Cardiopulm Tests And Tx Flashcards
MRC Sum Scale -
What it assesses. Cutoff score. Components
Gross muscle strength, graded 0-5 w/o + and -
12 tests: LE- ankle DF, knee ext, hip FL, UE- wrist ext, elbow FL, shoulder ABD
<48/60 = critical illness weakness
Respiratory Reserve - when is it sufficient?
Respiratory reserve ratio = PO2/FiO2
>300 = sufficient for mobilization
And SpO2 >90% (PO2 >60 mmHg)
Cardiovascular Reserve - when is it sufficient?
Resting HR <62% max HR, BP less than 20% recent variability and <200/<110. ECG normal. (SBP should not drop >10-20 mm Hg with exercise)
Mean Arterial Pressure - formula, amt needed for perfusion of organs?
MAP = DBP + 1/3 (SBP-DBP)
> 65 mm Hg
Active Cycle of Breathing - what are the components and why would you spend more time on a particular component?
- Breathing Control - to decrease bronchospasm, 10-30s between each phase. (More w reactive airways, anxiety)
- Thoracic Expansion - air behind secretions (more- atelectasis)
- Forced Expiratory Technique - mobilize sputum (more- productive cough. Peripheral airways - full exhale from normal inhale. Proximal airways- faster huff from a full inhale
GOLD - 4 Stages of COPD
I. FEV1 >80% predicted, smoker’s cough
II. FEV1 50-80% predicted, dyspnea on exertion, sputum cough
III. FEV1 30-50% predicted, dyspnea w mild exertion
IV. FEV1 <30% predicted, dyspnea w mild exertion + cyanosis, R heart failure
BODE Index - What does it predict? What 4 factors does it include?
For COPD patients, multidimensional index for 4 year prognosis of death & hospitalization. 10 points
1. Weight (BMI) 2. Obstruction (FEV1) 3. Dyspnea (dyspnea scale) 4. Exercise capacity (6 min walk test)
How does FEV1 impact prognosis? What are the cutoff scores?
FEV1 <30% predicted - 50% chance death in 2 yrs
FEV1 <55% predicted - 50% chance death in 5 yrs
Little to no obstruction - FEV1 >2.0 L in 1 s
Severe obstruction - FEV1 < 1.0 L
4 Causes of Restrictive lung disease and an example of each
- Primary lung disease - stiff parenchyma (IPF-idiopathic pulmonary fibrosis, pneumonia)
- Pleural abnormalities (pleural effusion)
- Thoracic abnormalities (kyphoscoliosis, decreased chest wall mobility)
- Other: limited lung expansion 2º pregnancy, morbid obesity
How does restrictive disease affect lung volumes & capacities?
Difficulty getting air IN
Decreased lung volumes: lowered vital capacity, inspiratory capacity, total lung capacity, and lower than normal residual volume
How does obstructive disease affect lung volumes & capacities?
Difficulty getting air OUT
Increased: reserve volume, total lung capacity, functional reserve capacity, tidal volume slightly up
Decreased: Inspiratory and expiratory reserve volumes, inspiratory capacity, vital capacity.
How does Arterial PO2 correspond to O2 Saturation? At what level of PO2 is oxygen therapy recommended?
40-50-60 PO2 / 70-80-90 % O2 sat rule
If PO2 < 60 mm Hg, hypoxemia, usually O2 therapy
SPPB (Short Physical Performance Battery) - What are the components? What do these components predict?
- Static balance: Romberg –> semi tandem –> tandem, 10s each
- Gait speed: normal pace 10m walk from a standstill. <0.6 m/s increases risk of hospitalization, dependency in ADL’s
- 5x Sit to Stand: if >15 s, 2x the risk of falls
SPPB - Scoring and MCID
12 points total. MCID: 1 point improvement, 14% reduced risk of death and rehospitalization
Score 0-4 - 5x increased risk of death, hospitalization
Score 5-7 - 2.6x increased risk
6 Minute Walk Test
Can use usual walking aids, standing breaks
Arterial Blood Gases (ABGs) - normal values, what indicates respiratory and metabolic cause
PH: acidosis < 7.35 - 7.45 < alkalosis
PCO2: respiratory acidosis, hypoventilating < 45 - 35 mm Hg < resp alkalosis, hyperventilating
HCO3: metabolic acidosis < 22 - 26 mEq/L < metabolic alkalosis
PO2: 80-100 mm Hg = normal, 40-60 = moderate hypoxemia
Fall Risk Stratification for Older Adults - What are the components? Risk scores?
Fall history (8 pts), Living alone (3 pt), Female (3 pt), 4 or more meds (3 pts) Risk is: Low (0-4 pt), Moderate (5-10 pt), High (11-16 pt)
DASI - Duke Activity Status Index - What does it measure? Cutoff for high surgical risk?
12 questions, activities you can do “without difficulty”
- Estimates VO2 peak up to 9.8 METs, fitness, functional capacity
<4 METs - high surgical risk
What is the minimal aerobic capacity to remain functionally independent?
Males: 18 mL/kg/min (5.14 MET)
Females: 15 mL/kg/min (4.3 MET)
6 Criteria for considering a patient “medically stable”
For the PAST 8 HOURS
- No new/recurrent chest pain
- No new signs uncompensated heart failure (dyspnea at rest, hypotension, B/L crackles >0.5 lungs)
- No significant abnormal ECG change
- Can speak comfortably at RR < 30
- Cardiac index (CO/mass) > 2 L/min/m2
- Central venous pressure < 12 mm Hg
Acute Care Exercise Guidelines (5)
- Warm up and cool down at 50% stimulus intensity
- HR increase no more than 20-30 bpm above RHR
- SBP drop no more than 10-20 mm Hg
- No significant dysrhythmia/dyspnea
- RPE 11-13 (Borg) or 3-4 (modified Borg, fairly light to somewhat hard)
