluid retention
28
when can you start strength training in Phase II?
- 5 wk post MI or 2-3 wks after PTCA
- no S/S
- peak of >5 METS exercise capacity
- below angina threshold
29
1 RM % for U/E strength training phase II
30-45% UE, LE 50-60%
30
How often should you strength train during Phase II?
- large muscles
- 2-4 sets
- 8-10 exercises
- 12-15 reps
- 2-3x/wk
31
RPE scale for Phase II strength training
11-14/20, acclimation technique
32
benefits of strength training
- less ischemia during exercise (more blood flow to heart)
- fewer arrhythmias during exercise
- higher DBP during exercise
- RPP similar to aerobic
33
exercise safely below anginla threshold
MI
34
40-75% HRR, 3-7 days/wk, 20-40 min, longer warm up and cool down
CHF
35
exercise at least 10-20 ppm below point of stimulation
Pacemakers and Implantable Cardioverter Difibrillatroes ICD
36
prolonged warm up and cool down
| 50-75% HRR from exercise test, RPE 11-15, monitor rejection
-cardiac transplant
37
intermittent exercise sessions
Peripheral vascular disease
38
when can you not do a target HR
w/ CABG initially and transplant
39
7 benefits of cardiac rehab
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
```
new onset or change in angina
sever dyspnea, unusual fatigue
light headedness, syncope, near-syncope
high HR, pulse irregularity
musculoskeletal pain
```
important warning signs of cardiac disease
41
Contraindications of exercise
- 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
Reasons to stop exercise
- 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
What medications have effect on exercise blood pressure and heart rate response
- beta blockers
- digitalis glycosides
- cannot accuraltey use target heart rate to prescribe medicine
44
Dietary recommendations: fats, cholesterol , sodium
Fats: <30 %
Cholesterol: <300 mg/d
sodium: <2-3 grams/day
45
type A personality
Anger
- increased HR, BP, RR, O2 consumption
- increased muscle tension
- increased blood flow
decreased: concentration, decision making skills
46
how many people adhere to cardiac rehab?
25-35 %
47
how you enhance adherence?
- clear communication
- emotional support, reduce fears, and anxieties
- sensible explanations
- fit into patient perspective
48
how much can exercise lower BP
5-7
49
when do you need to monitor oxygen saturation closely if:
- FEV1 <50% of predicted
- diffusing capacity <60% of predicted
- interpret O2 saturation wishing context of pts current status
50
lung disease categories:
mild: 75-80%
moderate: 55-75%
severe: below 55%
51
60% of HR range in borg scale
12-13
52
what should you do for moderate lung disease?
- increase submax exercise
- maintain intensity for 20-30 min
- intensity and HR lower than normal exercise
53
what should you do for severe lung disease?
- symptom based walking speeds
- interval training with very short exercise bouts
- continuos monitoring
54
what position is affective in increasing oxygen saturation?
prone
55
what position increases oxygenation?
sidling on unaffected side
56
what position provides better oxygenation when both lungs are diseased?
laying on the right
57
relaxation techniques:
1. jacobsens progressive relaxation
2. autogenic training
3. biofeedback
4. yoga
5. chest mobs
6. transcendental meditation
7. hypnosis
8. bensons relaxation response
58
freq 3-5 x/wk
standard prescription
20-60 min sessions
controlled asthma and COPD
59
optimal work intensity for severe or moderate COPD
60-80% peak work rtes
dyspnea scale
intermittent exercise
60-85% HRR
60
paroxysmal tachycardia
150-250 bpm
61
flutter
250-350 bpm
62
fibrillation
350-450 bpm
63
ventricular bigeminy
1 normal
| 1 abnormal
64
ventricular trigeminy
2 normal
| 1 abnormal
65
ventricular quadrigeminy
3 normal
| 1 abnormal
66
saw teeth ekg
atrial flutter
