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CAPE: Med Cond 1 > Intervention > Flashcards

Intervention Flashcards

1
Q

Pulmonary rehab objectives

A

Pt. education
- disease process
- medications
- risk factor reduction (smoking cessation)
- stress management
- energy conservation

Exercise training
- flexibility/posture
- strength
- balance
- inspiratory muscle training

Breathing retraining and ACT
Psychosocial screen
Nutrition

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2
Q

Pulmonary rehab FITT

A

Frequency: daily or 3-5x/week

Intensity: RPE goal of 3-5
- all other VS are normal
- moderate to severe
- are symptoms SOB or weakness
- oxygen >/= 89%

Time: Progress to >/= 150 min/week moderate intensity

Type: interval training (!!), ADL retraining, aerobic, progressive resistance training, IMT

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3
Q

Pulmonary rehab benefits

A

reduced dyspnea
improve endurance/strength
improved health-related QOL
reduce readmission rate and hospital length of stay

DOES NOT improve PFT

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4
Q

Pulmonary STOP criteria

A

RPE > 5
SpO2 <89%
- consider breathing device/pattern

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5
Q

Cardiac rehab: Phase 1

A

Acute/hospital based

Immediately after cardiac event and confirmed pt. stability (24-48 hrs)

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6
Q

Cardiac rehab: Phase 1 GOALS

A

Evaluate physiologic response to self-care and ambulation activities

Achieve 3-5 METS activities (assess pt. response)

Provide guidance for safe progression of activity during recovery

Education
- risk factor modification
- self-monitoring techniques (HR, RPE, symptoms)
- activity guidelines (HEP)

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7
Q

Cardiac rehab: Phase 1 FITT

A

Frequency: daily

Intensity: RHR +20-50 bpm
- assume RHR is normal
- maintain <75% of 220-age (+/- 10-20 bpm)
- guideline: HR increases ~5-15 bpm/MET
- RPE 2-3 (light to moderate)

Time: >150 min/week light to moderate intensity

Type: AROM to light intensity resistance; progressive mobilization/ADL retraining
- bed mobility, transfers, gait, stairs

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8
Q

Cardiac rehab: Phase 2

A

Subacute (1-3 weeks following discharge)

36 session
2-3x/week for 12 weeks
ECG monitoring
Supervised exercise program
Structured education series

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9
Q

Cardiac rehab: Phase 2 FITT

A

Frequency: 3-5x/week

Intensity: target HR = %(0.5-0.85) x HRmax
- HRmax via 220-age or exercise test

Time: >/= 150 min/week moderate intensity

Type: aerobic, resistance training

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10
Q

Cardiac rehab benefits

A

Slow/reverse atherosclerotic disease
Decrease obesity
Improve cholesterol profile
Decrease inflammation
Improve mental health
Improve mortality

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11
Q

Exclusions to cardiac rehab

A

Unstable angina
Class IV heart failure
Uncontrolled sustained tachy or brady
Symptomatic aortic or mitral stenosis
Severe pulmonary hypertension
Conditions that could be aggravated by exercise

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12
Q

Cardiac STOP criteria

A
  • Systolic BP drops >10 mmHG w/ increasing workload
  • Diastolic changes > 10 mmHg
  • > 75% AAMPHR +/- 10-20 bpm
  • > 15 bpm/MET
  • Unstable angina or related referred pain
  • Desaturation
  • RPE > 7
  • Signs of inadequate CO
    – dizziness/pallor
    – confusion/balance changes
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13
Q

Sternal precautions

A

Weight restrictions: 5-10 lbs
UE ROM: stay in “tube”
Driving: 6-8 weeks
Wound/incision: “sternal click,” infection
Bracing w/ cough

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14
Q

ACT/BE indications

A

Productive cough >30 mL sputum/day
Disorders associated w/ hypersecretion of mucus (CF, bronchiectasis, COPD)
Ineffective mucociliary clearance or cough
Immobility/weakness
Dysphagia, frequent aspiration, reflux

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15
Q

ACT/BE contraindications

A

Unstable head/neck injury
Active hemorrhage
Bleed abnormalities (increased INR)
Recent pacemaker insertion
Burn or skin graft at chest

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16
Q

ACT/BE relative contraindications

A

hemoptysis
intracranial pressure
hypoxemia/hypoxia
vomiting/aspiration
acute hypotension
chest wall pain, incision, injury (recent surgery)
osteoporosis
dysrhythmias

17
Q

Airway clearance techniques

A

Cough and huff
Chest PT (not in CAPE)
Active cycle of breathing

18
Q

Cough and huff steps

A

Forced expiration w/ an open glottis

Steps:
- Sit w/ chin slightly upward
- Use diaphragm to breathe in slowly
- Hold breath for 2-3 second
- Huff breath out of mouth in one quick burst of air

19
Q

Active cycle of breathing steps

A

Steps 1: breathing control
- Diaphragm breathing through nose, 3-5x

Step 2: thoracic expansion
- Deep breathing through nose followed by 2-3 sec inspiratory breath hold

Step 3: forced expiratory technique
- Huffing

Step 4: repeat

20
Q

ACT precautions

A

Worsening SOB
hypoxemia/desaturation
Pain/injury to chest wall or spine
Dysrhythmias
Nausea/vomiting
Bronchospasm

21
Q

Breathing exercises

A

Diaphragm breathing
Deep breathing (incentive spirometry)
Segmental/lateral costal breathing techniques
Pursed lip breathing
Inspiratory muscle training

CAPE: Med Cond 1 (5 decks)

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