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-cardiopulm Npte > cp interventions 1/22 > Flashcards

cp interventions 1/22 Flashcards

1
Q

continue to terminal exercise?
• Moderate to severe/increasing angina
• Marked dyspnea

A

stop and stabilize patient

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2
Q

continue to terminal exercise?
• Dizziness, light-headedness, ataxia
• Cyanosis/pallor
• Excessive fatigue

A

stop and stabilize patient

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3
Q

continue to terminal exercise?
• Leg cramps/claudication
• Blunted BP response
• Hypertensive BP response >180 or 110 mmHg

A

stop and stabilize patient

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4
Q

continue to terminal exercise?
• Fall in SBP of 10-15 mmHg
• Significant change in EKG rhythm- ST elevation/depression, looking for changes from baseline

A

stop and stabilize patient

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5
Q

Y/N? indication for cardiac rehab
• Medically stable post-MI
• Stable angina

A

yes, stable

- predictable threshold for angina

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6
Q 
Y/N? indication for cardiac rehab
• CABG
• Stable heart failure
• Heart transplantation 
• Valvular heart surgery
A

yes, stable

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7
Q

Y/N? indication for cardiac rehab

• PAD, CAD

A

yes, stable

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8
Q

normal ejection fraction?

A

~55-85%

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9
Q

Y/N? indication for cardiac rehab

Unstable angina

A

contraindication

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10
Q

Y/N? indication for cardiac rehab
• Uncontrolled hypertension (>180 or >110)
• Orthostatic BP drop of >20 mm Hg with symptoms

A

contraindication

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11
Q

Y/N? indication for cardiac rehab
• Aortic stenosis
• Uncontrolled arrythmias
• Pericarditis/myocarditis

A

contraindication

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12
Q

Y/N? indication for cardiac rehab
• 3rd degree AV block without pacemaker
• Uncontrolled PE/DVT

A

contraindication

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13
Q

6-Minute Walk Test

distance good long-term survival rate

A

> 300meters

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14
Q

calculate exercise intensity

borg scale vs HR

A

borg x 10 = HR

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15
Q

calculate exercise intensity

Rate Pressure Product

A

HR x SBP

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16
Q

Exercise Tolerance Test (ETT)
eg. bruce protocol
+Positive?
-Negative?

A

+Positive= signs of myocardial oxygen supply
inadequate for demand

  • Negative= balanced oxygen supply and demand, eg. cancer patient, nothing bad happening
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17
Q

what phase cardiac rehab?
Divided into 6 subcategory levels, targeting up to 6 MET’s
1. Bedrest 1-1.5 METs
2. Sitting 1.5-2.0 METs
3. Room 2-2.5 METs
4. Hall 2.5-3.0 METs
5. Progressive Hall 3-4 METs 6. Progressive Hall 4-5 METs

A

Phase I—Inpatient, acute stay

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18
Q

what phase cardiac rehab?
• Increase HR 10-20 bpm initially
• No complaints of dizziness, l/h, angina
• <13/20 Borg RPE

A

Phase I—Inpatient, acute stay

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19
Q

what phase cardiac rehab?
• Keep activities <90% of ISCHEMIC RPP (RPP at which ischemic symptoms are noted)
• RPE 11-13 (Light to Somewhat Hard)
• Target 5-9 MET’s

A

II—Outpatient Phase

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20
Q 
what phase cardiac rehab?
• Mode—Large muscle groups, aerobic
• Freq.—3x/week minimum
• Duration—12 weeks
• Warm-up, condition, cool-down 
• 55-90% HR Max
A

II—Outpatient Phase

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21
Q

phase I cardiac rehab
RPE should stay < #?
goal MET?

A

<13/20 borg rpe

6 MET

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22
Q

what phase cardiac rehab?
• Self-regulated
• Maintenance/progression x 6-12 months

A

III-Community Program

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23
Q

Cardiac Rehab Strength Training
target reps?
target RPE?
what muscle groups?

A
  • 12-15 repetitions comfortably
  • 11-13 RPE
  • Large muscle groups
  • Exhalation with exertion
  • Symptom management
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24
Q

what are sternal precautions?

  • lifting weight?
  • scap movement?
  • arm movement?
  • splinting during what?
A
  • UE lifting > 10 pounds
  • Pushing/pulling
  • Scapular adduction
  • UE resistive exercises above 90 degrees
  • No UE assistance with sit to stand
  • Sternal “splinting” with cough, laugh, or sneeze
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25
Q

what term?
• Intrathoracic pressure increased against a closed glottis
• Collapsed veins reduce BP and HR
• Overshoot of ↑ BP and HR

A

Valsalva

26
Q

medication for angina pectoris (unstable/prinzmetal/constant)?
how to administer?

A

Nitroglycerin (NTG)
• Patient brings their own meds
• Administer sublingual NTG and monitor 5 min.
• Repeat 3x
• If no resolution of angina pectoris, send patient to the emergency department

27
Q

normal tidal volume

A

0.5L, 500mL

28
Q

normal IRV

A

2.5L, 2500mL

29
Q

normal ERV

A

1.5L, 1500mL

30
Q

normal RV

A

1.5L, 1500mL

31
Q

normal IC

what is composed of?

A

IRV+TV

3L

32
Q

normal FRC

what is composed of?

A

ERV+RV

3L

33
Q

normal VC
max inhale followed by max exhale
what is composed of?

A

IRV+TV+ERV

4.5L

34
Q

normal TLC

what is composed of?

A

6L

35
Q

term?
palpable vibration from lungs full of fluid
goal?

A

Fremitus
Patient says a vowel sound
eg. tactile fremitus, say “99”
Goal is to find where the secretions are

36
Q

what condition?
auscultate: Crackles, Rhonchi
Tactile Fremitus (say “99”): Increased

A

Pneumonia

37
Q

what condition?
auscultate: Crackles
Tactile Fremitus (say “99”): Increased

A

Pulmonary edema

38
Q

what condition?
auscultate: Decreased breath sounds
Tactile Fremitus (say “99”): Decreased

A

Pleural effusion

39
Q

what condition?
auscultate: Decreased breath sounds, Rhonchi, Wheezing
Tactile Fremitus (say “99”): Decreased

A

COPD

40
Q

what condition?
auscultate: Decreased breath sounds
Tactile Fremitus (say “99”): Decreased

A

Pneumothorax

41
Q

obstructive or restrictive?
emphysema
asthma

A

obstructive

42
Q

obstructive or restrictive?
brochiecstasis
chronic bronchitis

A

obstructive

43
Q

obstructive or restrictive?

interstitial lung disease

A

restrictive

44
Q

obstructive or restrictive?

idiopathic pulmonary fibrosis

A

restrictive

45
Q

obstructive or restrictive?
pneumoconiosis
sarcoidosis
remove part of lung

A

restrictive

46
Q

obstructive or restrictive?
chest wall neuromuscular disease
obesity
pregnancy

A

restrictive

47
Q

obstructive lung disease

  • TLC +/-?
  • FVC +/-?
A

TLC normal or increased

FVC normal

48
Q

obstructive lung disease

  • FEV1?
  • FEV1/FVC?
A

FEV1 decreased

FEV1/FVC <0.8

49
Q

restrictive lung disease

  • TLC +/-?
  • FVC +/-?
A

TLC decreased

FVC decreased

50
Q

restrictive lung disease

  • FEV1?
  • FEV1/FVC?
A

FEV1 normal or decreased

FEV1/FVC normal

51
Q

how to perform Manual Secretion Removal

A
  • Postural drainage/ percussion/ shaking
  • Assisted cough
  • Tracheal stimulation
  • Endotracheal suctioning (last resort) • Catheter fed through nose/mouth/stoma
52
Q 
Exercise Prescription
Aerobic 
- Heart Rate Reserve (HRR)
- Intensity?
- Duration?
A
  • 40-85% Heart Rate Reserve (HRR)
  • use Karvonen method (HRR = HRmax-HRrest)
  • Moderate intensity
  • 20-30 min
53
Q
  • Loss of scalenes and intercostal muscles
  • Epigastric rise
  • Decreased chest wall expansion
A

Paradoxical Breathing Pattern

54
Q

EKG

  • Resting state
  • Contracting state
  • Resetting phase
A
  • Resting state is “polarized”
  • Contracting state is “depolarization”
  • Resetting phase is “repolarization”
55
Q

ABCDE for obstructive lung disorder

A 
asthma
brochiecstasis
chronic bronchitis
dry cough
emphysema
56
Q

2 reasons to do pursed lip breathing?

A 
\+ back pressure (expand lung alveoli), prevent airway collapse
slow RR (increase time for gas exchange)
57
Q

where to auscultate
aortic valve?
pulmonic valve?

A

aortic - 2nd IC R sternal

pulmonic - 2nd IC L sternal

58
Q

where to auscultate
tricuspid?
mitral?

A

tricuspid - 4th L sternal

mitral - 4th L midclavicular

59
Q

ECG big box = s?

how many is 1 sec

A

0.2sec

5 big box

60
Q

typical post MI is HR +/-?

what meds?

A

increased HR

take digitalis, beta blockers to decrease HR

-cardiopulm Npte (17 decks)

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