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cardiopulm > Cardiopulm comps practical > Flashcards

Cardiopulm comps practical Flashcards

1
Q

cardiac muscle dysfunction diseases

A
  • congestive heart failure

- cardiomyopathies

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2
Q

cardiac muscle dysfunction risk factors

A
  • Prolonged or uncontrolled hypertension
  • congenital of infectious myopathies
  • myocardial hypertrophy
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3
Q

cardiac muscle dysfunction- clinical findings

A
  • fatigue
  • SOB, orthopnea
  • swollen legs
  • Lung auscultation: normal breath sounds. fine or course crackles
  • heart auscultation: S3 and/or S4
  • decreased aerobic capacity
  • decreased functional strength
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4
Q

cardiac muscle dysfunction - objective tests

A
  • vitals
  • lung auscultation
  • heart sound auscultation
  • peripheral edema assessment
  • ROM and strength assessment
  • aerobic capacity asessment
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5
Q

Heart Rate

A
  • Locate the radial pulse at the base of the thumb
  • measure pulse for 30 sec and multiply by 2 for heart rate in bpm
  • norm: 60-100
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6
Q

Respiratory rate

A
  • do not tell the patient you are observing their RR.
  • count the number of times the patient’s chest rises for 30 seconds
  • multiply the number times 2 for breaths per minute
  • 12-20 bpm
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7
Q

blood pressure

A
  • Place the distal end of the cuff 1 inch above the antecubital fossa
  • palpate the brachial artery
  • align the artery marking on the blood pressure cuff with the brachial artery
  • make sure the valve is closed on the cuff
  • place the stethoscope
  • inflate the cuff 20-30 mmHg above where you expect the patient’s BP to be
  • release the cuff
  • first sound = systolic BP
  • sound disappears= diastolic BP

-normal 120/80

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8
Q

prehypertension levels

A

systolic 120-1139 or diastolic 80-89

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9
Q

hypertensive levels

A

systolic >140 or diastolic >90 or both

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10
Q

lung auscultation

A
  1. place the earbuds of stethoscope facing forward before placing in your ears
    - place the diaphragm on areas of the patient’s chest
    - ask your patient to take a deep breath in and out as you listen
    - listen to the upper lobes, middle lobe and lingual and anterior aspect of the lower lobes.

-on post chest. listen to the upper lobes above the level of T3. listen to the lower lobes below the level of T3.

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11
Q

Broncophony

A
  • place the stethoscope on areas of the patient’s chest
  • ask the patient to say “99”
  • auscultate the upper, middle lobe and lingual, and the lower lobes, listening for abnormal sounds
  • repeat over the posterior chest wall
  • Positive test= increase resonance or hearing a louder “99” sound in the area of consolidation
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12
Q

whispered pectroloquy

A
  • place the stethoscope on chest
  • ask the patient to whisper “99”
  • auscultate the upper lobes, middle lobe and lingual and the lower lobes
  • repeat over the posterior chest wall
  • positive test= increased resonance or louder “99” sound in the are of consolidation
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13
Q

egophony

A
  • place the stethoscope
  • ask the patient to say “e”
  • auscultate the upper lobes, middle lobe and lingual and the lower lobes
  • repeat over the posterior chest wall
  • Positive test= the word “e” sounds like “a” in the are of consolidation
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14
Q

tactile fremitus

A
  • place the ulnar border 2of your hand on areas of patient’s chest
  • instruct the patient to say “99”
  • palpate the upper lobes, middle lobe and lingual and the lower lobes
  • this can be repeated over the posterior chest wall
  • positive test= increased vibration felt with you hand over the area of consolidation
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15
Q

Heart sound auscultation

A
  • use the bell of the stethoscope and listen to the heart at the areas listed below
  • the 2nd intercoastal space, right lateral sternal border. this is the aortic area
  • the 2nd intercostal space, left lateral sternal border. this pulmonic area
  • the 4th intercostal space left or right lateral sternal border. this is the tricuspid area
  • the 5th intercostal space, left mid-clavicular line. this is the mitral area
  • the presence of an S3 heart sound is associated with CHF.
  • S4 heart sound = severe hypertension or a stiff ventricle.
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16
Q

when is S3 heart sound normal

A
  • presence of S3 is associated with CHF.

it is normal in children or young adult

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17
Q

when is S4 heart sound normal

A

-S4 may be associated with severe hypertension or stiff ventricle. it is considered normal in an elite athlete

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18
Q

peripheral edema assessment

A
  • calf girth measurement
  • place the tape measurer 10 cm below the tibial tuberosity
  • wrap the tape around the calf and record the circumference
  • repeat on the opposite leg and compare
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19
Q

supine AROM UE

A
  • full finger flexion and extension
  • elbow flexion and extension
  • shoulder flexion
  • shoulder abduction
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20
Q

supine AROM LE

A
  • full DF and PF
  • knee flexion and extension
  • hip flexion
  • hip abduction
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21
Q

supine MMT

A
  • squeeze your fingers
  • elbow flexion extension
    -shoulder flexion and extension
    -shoulder abduction and adduction
  • hip flexion
  • ask patient to bend their hip and knee. palce your hand on the plantar surface of their foot and ask the patient to push into your hand, extending their knee and hip
  • hip abduction
    hip adduction
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22
Q

seated AROM UE

A
  • full finger flexion and extension, elbow flexion and extension, shoulder flexion, and ahoulder abduction
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23
Q

seated AROM LE

A
  • perform full DF, PF
    knee flexion and extension
    hip flexion
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24
Q

Seated MMT

A
  • finger flexion
    -elbow flexion and extension
    shoulder flexion and extension
  • shoulder abduction
  • knee extension
    -knee flexion
    hip flexion
  • with the patient’s feet on the ground, apply resistance at the lateral and medial knees for hip abduction and adduction
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25
Q

Contraindications to beginning assessment and exercise

A
  • unstable angina during the previous month
  • myocardial infarction during the previous month
  • resting systolic BP >200 mmHg
  • resting diastolic BP >110 mmHg
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26
Q

signs and symptoms to consider for stopping exercise

A
  • angina
  • dyspnea
  • marked fatigue
  • ataxic gait
  • drop in Oxygen sat >3-5 %
  • Rise in HR >20 bpm above resting
  • abnormal ECG
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27
Q

acute aerobic capacity in supine

A 
assess vitals. Ask the patient to complete 10 reps of: 
- neck circles
-shoulder shrugs
-elbow flexion and extension
shoulder flexion to 90 degrees
-shoulder abduction to 90
-ankle pumps
- knee flexion
- hip abduction
  • reassess vitals, if stable proceed to seated at the edge of the bed.
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28
Q

acute aerobic capacity - Seated

A

assess vitals, Ask the patient to complete 10 reps of :

  • elbow flexion and extension
  • shoulder flexion to 90 deg
  • shoulder abduction to 90 deg
  • neck circles
  • shoulder rolls
  • heel and toe rises
  • knee extension
  • hip flexion
  • if tolerated add seated trunk side bend and rotations
  • reassess vitals after completing exercise
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29
Q

6 minute walk test

A
  • 2 cones 100 feet apart, RPE scale, a stop watch BP cuff, pulse oximeter, and a chair
  • take viatls before the test
  • instruct the patient to walck back and forth between the cones for 6 minute or as long as he/she is able
  • patient can sit down at any point during the test if necessary
  • do not stop the clock even if the patient chooses too rest
  • throughout the test, assess for changes in the patient’s sx. SOB, dizziness, RPE, chets pain
  • provide encouragement every 2 minutes
  • after 6 min ask the patint to stop and reassess vitals, oxygen sat, and RPE
  • record the total distance walked and the number of times the patient stopped
  • <400 meters = predicted mortality
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30
Q

standing therapeutic exercise

A
  • assess vitals. repeat 10x
  • mini squats
  • heel raises
  • side bending
  • rotation of the trunk
  • reassess vitals before proceeding to walking
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31
Q

walking home exercise program

A
  • assess the amount of time the patient is able to safely walk at one time while in the hospital
  • instruct the patient to walk that length of time 3x/day at home.
  • patient should begin with warm up exercise before walking
  • increase walking time by 1-2 minutes a day each day of the week
  • Patient should report a workload intensity of 11-13 on the RPE scale when walking
  • walking should be performed on a flat and level surface
  • patient should not walk on the incline or stairs until he/she is able to tolerate 20 minute of walking
  • patient should not walk outdoors in very hot or very cold weather
  • remind the patient to stop walking if he or she feels dizzy, light headed , SOB or has chest pain
32
Q

LE restorator program

A
  • assess patient’s vitals
  • ask patient to pedal at a comfortable pace
  • Patient should report the workload as 1113 on the RPE scale
  • start timer and record how long the patient tolerates the workload
  • intermittently monitor vitals, and signs and sx of distress
  • after demonstrating safety, prescribe an exercise program with a 1:1 work to rest ratio.
  • instruct the patient to perform exercise 3x/day slowly increasing the time per session as tolerated
33
Q

inspiratory muscle trianer

A
  • to strengthen muscles of inspiration or to assist weaning from a ventilator
  • turn the knob at the bottom of the inspiratory muscle trainer to 20-40% of the maximum inspiratory pressure as measured on the magnahelic
  • instruct the patient to breath in through the mouthpiece and the he/she may experience some resistance
  • assess the patient’s oxygen saturation throughout the training and ask if they feel SOB
  • begin training fo r5 minutes 2-3x/day, 7 days/wk at 20-40% of MIP
  • Progress to 15 minutes, 2-3x/day, 7 days/week at 20-40% MIP
  • once the patient can train at this level for 15 minutes, increase the MIP to 40-60% as tolerated
34
Q

PRecaution for resistive exercise

  • –Following a MI
  • –Following a sternotomy:
A
  • MI should not begin till 5 weeks post

- sternotomy should not begin till 8 weeks post

35
Q

upper extremity resistive exercises

A
  • elbow flexion with lbs
  • shoulder flexion
  • shoulder abduction
  • shoulder press
36
Q

LE resistive exercises

A
  • knee extension
  • hip flexion
  • hip abduction
  • hip extension
37
Q

risk factors intermittent claudication

A
  • systemic atherosclerotic disease
  • history of smoking
  • typically involving males more than females
38
Q

intermittent claudication reposted findings

A
  • calf pain by weight bearing exercise, relived by rest
39
Q

assessment and walking program for intermittent claudication

A
  • assess baseline vitals
  • instruct the patient to walk back and forth between the chair and cone as long as possible, eben with moderate to severe calf pain
  • monitor the patients pain level and signs of distress throughout
  • use a stopwatch to record the length of time the patient can walk before having to sit down and rest
  • after stopping reassess vitals
  • allow them to rest for 10.5 minutes or until pain subsides before walking again
  • this will be the patients home exercise program using interval training at a 1:1 work to rest ration, increasing the intervals as tolerated
  • the goal is to walk a total of 30-60 minutes most days of the week
  • walking is the mode of choice
40
Q

obstructive lung dysfunction diseases

A
  • COPD, cystic fibrosis, alpha-1 antitrypsin defieciency
  • narrowing of the pulmonary bronchi due to inflammation or spasm, resulting in diminished expiratory flow rates with SOB and reduced aerobic capacity
41
Q

risk factors of obstructive lung disease

A
  • prolonged smoking

- congenital pre-disposition

42
Q

reposted findings of obstructive lung disease

A
  • progressive SOB, with or without excessive mucous production
43
Q

maximum expiratory pressure

A

pupose- to objectively meaure maximum expiratory pressure and determine at which level to begin expiratory muscle training

  • ensure that the patient is breathing into the correct tube on the magnehelic
  • ask the patient to take a deep breath in and then fully breathe out into the magnehelic
  • repeat a total of 3 times, recording thehighest reading
44
Q

maximum inspiratory pressure

A
  • ensure that the patient is breathing into the correct tube on the magnehelic
  • ask the patient to fully expire air out and then breathe in via the magnehelic
  • repeat a total of 3 times, recording the best reading
45
Q

breathing control positioning

A
  • changing body position to regain control of breathing

- ask the patient to sit, place hands on table in front of him or her, and lean forward

46
Q

pursed lip breathing

A
  • to regain control of breathing when the patient experiences SOB
  • instruct the patient to breathe in through their nose, purse their lips and breathe outthrough their mouth
  • perform until respiratory rate is under control
47
Q

paced breathing

A
  • to regain control of breathing when the patient has SOB
  • instruct the patient t o breathe in through their nose and then exhale in a slow and controlled manner
  • inhale to exhale ratio is 1:2
  • when acute SOB, the patient may have a 1 second inhale and 2 second exhale. attempt to progress to a 2 second inhale and 4 second exhale
48
Q

combination of positioning, pursed lip breathing and paced breathing

A
  • regain control of breathing when SOB
  • ask the patient to sit, lean forward and place hands on table to support their forearms
  • instruct the patient to breathe in through their nose, purse their lips and breathe out through their mouths
  • instruct the patient to breathe in through their nose ans then slowly exhale. inhale to exhale ratio is 1:2
49
Q

facilitating diaphragmatic breathing

A
  • to facilitate the diaphragm in patients with porr diaphragm activation or increased accessory muscle breathing
    tactile cue: assist the patient in placing their hand over the diaphragm. instruct the patient that his/ her should rise and fall when breathing

sniffing: if needed, instruct the patient to sniff to feel their diaphragm under their hand

quick stretch: if further facilitation is neede, place your hand over the diaphragm and apply a quick stretch at the end of expiration

50
Q

inhibiting accessory muscle

A

-to encourage diaphragmatic breathing

  • place the forearm over the patient’s upper hcest and apply a downward pressure
  • place other hand over the diaphragm for a cue
  • a quick stretch can be applied for further faciliatation
51
Q

lateral costal stretch with faiclitation

A

to facilitate unilateral chest wall expansion

  • use one hand to block the lateral surface of the chest wall that is closest to you
  • in this case, you are blocking the left chest wall in order to facilitate expansion on the right side
  • place your other hand under the patient’s opposite scapula
  • side bend the patient toward you
  • instruct the patient to take deep breaths in and out while in this position
  • this position forces air into the right side of the chest wall, faciliatating expansion of the right lung
  • maintain position for 5 minutes or a slong as tolerated
52
Q

trunk rotation stretch

A
  • to increase unilateral lung expansion
  • ask the oatient to cross their arms, while blocking one side of the chest wall
  • rotate the patient toward you, asking them to take a deep breath in
  • return them to starting position as they exhale
  • repeat with deep breaths
  • patient can also practice deep breathing while remaining in side lying position
53
Q

vertical towel roll stretch

A
  • to incr chest mobility/expansion
  • place a towel roll vertically down the patient’s spine starting at the base of their neck
  • sustain this position for several minutes or as tolerated
  • incorporate upper extremity ex, inhaling during arm elevation and exhaling when bringing arms back to the patient’s side. bilateral shoulder abduction. bilateral shoulder horizontal abduction
54
Q

horizontal towel roll stretch

A

-to incr chest mobility/anterior chest wall expansion

  • place a towel roll horizontally at the apex of the patient’s thoracic spine kyphosis
  • encourage the patient to stretch over the towel in supine
  • sustain this position for several minutes or as tolerated
  • incorporate UE ex, inhaling during arm elevation and exhaling when bringing arms back to the patient’s side
55
Q

active cycle of breathing

A
  • to improve breathing control and secretion removal
  • normal breathing for 5-10 sec
  • deep inspiration and relaxed expiration 3-4 times
  • normal breathing for 5-10 sec
  • deep inspiration and relaxed expiration 3-4 times
  • fored expiratory technique : now instruct the patient to turn their and huff on exhalation
56
Q

forced expiratory maneuver with butterfly technique

A
  • for patient with an obstructive pathology attempting to remove secretions and excess air in their lungs
  • instruct the patient to place their hands behind their head.
  • during inhalation tell the patient to bring theor elbows back and look up
  • during exhalation tell the patient to bring their elbows together and bend forward
  • instruct the patient to huff during exhalation
57
Q

flutter valve

A
  • to assist in secretion removal
  • instruct the patient to breathe in deeply through the nose
  • hold the breath for 2-3 sec
  • then exhale through the mouth piece of the flutter valve quickly but not too forcefully
  • repeat 10x
  • then following full inspiration, instruct the patient to exhale forcefully through the flutter valve 2x. this may elicit a couch. if not, ask the patient to take a deep breath in and cough or huff to clear secretions
  • repeat the flutter valve technique 2x/day as often as needed to help clear secretions
  • turning the nozzle at the bottoomof the flutter valve will change the amt of vibrations the patient feels in their chest which may aid in eliciting a cough
58
Q

postural drainage percussion of upper lobe apical segment

A
  • to facilitate removal of secretions in th eupper lobe apical segments
  • patient long seated position, leaning back 30 deg
  • percuss or vibrate for 5 minutes during respiration on the top back posterior trap
59
Q

introduction to percussion and vibration

A
  • to facilitate secretion removal
  • have the patient either rest, breathing normally in the desired position for 10 min, or you can perform percussion in the desired position for 5 min
  • to perform percussion, cup your hands and place them over the lobe you wish to drain
  • percuss for 5 min
  • after 5 mins, ask the patient to take a deep breath in
  • add vibration over the lobe as the patient exhales
  • ask the patient to take a deep breath in again and huff on exhalation
  • a quick stretch can also be added at the end of expiration to facilitate inspiration
60
Q

upper lobe anterior segment

A
  • supine with the table level

- percuss or vibrate for 5 minutes during respirations. percuss over the top upper chest above nipple

61
Q

upper lobe posterior segment percussion

A
  • patient is short sitting position, leaning forward 30 deg

- percuss or vibrate for 5 minutes during respirations percuss in the upper back upper scapula

62
Q

middle lobe percussion

A
  • middle lobe is in right lung
  • left sidelying, head down 15 deg, and rotated 1/4 turn backward
  • right arm flexed up to head to leave space to percuss over the anterior lateral chest at nipple level
63
Q

lingual postural drainage ,percussion

A
  • right sidelying, head down 15 deg and rotated 1/4 turn back
  • percuss on the left chest anterior lateral at level of nipple. take their left arm and move it back out of the way
64
Q

lower lobe superior segment percussion and postural drainage

A
  • pt is prone at bed level

- hitting the post middle back inf angle of scap

65
Q

lower lobe anterior basal segment postural drianage

A
  • pt sidelying with head down 30 deg

- lateral chest mid chest

66
Q

lower lobe posterior basal segment postural drainage percussion

A
  • pt is prone with head down 30 deg

- percuss in back below scapula

67
Q

lower lobe lateral basal segment postural drainage percussion

A
  • sidelying head down 30 deg rotated one quarter turn forward
  • posterior lateral mid back
68
Q

pflex

A
  • to increase inspiratory muscle strength or to assist in weaning from a ventilator
  • turn the dial on the pflex to change the resistance. the larger the hole on the pflex, the easier the resistance
  • begin at a resistance where your patient is able to perform 5 min w/o becoming SOB or experiencing a decr in their oxygen sat
  • instruct the patient to breathe into the valve with normal breaths and to remove the valve from their lips during exhalation
  • instruct thepatient to remove the valve from their lips during exhalation
  • perform for 5 minutes 3x/day for 7 days
  • progress to 15 mins 3x day for 7 days
  • then progress by increasing the resistance
69
Q

expiratory muscle trainer

A

-to incr abdominal strength or to help patient with a weak cough

  • adjustteh valve at the bottom of the expiratory muscle trainer to 5-10% of the patient’s maximum expiratory pressure
  • instruct the patient to breath in normally and exhale through the mouthpiece
  • the patient should feel resistance
  • ask the patient if he or she feels SOB at any time and make sure the Oxygen sat does not decr
  • perfrom training 5-15 min 2-3x/day, 7 days/wk at 5-10% of MEP
  • once the patient can tolerate 15 mins at this level, incr the resistance to 10-15% of MEP or as tolerated
70
Q

restrictive lung dysfunction diseases

A
  • interstitial pulmonary fibrosis, SC or other neurologic lesion
  • scarring and fibrosis of lung tissue, chest wall malformation, or decr inspiratory muscle strength resulting in diminished lung volumes with SOB and deccr aerobic capacity
71
Q

risk factors of restrictive lung disease

A
  • long-term exposure to dust, coal, smoke, asbestos
  • trauma
  • neurologic insult
72
Q

facilitating accessory muscle breathing

A
  • to use accessory muscles of breathing when the use of the diaphragm alone is inadequate, especially in patients with a restrictive pathology such as a spinal cord injury
  • ask ther patient to place their hand over the top of their chest
  • tell the patient to focus on making their hand rise and fall
73
Q

Quick stretch to facilitate accessory muscles

A
  • if the patient is still having difficulty recruiting their accessory muscles you can add a manual cue
  • place your hands in a vertical position, parallel to muscle fibers in order to facilitate the scalenes
  • place your hands in an onlique position “v” to facilitate pectoralis muscle
  • ask the patients to try to make your hands rise on their chest
  • a quick stretch can be added at the end of expiration for further cueing of the accessory muscles
74
Q

deep breathing with UE movement in supine

A
  • to encourage lung and chest wall expansion through UE movement while deep breathing
  • instruct the patient to raise their arms up over their head (shoulder flexion) while inhaling
  • instruct thepatient to lower their arms to their side (shoulder extension) while exhaling
  • repeat 10x
  • remind the patient to breathe in through their nose and out through their mouth
75
Q

deep breathing with UE movement in sitting

A
  • instruct the patient to raise their arms up over their head while looking up at their hands duringgg inhaling
  • instruct the patient to lower their arms to ther side while looking down attheir hands during exhaling
  • repeat 10x
  • remind the patient to breath in through their nose and out through their mouth
76
Q

deep breathing with UE movement in sitting diagonal pattern

A
  • the patient can also perform UE movement in a diagonal pattern
  • instruct the patient to begin with their hands together in their lap and bring their hands up aand out to the side suring inhalation
  • instruct the patientto begin to bring heor arms down and in, hand together, during exhalation
  • remind the patient to look up at their hands during the exercise
77
Q

self-assisted cough with heimlich

A
  • to assist removal of secretion in the lungs, particularly for patient with weak abdominal muscle strength
  • instruct the patient to make a fist with their hand, place it directly above their belly button, and place the opposite hand on top
  • instruct the patient to place other hance n top of their fisted hand
  • ask the patient to take a deep brethh in and cough during exhalation
  • the patient should push in and up with their fisted hand during the cough

cardiopulm (4 decks)

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