Cardiopulmonary Interventions Flashcards
Initial exam items
BP
HR
Rate pressure product (HR x BP)
Heart sounds
Auscultation
Cardiac output
How to decrease metabolic acidosis
Bicarbonate infusion
How to decrease respiratory alkalosis
Have pt breath into rebreathing mask
How to decrease metabolic alkalosis
Fluid and saline infusion
How to decrease respiratory acidosis
Use supplemental oxygen
Postural drainage summary
Bronchus of involved lung needs to be perpendicular to the ground (bad lung up)
Indications
- pulmonary complications
- weak/elderly patient
- atelectasis, pneumonia, COPD
Maintain each position 5-10 min
Secretions cleared by coughing or suctioning
Postural drainage: superior segments of lower lobes
Prone
Table elevated to 18 in
or two pillows under pelvis
Postural drainage: posterior apical segments of upper lobes
Seated
Leaning forward over a folded pillow
Postural drainage: anterior segments of upper lobes
Supine
Pillows under knees
Postural drainage: anterior apical segments of upper lobes
Seated
Slightly reclined
Precautions to postural drainage
Pulmonary edema
Hemoptysis
Massive obesity
Large pleural effusion
Massive ascites
Relative contraindications to postural drainage
Inc intracranial pressure
Hemodynamically unstable
Recent esophageal anastomosis
Recent spinal fusion or injury
Recent head trauma
Diaphragmatic trauma
Exercise termination criteria: BP
Ex hypertension:
SBP > 240 mmHg
DBP > 110 mmHg
Hypotension:
>20 mmHg drop from upright resting SBP
Exercise termination criteria: HR
Too rapid inc in HR
Failure to inc HR
Dec in HR w/ inc exercise intensity
Exercise termination criteria: symptoms
Significant anginal response
Severe leg claudication
Undue dyspnea
Excessive fatigue
Dizziness
Exercise termination criteria: signs
Pallor
Cold sweats (diaphoresis)
Ataxia
New murmur
Pulmonary rales
Onset of significant third heart sound
Exercise termination criteria: ECG abnormalities
Second or third deg heart block
Onset of R or L bundle branch block
Acute ST changes
Cardiac rehab: Phase 1
Acute/monitoring phase
Begins when pt is medically stable
Tx:
Pt ed
Hemodynamic and ECG monitorinig
Cardiac rehab: Phase 2
subacute/conditioning phase
Begins as early as 24 hrs after discharge up to 6 weeks
tx:
50-70% HR max
Cardiac rehab: Phase 3
Training/intensive rehab phase
~5-6 weeks from discharge and extends indefinitely
tx:
70-85% HR max
Begin resistance training
Cardiac rehab: Phase 4
Maintenance/conditioning phase
Lasts 6-12 months
For pts that are high risk for MI and/or who wish to continue under the supervision of trained professional
Cardiac rehab: Phase 1 and 2 FITT
Initiated after 24 hours of being stable
No resistance training
F: short, 2-3x/day
I: 50-70% HR max
T: 10-15 min (phase 1); 30 min (phase 2)
T: ADLs, supervised ambulation
Typically undergo symptom-limited maximal stress test (ETT) 4-6 weeks post MI
Cardiac rehab: Phase 3 FITT
F: 2-3x/week
I: 70-85% HR max
T: 30-60 min w/ 5-10 min warm up and cool down
T: Walking, treadmill, cycle
Phase 3 strength training guidelines
Begin w/ RB and light weights (1-3 lbs) or 30-50% 1RM
Begin w/ 8-10 reps > 12-15 reps
Avoid UE resistance ex as soft tissue is still healing
