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Kin 187 > Health Screening and Risk Factor Analysis > Flashcards

Health Screening and Risk Factor Analysis Flashcards

1
Q

What were the old guide lines for Exercise preparticipation Health Screening (7 steps)

A
  1. Determine readiness
  2. Identify signs and symptoms of disease
  3. Coronary/atherosclerotic cardiovascular risk factor analysis
  4. Disease risk classification
  5. Medical History
  6. Lifestyle history
  7. Informed Consent
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2
Q

What are the new guidelines for Exercise Preparticipation Health Screening (6 steps)

A
  1. The individuals current level of structured PA
  2. The presence of major signs and symptoms suggestive of CV metabolic or renal diseases
  3. Desired exercise intensity
  4. Medical history
  5. Lifestyle history
  6. Informed consent
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3
Q

What is the purpose of health screening

A

There is risk inherent in any exercise program or exercise test

Detailed knowledge of your clients background and medical status allows you to prescribe exercise more effectively

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4
Q

What is step 1 (PARQ)

What is the purpose of it

What type of method is it

What does it involve

A

Determine readiness of activity

Purpose: To determine clients readiness for physical activity

Self guided method

7 questions
Identifies who needs medical clearance before fitness testing or exercise program initiation
One single yes means that medical clearance is required
No means you are ready to be physically active

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5
Q

What is step 2

What is the purpose of it

What is the definition

A

Identify signs and symptoms of disease

To identify those in need of medical clearance

Disease definition
Any established cardiovascular pulmonary or metabolic disease or symptom thereof

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6
Q

What are known diseases for CVD

A

Cardiac, peripheral artery (PAD)

Cerebrovascular disease (stroke)

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7
Q

What are known diseases for pulmonary

A

Chronic obstructive pulmonary disease (COPD)

Asthma

Interstitial lung disease

Cystic fibrosis

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8
Q

What are known diseases for metabolic

A

Diabetes

Thyroid disorders

Renal or liver disease

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9
Q

Is hypertension considered a known established cardiovascular disease

A

No

This is a risk factor that may or soon cause the previous disease - it is not a disease

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10
Q

Is obesity a disease

A

No

It is a risk factor

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11
Q

What are the major signs or symptoms suggestive of cardiovascular metabolic and renal disease

A

Pain/discomfort in chest, neck, jaw, arms or other areas that may result from ischemia

Shortness of breath

Dizziness or syncope

Orthopnea or paroxysmal nocturnal dyspnea

Ankle edema

Palpitations or tachycardia

Intermittent claudication

Known heart murmur

Unusual fatigue or dyspnea

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12
Q

The pain symptom has a ischemic origin if

Character:
Location:
Provoking factors:

A

Character: Constricting, squeezing, burning, heaviness

Location: Substernal, across midthorax, anteriorly in one or both arms, in neck, cheek, teeth, forearms, fingers, interscapular region

Provoking factors: Exercise or exertion, excitement, other forms of stress, cold weather, occurence after meals

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13
Q

What is ischemia

A

Lack of blood flow

Cells dying and causing pain

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14
Q

Dyspnea symptoms signs:

Classification/significance:

A

Shortness of breath at rest or with mild exertion

  1. An abnormally uncomfortable awareness of breathing
  2. One of the principal symptoms of cardiac and pulmonary disease
  3. During strenuous exertion in health well trained individuals
  4. During moderate exertion in healthy untrained individuals
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15
Q

What does dyspnea suggest the presence of

A

Left ventricular dysfunction

Chronic obstructive pulmonary disease

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16
Q

What is dyspnea

A

Shortness of breath

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17
Q

Syncope signs/symptoms

Classifications/significance:

A

Dizziness or feeling faint

  1. Loss of consciousness
  2. Caused by reduced perfusion of the brain
  3. Result from cardiac disorders during exercise that prevent the normal rise or fall in cardiac output
  4. May occur in healthy individuals as a result of a reduction in venous return to the heart
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18
Q

What are the ways to increase venous return

A

Skeletal pump
Respiratory pump
Contractility of the veins - vasoconstriction

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19
Q

Orthopnea signs/symptoms

Classification/significance

Symptoms of:

A

Orthopnea or paroxysmal nocturnal dyspnea

  1. Orthopnea - dyspnea occuring at rest in the recumbent position
  2. Paroxysmal nocturnal dyspnea - dyspnea beginning usually 2-5 hr after the onset of sleep

Symptoms of:
Left ventricular dysfunction
Sometimes COPD

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20
Q

Ankle edema:

Classification/significance:

A

Flow limited

  1. Bilateral ankle edema at night - sign of heart failure or bilateral chronic venous insufficiency
  2. Unilateral edema - from venous thrombosis or lymphatic blockage
  3. General edema - nephrotic syndrome, severe heart failure or hepatic cirrhosis
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21
Q

Bilateral ankle edema at night is a sign of

A

Heart failure or bilateral chronic venous insufficiency

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22
Q

Unilateral edema comes from

A

Venous thrombosis

Lymphatic blockage

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23
Q

General edema is a sign of

A

Nephrotic syndrome

Severe Heart Failure

Nepatic cirrhosis

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24
Q

Classification/significance of Palpitations and tachycardia

What is it often a result from:

A
  1. Palpitations - unpleasant awareness of forceful or rapid beating of the heart
  2. Tachycardia, bradycardia of sudden onset

Result from anxiety state or high cardiac output state

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25
Intermittent claudication classification/significance Also known as: Often due to:
The pain that occurs in a muscle with an inadequate blood supply that is stressed by exercise Cramping Due to: Atherosclerosis Coronary artery disease
26
Classification/significance of heart murmur
Valvular or other cardiovasuclar disease 1. hypertropic cardiomyopathy 2. aortic stenosis 3. Cause of exertion-related sudden cardiac death
27
What are the ACSM preparticipation algorithm components (4)
Classify individuals who do or do not regularly exercise Identify individuals with known CV, metabolic or renal diseases Identify individuals with signs/symptoms suggestive of cardiac peripheral vascular, type 1/2 diabetes and renal disease Identify desired exercise intensity
28
Someone who does not regularly exercise and has No CV, metabolic or renal disease AND no signs or symptoms requires...
No medical clearance Light to moderate exercise May progress to vigorous intensity exercise
29
Someone who does not regularly exercise and has known CV, metbolic or renal AND Asymptomatic requires...
Medical clearance After medical clearance, light to moderate May progress as tolerated
30
Someone who does not regularly exercise and has known CV, metbolic or renal AND has signs/symptoms requires...
Medical clearance After medical clearance, light to moderate May progress as tolerated
31
What are the 3 steps of diagnosing
1. Does the person physically exercise 2. Medical History 3. Have sign or symptoms
32
Exercise professionals working with patients with known CVD in exercise based cardiac rehabilitation and medical fitness setting are advised to...
Use more in depth risk stratification procedures
33
Risk stratifications for patients with CV disease is broken down into...
Lowest risk Moderate risk Highest risk
34
What are the characteristics of patients at lowest risk for exercise participation WITH EXERCISE TESTING
Absence of complex ventricular dysrhythmias during exercise testing and recovery Absence of angina or other significant symptoms Presence of normal hemodynamics during exercise testing and recovery Functional capacity is >= 7 metabolic equivalents (mets)
35
What are the characteristics of patients at lowest risk for exercise participation WITH NON EXERCISE TESTING
Resting ejection fraction >= 50% Uncomplicated myocardial infarction or revascularisation procedure Absence of: 1. Complicated ventricular dysrthmias at rest 2. Congestive heart failure 3. Signs or symptoms of post event/post procedure ischemia 4. Clinical depression
36
What are the characteristics of patients at Moderate Risk for exercise participation WITH EXERCISE TESTING
Presence of angina or other significant symptoms - shortness of breath, light headedness/dizziness orcuring only at high levels of exertion (>= 7 mets) Mild to moderate level of silent ischemia during exercise testing or recovery (ST segment depression <2mm from baseline) Functional capacity < 5 mets
37
What are the characteristics of patients at Moderate Risk for exercise participation WITH NON EXERCISE TESTING
Rest ejection fraction 40% to 49%
38
What are the characteristics of patients at Highest Risk for exercise participation WITH EXERCISE TESTING
Presence of complex ventricular dysrythmias during exercise testing or recovery Presence of angina or other significant symptoms at low levels of exertion (< 5 METS) High level of silent ischemia (ST segment depression >= 2mm from baseline) Presence of abnormal hemodynamics with exercise testing or recovery
39
Presence of abnormal hemodynamics with exercise testing (highest risk) involves with recovery involves
Chronotropic incompetence or flat/decreasing systolic BP with increasing workloads Severe post exercise hypotension
40
What is post exercise hypotension
Dramatic reduction in blood pressure
41
What are the characteristics of patients at Highest Risk for exercise participation WITH NON EXERCISE
Rest ejection fraction <40% History of cardiac arrest or sudden cardiac death Complex dysrhythmias at rest Complicated myocardial infarction or revascularisation procedure Presence of congestive heart failure Presence of signs or symptoms of postevent/postprocedure ischemia Presence of clinical depression
42
With the different risk categories what does the person have to have in order to put them in a certain category
At least one of the issues to deem them that category
43
Hypertension new report as of 2017 has... Which are
2 stages stage 1: SBP 130 - 139 mmHg OR DBP 80 - 89 mmHg Stage 2: SBP >= 140 mmHg OR DBP >= 90 mmHg
44
The new 2017 report states that SBP and DBP are for: Normal Elevated Hypertension 1 Hypertension 2
Normal SBP < 120 mmHg AND DBP < 80 mmHg Elevated SBP 120 - 129 mmHg AND DBP < 80 mmHg Hypertension 1 SBP 130 - 139 mmHg OR DBP 80 - 89 mmHg Hypertension 2 SBP >= 140 mmHg OR DBP >= 90 mmHg
45
What is step 3
Preparticipation screening algorithm Risk factors Risk stratification for patients with CVD
46
What is a risk factor
Sign, symptom or characteristic that increases or decreases the chance of developing a disease
47
What is a positive risk factor What is a negative risk factor
Increase risk of disease Decrease risk of disease
48
What is step 4
Medical history
49
What does medical history involve
Medical diagnosis Previous physical examination findings History of symptoms Recent illness, hospitalisation, new medical diagnoses, surgical procedures Orthopedic problems Medication use including supplement including supplements and drug allergies Other habits like caffeine alcohol tobacco or drugs Exercise history Work history Family history
50
What is step 5
Lifestyle evaluation
51
What is involved with lifestyle evaluation
What physical activity are they doing Other lifestyle behaviours and habits e.g. smoking, diet and alcohol
52
What is step 6
Informed consent
53
What is the purpose of informed consent What questions should they ask
To explain the risks and benefits of the assessment and to obtain permission for participation What is the risk? What is a benefit? When to terminate the testing?
54
You don’t participate in regular exercise. And, you don’t have any known CV, metabolic or renal disease AND no signs or symptoms suggestive of these diseases. Following ACSM preparticipation screening algorithm, your recommended exercise intensity is moderate to vigorous level
False
55
Clint has a coronary artery disease, and he had an exercise testing at the cardiac rehab. The testing result indicates that he had 1.5mm of ST segment depression during exercise testing. He is at _______ based on risk stratification criteria
Moderate risk
56
Having dyspnea typically suggests the presence of ____
Left ventricular dysfunction
57
If your patient has unilateral edema, it indicates that he/she may have lymphatic blockage
True
58
________ is shortness of breath at rest in the recumbent position and is suggestive of cardiovascular disease
Orthopnea
59
Dona is a 54 years old woman and her father had a heart attack when he was 45 years old. Her risk factor for family history is ______
Positive Present
60
According to the new report from American Heart Association, Stage 1 hypertension is determined if
SBP is between 130 and 139 mmHg or DBP is between 80 and 90 mmHg
61
If your client’s HDL level is 45 mg/dL, his risk factor for dyslipidemia is absent neutral
True
62
Your client’s body weight is 220 lbs and height is 5’9’’. What is his body mass index
33 kg/m^2
63
You forgot to record your client’s weight and height on the file, but recorded information on gender and waist circumference. Can you identify your client’s risk factor for obesity
Yes
64
Your client’s body weight is 220 lbs and height is 5’9’’. How does the BMI classify the level of obesity
Obese Class 1
65
What is graded exercise test recognised for
Detection of CAD in people with CHEST PAIN syndromes or potentially equivalent symptoms Evaluation of the anatomic and functional severity of CAD Prediction of CV event and all cause death Evaluation of physical capacity and effect tolerance Evaluation of exercise related symptoms Assessment of chronotropic competence, arryhthmias and response to implanted device therapy Assessment of the response to medical interventions
66
CDD4 recommendations for evaluation of physical functions states that patients at a minimum should be able to:
6 or 8m gait > 0.6m/s 8 sit to stand repetitions in 30 secs 8 arm curls with a 4kg mass Ascending a flight of 10 steps in under 30s Chair sit and reach to the toes on both sides
67
What are the recommendations for activity when Test Not Available for aerobic training
Activities in the range of 2 to 4 METs Exercise HR = resting HR +20 contraction/min RPE no higher than 11 to 14 Start slow, go slow, and be alert for symptoms
68
What are the recommendations for activity when Test Not Available for strength training
2 sets of 30s of sit-to-stand repetitions 2 sets of 8 arm curls with 4kg mass 10 step ups 2 times Chair sit and reach 2 times, holding for 30 secs
69
Intensity of physical activity and breathing for: Light Moderate Vigorous High
Light = 1.5-3 METs Barely detectable increased depth Moderate = 3-6 METs Can pass the talk test Vigorous = 6-9 METs Cant pass the talk test High = > 9 METs Heavy breathing
70
What is Step 1 of the essential steps for exercise programming
Step 1: Assess current health status (history of the disease, current symptoms and physical and cardiovascular restrictions and treatments)
71
What is Step 2 of the essential steps for exercise programming
Step 2: Assess current level of physical activity
72
What is Step 3 of the essential steps for exercise programming
Identify exertional symptoms that limit physical activity
73
What is Step 4 of the essential steps for exercise
Evaluate physical function and performance Mildly impaired to normal = >=6 METs Moderately impaired, low functioning = 4-5 METs Severely impaired, very low functioning = 3-4 Mets Needs aid, debilitated = <=3 METs
74
What is Step 5 of the essential steps for exercise programming
Select recommended physical performance assessments
75
What are the commonly used tests of physical functioning
``` Walking test Gait speed test Core and lower extremity functional test Chair to stand test Timed up and go test Arm curl test ```
76
Someone who regularly exercises, has no CV, metabolic or renal disease AND no signs or symptoms what is required
Medical clearance not necessary Continue moderate or vigorous intensity exercise May progress following ACSM guidelines
77
Someone who regularly exercises, has known CV, metabolic or renal disease AND Asymptomatic
Medical clearance for moderate intensity exercise not necessary Medical clearance (within the last 12 months if no chance in signs/symptoms) recommended before engaging in vigorous intensity exercise Continue with moderate intensity exercise Following medical clearance may progress as tolerated
78
Someone who regularly exercises, has signs or symptoms regardless of disease status is required
Discontinue exercise and seek medical clearance May return to exercise following medical clearance Progress as tolerated

Kin 187 (21 decks)

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