Cardiopulmonary Interventions

Question 1

Initial exam items

Answer 1

BP
HR
Rate pressure product (HR x BP)
Heart sounds
Auscultation
Cardiac output

Question 2

How to decrease metabolic acidosis

Answer 2

Bicarbonate infusion

Question 3

How to decrease respiratory alkalosis

Answer 3

Have pt breath into rebreathing mask

Question 4

How to decrease metabolic alkalosis

Answer 4

Fluid and saline infusion

Question 5

How to decrease respiratory acidosis

Answer 5

Use supplemental oxygen

Question 6

Postural drainage summary

Answer 6

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

Question 7

Postural drainage: superior segments of lower lobes

Answer 7

Prone
Table elevated to 18 in
or two pillows under pelvis

Question 8

Postural drainage: posterior apical segments of upper lobes

Answer 8

Seated
Leaning forward over a folded pillow

Question 9

Postural drainage: anterior segments of upper lobes

Answer 9

Supine
Pillows under knees

Question 10

Postural drainage: anterior apical segments of upper lobes

Answer 10

Seated
Slightly reclined

Question 11

Precautions to postural drainage

Answer 11

Pulmonary edema
Hemoptysis
Massive obesity
Large pleural effusion
Massive ascites

Question 12

Relative contraindications to postural drainage

Answer 12

Inc intracranial pressure
Hemodynamically unstable
Recent esophageal anastomosis
Recent spinal fusion or injury
Recent head trauma
Diaphragmatic trauma

Question 13

Exercise termination criteria: BP

Answer 13

Ex hypertension:
SBP > 240 mmHg
DBP > 110 mmHg

Hypotension:
>20 mmHg drop from upright resting SBP

Question 14

Exercise termination criteria: HR

Answer 14

Too rapid inc in HR
Failure to inc HR
Dec in HR w/ inc exercise intensity

Question 15

Exercise termination criteria: symptoms

Answer 15

Significant anginal response
Severe leg claudication
Undue dyspnea
Excessive fatigue
Dizziness

Question 16

Exercise termination criteria: signs

Answer 16

Pallor
Cold sweats (diaphoresis)
Ataxia
New murmur
Pulmonary rales
Onset of significant third heart sound

Question 17

Exercise termination criteria: ECG abnormalities

Answer 17

Second or third deg heart block
Onset of R or L bundle branch block
Acute ST changes

Question 18

Cardiac rehab: Phase 1

Answer 18

Acute/monitoring phase

Begins when pt is medically stable

Tx:
Pt ed
Hemodynamic and ECG monitorinig

Question 19

Cardiac rehab: Phase 2

Answer 19

subacute/conditioning phase

Begins as early as 24 hrs after discharge up to 6 weeks

tx:
50-70% HR max

Question 20

Cardiac rehab: Phase 3

Answer 20

Training/intensive rehab phase

~5-6 weeks from discharge and extends indefinitely

tx:
70-85% HR max
Begin resistance training

Question 21

Cardiac rehab: Phase 4

Answer 21

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

Question 22

Cardiac rehab: Phase 1 and 2 FITT

Answer 22

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

Question 23

Cardiac rehab: Phase 3 FITT

Answer 23

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

Question 24

Phase 3 strength training guidelines

Answer 24

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

Question 25

Cardiac rehab: Phase 4 guidlines

Answer 25

Exercise:
Clinically stable angina
Medically controlled arrhythmias

Progression:
50-85% functional capacity
3-4x/week
45 min or more/session

D/c at 6-12 months

Question 26

Weight reduction guidelines for obesity (FITT)

Answer 26

Minimum:
250-300 min/week required

Frequency:
>5 days/week to maximize caloric expenditure

Intensity:
Initially moderate 40-60% VO2; progression to >60%

Time:
From 45-60 min/day

Type:
Moderate exercise
Aerobic, resistance, flexibility