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CP Clin Management > Final Study Guide > Flashcards

Final Study Guide Flashcards

1
Q

Blood Pressure Guidelines

A

Normal: z120/z80
Prehypertension: 120-139/80-89
Hypertension Stage 1: 140-159/90-99
Hypertension Stage 2: >160/100

Hypertensive crisis! >180/110

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2
Q

Metabolic syndrome factors

A

3 out of 5

Waist circumference >35/40
TG > 150
HDL z40/50
BP >130/85
Glucose > 100
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3
Q

BP=

CO=

A

BP= COxTPR

CO= SVxBP

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4
Q

Cardiac Rehab STABLE parameters

A
  1. No episode chest pain last 8 hrs
  2. No sign uncomp HF: dysp at rest, bilat cracklers 1/2lung, hypotension
  3. No new ECG last 8hrs
  4. Speak comfortable and RR2L
  5. Central venous pressure z12mmHg
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5
Q

Basic Acute Tolerance to exercise Guidelines

A

HR 20-30-40 bpm above resting
No hypoactive BP response drop 10-20
No dysrhythmia/dyspnea
RPE 11-13 (3-5 light to somewhat hard)

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6
Q

Characteristics CHF

A 
DYSPNEA/cough
-paroxys, orthop, exercise
S3 HEART SOUND
Fatigue
Exercise intolerance
Periph edema
-JVD
-pitting

[[tachy, cold, pale, cyanotic extemities, weight gain, cracks]]
tubular sounds

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7
Q

NYHA Functional Classifications HF

A

Class 1
No limitation exercise, no symptoms with normal activity
-poor prognosis

Class 2
Slight limitation to exercise, symptoms with normal activity
-bad prognosis

Class 3
Marked limitation with exercise, symptoms with easy activity
-awful prognosis

Class 4
Inability to carry out activity w/out discomfort, sx at rest
-Terminal prognosis

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8
Q

ACC/AHA New Classification HF

A

A
At risk for HF without structural heart disease/sx

B
Structural disease without HF
-NYHA 1

C
Structural disease with prior/current HF sx
-NYHA 2/3

D
Refractory HF needing specialized interventions
-NYHA 4

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9
Q

CXR reason

A

Cheap/fast way

Look at abnormalities of heart/lungs

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10
Q

Blood Cell Count reason

A

RBC: O2 transport
Hemoglobin: oxygenation
Hematocrit: impedes blood flow-> chest pain, dizzy, SOB
WBC: infection response-> ex intol, fever, sweat
Platelets: clotting ability

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11
Q

Electrolyte reason

A

Sodium: fluid levels in body
Potassium: dysrythmia risk/cardiac evens
Calcium: due to renal insufficiency-> dysryth/muscle weakness
BUN/creatanine: shows kidney function

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12
Q

Cardiac Markers reason

A

Shows necrosis- releases enzymes when tissue death
Trop 1 in striated muscle

CK-MB: peaks 12-24hrs
Myoglobin: peaks 8-10
Troponin: peaks 12 hrs-> last up to 10 days

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13
Q

Echo reason

A

Heart function: valve function, motion of wall. EF

Heart anatomy: size ventricles, thickness of walls, valves

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14
Q

Vital Signs

A 
BP
HR via ECG
Auscultations
Temp
RR
Pulse ox (SpO2)
RPE
Pain
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15
Q

Sternal Precaution Risk Factors

A 
Obesity
Diabetes
COPD
Smoking
Female big boobs
Increase CP bypass
Increase time on vent
Limited functional capacity
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16
Q

Universal Sternal Precaution

A

Pain free ROM ASAP

  • log roll bed mobil; avoid active curl up
  • splint chest when coughing
  • limit 10 (20) lb lifting; use bilateral
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17
Q

Common Medications

A 
-olol: B blockers (arythmias, MI prevention, HTN)
Digoxin: (heart failure)
-prils: ACE inhib (CHF, HTN)
Medtormin: anti-diabetic
Statins (cholesterol)
Heparin/Coum (anti-coag)
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18
Q

Angiogram reason

A

Percentage of occlusion in cardiac arteries

-CAD/MI risk

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19
Q

Cardiac Rehab Risk Stratisfication

A

HIGH: z5 Mets

  • EFz40%
  • survivor cardiac arrest
  • complex vent dysrythmias
  • abnormal hemodynamics with exercise

MOD: 5-7 METS

  • EF 40-49%
  • angina with mod exercise or in recovery

LOW: 7+ METS

  • EF >50%
  • absence of induced dystrythmias, uncomplicated ME
  • normal hemodynamics with exercise
  • no angina
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20
Q

ABSOLUTE Contraindication to exercise

A

Unstable angina

Active endocarditis

Uncontrolled cardiac arythmias w/ hemodynam compromise: VT, 3rd hb, New SVT, New brady,tachy

Severe/sx aortic stenosis

Decompensated symptomatic HF

Acute PE

SBP dropp more than 10

Sign/sx of exercise intolerance: angina, marked dyspnea, pallor, cyanosis

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21
Q

Relative Contraindications to exercise

A

Acute myo/pericarditis

Left main coronary artery stenosis

Mod steontic valvular disease

Electrolyte abnormal

New brady,tachy without compromise

Afib with uncontrolled vent rate

Resting BP 200/110

RPE 15+

Uncontrolled diabetes Glucose 400+

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22
Q

Post-Op Intervention

A

Mobilize: graviatational stress
Establish cough: prevent aspiration, increase ventilation
Ventilate: improve inspiratory capacity
Ambulate: increase FRC

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23
Q

Phase 1 Cardiac Rehab

A

POD 1: 1-2 METs

  • UE/LE warm upo
  • OOB to chair

POD 2: 2-3 METs

  • UE/LE warm up
  • Ambulate/gait

POD 3-5: up to 3-4 METs

  • ambulate 5-10 min 2-4x/day
  • 1-2 flights stairs
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24
Q

When to treat a DVT?

A

Above knee-> give medication

Below knee->
PE/severe cardiopul compromise? -> meds
DVT with risk limb loss? -> meds

If no->
Active/high bleed risk? -> meds

If no->
Treat!!! compression, early ambulation, meds
With coumadin if proper renal sufficiency

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25
Q

VTE tests

A

Wells prediction rule
Canadian Probability model

D-dimer if prediction rule says

Venous US

Computed tomography

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26
Q

Canadian Probability of DVT

A 
Cancer
Paralysis
Surgery z4 weeks
Thigh swelling
Tendernous
Edema

3+ points= assume DVT and treat with anticoags

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27
Q

Wells Prediction Rule for PE

A 
Sx of DVT
Pulse 100+
4 weeks immob or surgery
Previous DVT/PE
Hemoptysis
Malignancy

High risk 6+= 78% PE
Mod risk 2-6= 28% PE
Low risk 0-1= 3% PE

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28
Q

Heparin/Anticoag Side-effects

A

Bleeding
Hemorrage
Thrombocytopenia: life threatening increase platelet ag
-starts 5-10 days aftery start meds
– look for decrease platelet count 30-50%

Look for:
new pain, discomfort
Joint swelling
Bruising
Falls
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29
Q

Aerobic fitness based off MET levels

A

Low z7.9 -> higher rates mortality/CAD
Intermed: 7.9-10.8
High: 10.8+

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30
Q

Fall RIsk Stratification

A

Fall history 8
Live alone 3
Female 3
4+ meds 3

0-4= low risk
5-10= mod risk
11-16= high risk
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31
Q

Life space mobility assesment

A 
bedroom
home
outside home
neighborhood
town
further

points off of how often and if need help

z60= high risk for disability/ deacreased aerobic capacity

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32
Q

Duke Activity Status Index

A

measures FUNCTIONAL CAPACITY
12 y or no

-estimates VO2 peak

To maintain Independence:
Males: 18+ Vo2= 5.14 METS
Females: 15+ Vo2= 4.3 METS

33
Q

SPPB Components

A

Balance:
side-side >10s= 1 point
semi-tand >10s= 1 point
tandem >10s= 2 points/ 3-9=1 point

Gait Speed:
4M no ramp up best of 2
Up to 4 points based off time

FTSS:
Pre-test first; Repeat 5 times with arms crossed
Up to 4 points based on time
>15 seconds= INCREASED FALL RISKx2

34
Q

SPPB Rresults

A 
0-3= severe limitations
4-6= moderate limitations
7-9= mild limitations
10-12= minimal limitations

0-4 5x increase risk Re-hosp/death
5-7 2.5x increase risk Reposh/death

MCID 1 point = 14% less risk

35
Q

Walking Speed stratification

A

z0.4 m/s longer stays/nursing home or rehab discharge
z0.6 m/s risk hospitalization/falls/dependant in ADLs
>1 m/s dependant ADLS/no risk of falls

Disability factors: cognition, depression, gait speed

36
Q

Hemodynamic Stability

A

Stable last 24 hrs

ACS/myopathy

Sepsis

Casopressors

Cause of compromise

EF

Fluid imbalance

37
Q

Hemodynamic Values

A

Pulmonary artery pressure: 10-20
Central venous pressure: 2-8
Mixed venous sat: 60-80%
CO 5-7

38
Q

Respiratory Stability

A

Oxygen therapy?
- increased over 8 hrs?

Respiratory reserve ratio (PaO2/FiO2)
> 300 to mobilize
-Shows arterial blood oxygenation

SpO2
>90
-STOP 6MWT if under 85
-PaO2 decreases to 60 means at risk for rapid decline in saturation

39
Q

ABGs

A

ph 7.35-7.45
pCO2 35-45 (shows alveolar ventilation)
pO2 80-100 (z60= rapid dissociation)
Bicarb 22-26

40
Q

Primary/Compensatory Acidocis/Alkalosis

A

LOW pH: Acidemia
if High PCO2-> respiratory acidosis (comp met alk)
-hypoventilating
if Low HCO3 -> metabolic acidosis (comp resp alk)

HIGH pH: Alkalemia
if Low PCO2-> respiratory alkalosis (comp met ac)
-hyperventilating
if High HCO3-> met alkalosis (comp resp aci)

41
Q

Hypoxemia PO2

A

80-100 normal
60-80= mild
40-60= mod
z40= severe hypoxemia

42
Q

AFib controlled vs. uncontrolled

A

Vent response less than 100= controlled if no symtoms

>100 response= fast/uncontrolled with symptoms

43
Q

Activity MET guideline Phase 1

A

1-2 METS (day 1):
urinating, sitting, small exercises in bed

2-3 METS (day 2):
bathing, walking short bouts, UE/LE exercises

3-4 METS (day 3-5):
gait, stairs

44
Q

MET level Exercise Frequency

A

3 METS: 2-3x/day
-walking, stationary bike no resistance

3-5 METS: 1-2x/day
-walking, biking, stairs

5-7 METS: 3-5x/week for 20-30 min
-walking, bike, jog

> 7 METS: 5-7x/week for 30-40 min
-anything :)

45
Q

Interventions for Ventilatory Pump Dysfunction

A

UPRIGHT and MOVING!

Positioning/mobility
Correct biomech impairments
Breathing inhibition accessory muscle
Facilitated breathing: pursed lips, diaphragm, sniff, segmental
Clearance techniques
Supplemental oxygen
Exercise retraining
46
Q

Gas Flow Rate Tests

A

Function of lungs, degree of impairment, and location of problem

  • Obstructive: larger capacities
  • Restrictive: smaller capacities

FVC: forced vital
-max amount gas patient exhale quickly

FEV1: forced expir in 1 second

  • exhaled during 1st second FVC
  • shows airflow in larger airways

FEV1/FVC: % vital capacity expired in 1 s

47
Q

Hallmark signs COPD

A 
4 risk factors:
cigarret smoking
>40 y.o.
exposure to chemicals
exposure to pollutants

SOB with phlegm couch/wheezing episodes

  • previous diagnosis of bronchitis, asthma, emphysema
  • increased wheezes or chest tightness
  • brown sputum production
  • episodic deterioration
  • increasing limitations in ADL

Look cakectic (red small) or cyanotic (blue puffer)

48
Q

FEV1 Measurements with Obstruction

Staging of COPD based on FEV1

A

Little/non: >2 L to normal
Mild-mod: 1-2
Severe: z1L

Staging:
I: 50-79% predicted
II: 35-49% predicted
III: z35% predicted

–present with high RR, wheezes, barrel chest, lower SpO2, accessory muscle use, dyspnea, and functional limitations

49
Q

Global Initiative for COPD (GOLD)

A

Symptom based- management, treatment, and impact

Stage I: Mild
smoker cough, little SOB, no clinical signs
FEV1 >80%

Stage II: Mod
SOB on exertion, sputum produced, some clinical signs
FEV1 50-80%

Stage III: Severe
SOB on mild exertion
FEV1 30-50% predicted

Stage IV: Very severe
SOB on mild exertion, RCHF, cyanosis
FEV1 30% predicted

50
Q

FEV1 and Mortality

A

z30% FEV1 predicted = 50% change dying in 2 years
z55% FEV1 showed half of those below died within 5 years
>55% FEV1 96% survived

51
Q

BODE Index

A

Assess risk of death from COPD using weight, obstruction, dyspnea, and exercise capacity

  • BMI
  • FEV1
  • dyspnea score
  • 6MWT
4 year survival:
0-2 points= 80% survival
3-4= 67% survival
5-6= 57% survival
7-10%= 18% survival
52
Q

5 Causes of Hypoxemia

A 
Decreased inspired oxygen
Hypoventilation
Alveolocapillary diffusion problem
V/Q mismatch
Shunting (perfusion without vent)
53
Q

4 Breathing Strategies for increased ventilation

A

Diaphragm:

  • reduce accessory pattern/improve efficiency
  • do it first :)

Pursed-lip:

  • increases positive pressure in airways/promotes effective expiration
  • prevents small bronchioles from collapsing
  • reduces FRC

Segmental:
-localized expansion to specific area

Sustained max inspir:

  • visual/audio feedback
  • prophylaxis/treatment of atelectasis
54
Q

Key pediatric Subjective

A

Birth history
Developmental history
Favorites/interests
Learning preference

Involve family

55
Q

Oncologic Hematologic Guidelins

A

Hematocrit:

  • Normal: 38-47%
  • No exercise z25%

Hemoglobin:

  • Normal: 12-16.9
  • No exercise z8
  • Resistive ex >10
  • Anemia at 10; symptoms at 8-10; still PT but monitor symptoms

Platelets

  • Normal: 200-400k
  • No exercise: z5k
  • Resistance ex > 50k

WBC

  • Normal: 4-10k
  • No exercise: z500

Absolute granulocyte

  • High risk infection: z500
  • Predisposed risk: z1500
  • Protected: >1500
56
Q

Oncology and Electrolytes

A

Sodium: z130 no exercise

Potassium: high or low still exercise; be aware possible muscle weakness

Calcium: Hyper causes weakness; still exercise- ambulation prevents further calcium loss

57
Q

Thrombocytopenia Clinical Exercise Guidelines

A

Platelet normal 150-400k

50-150: PRE, walking, biking no grade

ALL below 50k at risk for bleed!

30-50: AROM, walking, aquatics, bike

20-30k: light AROM, walking

z20K: minimal AROM, ADL as tolerated

58
Q

Hemoglobin Oncology Guidelines

A

Hemoglobin:

  • Normal: 12-16.9
  • No exercise z8
  • Resistive ex >10
  • Anemia at 10; symptoms at 8-10; still PT but monitor symptoms
Ex Intol Symptoms:
tachy
decreased DBP
dyspnea on exertion
gait disturbances
patesthesia
pallor
angina
59
Q

Neutropenia Oncology

A

Normal WBC 4.8-10.8k

5k: light exercise with progression as tolerated
z5k with fever: None
z1k: protective match/no activity

Guidelines:
Wear mask
No fresh produce/flowers
No contact with kids, URI people, big environment

60
Q

Exercise Contraindication Oncology

A 
Irregular pulse; resting >100
Recurring leg pain/cramps
Chest pain/SOB
Acute nausea
Disorientation/confusion
Bone, back, neck pain not relieved with rest
Fever
Unusual fatigue/weakness
61
Q

Cancer Related Fatigue Intervention

A

Manage contributing factors: blood counts, nutrition, sleeping
Energy conservatioin techniques
Short bouts exercise
Schedule exercise around high energy time
Aerobic and strength training

62
Q

Excercise Treatment Goals Oncology

A 
First 3 months post treatment:
40-65% HR max
Post-3 months:
65-80%
6 months post:
above 80%

30-40 min aerobic 3x/day
2 day/week resistance

2-6 min intervals with 1-2 min rest 2-3x/day initially
RPE 11-14
No angina, exertional dyspnea

63
Q

Breast Cancer Interventions

A 
STM: skin, scar, fibrosis
Mobs: grade II or III
ROM
Strengthening: decreases fibrosis
Cores stability
Neuromusc

NO heat or manips

64
Q

Key Subjective Lymphedema

A

Where/when did swelling first start? Oncolog prox to dist
Better with elevation/exercise?
SINS of swelling
History of heart, kidney, liver disease
History of injections? Risk due to stagnant fluid
History blood clots? Probs with veins or arteries
Med changes recently?

65
Q

Purpose of MLD

A 
Stimulate superficial vessels
Create negative pressure gradient
Stimulate lymph-angion contraction
Promote reobsorption of protein molecules
Promote mvnt to healthy quadrant
66
Q

MLD Contraindications

A 
Untreated acute infections
Undiagnosed malignancies
Uncontrolled CHF
Recend PE
Acute TB, Renal failure, DVT
67
Q

Purpose of Compression therapy

A

Increasing pressure/mechanical force on body part
Reduces edema, improves circulation, and remodels scar tissue

Pressure= tension/diameter

68
Q

Compression Contraindications

A 
ABI 0.6-0.8 without MD consent/z0.6
Untreated CHF, pulmonary edema
Kidney disease
Obstructed lymph nodes
Infection
Fractures
Arterial insufficiency
Undiagnosed blood clots
69
Q

Compression Pressure Guidelins

A

20-30
varicose veins, DVT, mild edema, leg fatigue, lymphedema

30-40
severe varicose, mod CVI, lipidema, lymphedema (with or without CVI)

40-50->60
Severe CVI, lipidema lymphedema, lymph with CVI

70
Q

Stages of lymphedema

A

0- latency
Reabsorption less than filtration but not symtoms

Stage 1
Disapears with bed rest/elevation
Soft pitting with minimal resistance to pitting
No stemmer
Small protein accumulation
Stage 2
Protein rich edema 
No decrease at night/elevation
CT/scar formation, becomes hard
Non-pitting edema with normal pressure
Positive Stemmer
Stage 3
CT/scar proliferation
Hardening of dermal tissue
Significant increase fibrosis
Difficult to pit, refils RAPIDLY
Fat deposits at joint sulci
Thick protein tissue with collagen
Positive stemmer
71
Q

ABI Result interpretation

A

> 1.3 not reliable measure
seen in diabetes/arthosclerosis patients; use great toe pressure (normal >55mmhg; TBI 0.8-0.99 normal)

1-1.2 normal

  1. 8-1 minimal arterial disease; compression safe
  2. 6-0.8 Moderate arterial disease; possible intermitant claudication refer to MD for compression
    z0. 6 severe ischemia with resting pain NO compression
72
Q

HbA1C Risk levels

A 
4-6 (60-125bg) : normal/no risk
6-7 (125-155): some risk
7-8.4 (155-195): monitor closely/take action
8.5-10 (195-250): elevated/take action
10.5+ (z250): seriously elevated
73
Q

Blood Glucose Control Levels

A

Pre-diabetes Impaired fasting glucose: 110-126
Diagnosis diabetes fasting: >126
Wound healing needs z200

Hb1Ac 6.5+ diagnose diabetes!!

74
Q

Diabetes Contraindication to Exercise

A

Active retinal Hemorrage/recent retinotherapy
Illness or infection
Glucose >250 and ketones present
Glucose z70- hypoglycemic risk

75
Q

Skin Surface temps and wounds

A

4+ compared to other foot= potential for ulceration (Charcot)– restrict activity

Periwound temp 3+ other= infection

76
Q

Deep Compartment Wound

A 
Size increasing
Temperature
Osteomy
New wound
Erythmia
Edema
Smell

3 or more= systemic therapy

77
Q

Superficial Compartment Wound

A 
Nonhealing
Exudate
Redness
Debris
Smell

3 or more= treat topical

78
Q

Post-Op Amputation Protocol

A

24-48hrs sterile dressings
Once epithelial dressings optional
Healing ridge by day 5

Bed rest 7-10 days depending on surgeon/healing
Focus on uninvolved extremities

79
Q

Reasons for compression Post-amputation

A

Control edema
Shape residual limb
Pain control

CP Clin Management (8 decks)

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