LC 1- Spring 2025 Flashcards
1
Q
things to know about motivational interviewing
A
- engage with them
- focus on the goal
- ask evocative Q’s
- utilize an importance ruler
- utilize confidence ruler
- make a plan “together”
2
Q
what does RCR stand for in behavior change?
A
Routine I want to change
Cue to action
Reward I get now/later
3
Q
what are SMARTER goals
A
Specific
Measurable
Achievable
Relevant
Time-bound
Alternatives
Reward
4
Q
how can we overcome barriers to exercise with clients?
A
have a plan B from day 1. Life happens so have something to fall back onto
5
Q
how can we get clients from precontemplation to contemplation
A
-Provide pts with info about benefits of regular physical activity
- Discuss how some perceived barriers may be misconceived
- Have client visualize what they would feel like if they were physically active with an emphasis on short-term, easily achievable benefits of activity such as sleep better, reduce stress, and have more energy
- Explore how their inactivity impacts individuals other than themselves such as their spouse or children
6
Q
how can we help clients move from contemplation to preparation
A
- Explore potential solutions to their activity barriers
- Assess level of self-efficacy and begin techniques to build efficacy
- Emphasize importance of small steps in progressing toward being regularly active
- Encourage viewing oneself as healthy, physically active person
7
Q
how can we help clients move from preparation to action
A
- Help develop appropriate plan of activity to meet physical activity goals and use goal setting worksheet or contract to make it formal commitment
- Use reinforcement to reward steps towards being active
- Teach self-monitoring techniques such as tracking time and distance
- Continue discussion of how to overcome any obstacles they feel are in their way of being active
- Encourage them to help create an environment that helps remind them to be active
- Encourage ways to substitute sedentary behavior with activity
8
Q
how can we help move clients from action to maintenance
A
-provide positive and contingent on goal process
-explore different types of activities they can do to avoid burnout
-encourage working with and even helping others become more active
-discuss relapse prevention strategies
-discuss potential rewards that can be used to maintain motivation
9
Q
self-motivation scale for compliance or adherence scale- what do the scores mean
A
higher score=more compliant
24 is the cutoff
10
Q
what is steady-state HR
A
the point during exercise when your heart rate plateaus and remains relatively consistent. this typically occurs during moderate-intensity activities where your body can efficiently supply oxygen to your muscles
10
Q
what are the equations for target weights for clients based on current weight and fat %
A
fat mass= (% fat/100) x body mass (kg)
fat-free mass= body mass-fat mass
target weight at ____% fat = FFM / 1-target % fat in decimal form)
11
Q
when does steady-state HR occur and how do you know?
A
HR stabilizes and is within 5-10 bpm between work zones
12
Q
how should SBP change during exercise? How much per MET?
A
SBP should increase 5-7mmHg per MET by min 2-3
13
Q
how much should DBP change during exercise? how much per MET?
A
DBP should not change more than + or - 10 mmHg from start to end of test
14
Q
how should HR change during exercise and how much per MET?
A
HR should increase 10 b/min per MET by 2-3 min
15
Q
How should METS change during exercise? How much per MET?
A
METs should increase as the intensity of the activity increases. meaning the harder you work, the higher your MET value will be, indicating a greater energy expenditure
16
Q
how should MAP change during exercise?
A
increase (CO increases)
17
Q
how should VO2 change during exercise? how much her MET?
A
VO2 (oxygen uptake) should generally increase as the intensity of the exercise increases, reaching a steady state at a moderate intensity, and then potentially showing a gradual upward drift at higher intensities, especially if the exercise is prolonged
18
Q
convert CO2 to METs and prescribe exercise using reserve equation
A
1 MET= 3.5 ml/kg/min
to get L/min: (3.5 x VO2max)/1000
L/min x 5=calories burned
reserve equation: target=[(max-rest) x intensity] + rest
19
Q
how does muscle mass affect VO2 max?
A
more muscle mass has the potential for a higher vo2 potential. Muscles are primary tissue that consumes oxygen during exercise; therefore, a greater muscle mass allows for a higher oxygen uptake during physical activity
20
Q
signs and symptoms of CV, metabolic, and renal disease
A
-intermittent claudication
-dizziness or syncope
-unusual SOB or fatigue with usual activities
-murmurs
-pain, discomfort in chest, neck, jaw, arms, or other areas that may result from myocardial ischemia
-shortness of breath at rest or with mild exertion
-orthopnea or paroxysmal nocturnal dyspnea
-ankle edema
-palpations of tachycardia
21
Q
cardiac risk factors
A
HBP, high cholesterol, obesity, physical inactivity, smoking, diabetes, poor diet, excessive alcohol consumption, stress, age, family Hx, gender, race
22
Q
identify concepts of submax exercise test
A
using standard protocols, predicting VO2 max based on linear relationship between heart rate and oxygen consumption
23
Q
Bruce protocol treadmill test
A
-prepare client and calculate predicted max HR
-obtain standing pretest resting physiological data
-obtain HR or ECG data each min and BP data in the last 3 min of each 3-min exercise stage
-client rates perceived exertion, angina, dyspnea, and claudication the last min of each state, or as needed
-holding handrails or leaning on front or side during testing is discouraged. if unstable, just rest hand on rails
24
Ebbling treadmill test
two 4 minute workloads
1st workload= increase elevation 0-5%(workload between 2.5-4 mph)
2nd workload= (workload stays the same)
take vitals at 8 minute mark, plug into equation
25
6 MWT hallway
- Instruct clients to avoid eating, drinking caffeinated beverages, or smoking for 2-3 hours prior to the test
- Instruct client that they may stop the test at any time
- Instruct the client that you may stop the test at any time
-Instruct the client to share if they are having any difficulties and show them the various appropriate scales
Walk Tests:
- Affix Stethoscope and BP cuff
- Measure pre-exercise HR, BP, O2sat
- Have tape available to mark floor for end-point
- Have RPE, other scales available (angina, SOA, IC, etc.)
- Measure total distance and if possible, at 1, 2, 4-min
26
6 MWT treadmill
1% grade on treadmill
client controls speed- walk as fast as they can as far as they can
record distance covered put into equation
VO2max (L/min)= [-1.732 + (weight (kg) x 0.0490] + (distance (m) x 0.005) + (HR (bpm) x -0.015)
27
list procedures and equation for using the PFA and PAR surveys to predict VO2max
predicted VO2max= 48.073 + (6.17779 x gender (0-F, 1-M)-0.2463(age)-0.6186(BMI)+0.715(PFA)+0.679(PAR)
28
why would you stop a 6 MWT?
- SBP drops >10 mmHg from baseline with increase in workload
- SBP rise to >250 and DBP rise to >115
- Necessary Equipment Malfunction
- HR fails to increase as workloads increase
- Angina (or like symptoms)
- Asks to stop
- SOB, leg cramps, wheezing, fatigue, dizziness, loss of balance
- Light headedness, confusion, ataxia, pallor, cyanosis, nausea, cold clammy skin
29
how to perform PA-R
have pt select the number that best describes their overall level of physical activity for the previous months
30
how to perform PFA
have patient select how fast they could complete a mile and 3 miles without becoming breathless or overly fatigued
31
performing DASI
questionnaire and score will range from 0-58.2, higher score indicates greater functional capacity
32
what is the duke activity status index?
patient reported estimate of functional capacity, VO2 max, and METS
scores range 0-58.2 which is linearly correlated with patient's VO2 max and max METS
33
who is the duke activity status index for?
cardiac and pulmonary patients
34
signs and symptoms of peripheral arterial disease
*Loss of hair on the leg
*Erectile dysfunction
*Ulcers on the toes, feet, or legs -cookie cutter, deep
*Red, yellow, black sores, no bleeding
*Red dangling, pale elevated
*Poor toenail growth
*Leg, foot or toes cool/cold to the touch
*Skin changes such as: brittle, thin, shiny, or reddish blue discoloration on the legs and feet.
*Lateral ankle, feet, heels, toes
*Pain or cramping in the calf, thigh or buttocks during activity that disappears when at rest
*Pain with leg elevation
*Pain at night
35
signs and symptoms of peripheral venous disease
*Aching, throbbing
*Heaviness
*Itching
*Burning sensation in the calf or thigh
*Restless Legs
*Swelling in in the legs, ankles, or feet
*Numbness/tingling in the legs
*Difficulty standing for long periods of time
*Ulcer(s) - medial tibial shaft
*Ulcers(s) - shallow, large irregular margins
*Brown colored skin (often near ankles)
*Bleeding, hard skin, scab/flaking, swelling, inflame, discharge
*Cramping, usually at night or in the evening
*Bulging varicose veins or spider veins
*Not painful unless infected
Pain relief with elevation
36
how are signs and symptoms different from pt hx in arterial vs venous disease
patient hx provides context for signs and symptoms
37
what vessels are most elastic
aorta
38
what vessels are least elastic
capillary/venule
39
describe anatomy of vessels and accompanying smooth muscle
-muscularity of arteries
artery> vein, arteriole and terminal arteriole>venule
smooth muscle:
-artery
-terminal arteriole
-arteriole
40
diameter of vessels from greatest to least diameter
vena cava, aorta, vein, artery, arteriole, venule, terminal arteriole, capillary
41
describe capillary anatomy
diameter of 8um
wall thickness of 1um
42
describe artery anatomy
diameter of 4mm
wall thickness of 1mm
made mainly of smooth muscle but contains elastic tissue and some fibrous tissue
43
describe vein anatomy
diameter of 5mm
wall thickness of 0.5mm
composed of elastic, fibrous, and smooth muscle
44
describe relationship between blood flow and blood velocity
velocity= flow/area
when flow>area, velocity is high
when flow is
45
Q=change P/R is what and how can it be manipulated
Ohm's law, which states flow (Q) is equal to change in pressure divided by resistance
46
C= change V/change P is what and how can it be manipulated
compliance (ratio of change in volume to change in pressure)
47
how/why does compliance change with volume and pressure in veins, arteries, and old arteries
compliance describes distensibility, veins have higher compliance than arteries
aging arterial compliance low
old arteries have same volume of blood as younger arteries but as higher pressure (why old people have elevated blood pressures)
48
Describe how pressure, flow, and blood velocity change from aorta-->capillary
In the aorta, velocity and pressure are both high (at their highest point) while the cross sectional area is very low (blood volume is at threshold)
In the capillaries, the velocity and the pressure both decrease (velocity more than pressure) while the cross sectional area shoots up to its highest point and blood volume is rising
Once in the vena cava, the pressure and cross sectional area are both at their lowest, the velocity has gone back up again, and the volume of blood goes back to threshold
Blood volume reaches it peak in the SV
Arterial velocity is high because area is low
Arteriole velocity is decreasing as area and resistance is increasing
Capillary and venous velocity is low due to great area
49
identify vessels that allow for major pressure drops
arterioles due to increased resistance- smooth muscle (provides greatest resistance to flow)
50
ID pressures within all vessels and explain the differences
Pressure is highest in the aorta and left atrium then slowly decreases in the SA node then shoots down once it gets in the arteries then slowly continues to decrease from the capillaries all the way to the vena cava
51
Discuss permeability of vessels and again, where is it greatest and why? X-sectional area and velocity
The greatest permeability is in the capillaries because that is where the velocity is at its lowest, the blood pressure is also very low (still decreasing), the blood volume is rising and the cross sectional area is at its highest.
This allows for there to be more gas and nutrients exchange with all the extra cross-sectional area and space
52
MAP equation
MAP= DBP + 0.33 (SBP-DBP)
53
cardiac output equation
CO= MAP - TPR (total peripheral resistance)
CO= HR x SV
54
TPR
MAP/CO
55
When it comes to changing BP, why is radius and resistance so important
Because radius and resistance have an inverse proportionality
When a vessel radius increases, resistance to flow decreases and pressure decreases so this can cause someone to become lightheaded
56
How does MAP change if SBP/DBP changes?
MAP = ((SBP - DBP)x.33) + DBP. If either SBP or DBP increases, then MAP would increase. Therefore, MAP decreases if SBP or DBP decreases.
57
Describe how nitroglycerine would affect patient care (pt sits down --> vasodilates any vessel with smooth muscle --> pt feeling light headed/faint)
*A patient takes nitroglycerin which relaxes arterial and venous smooth muscle
*Vessel radius ↑'s, resistance to flow ↓'s, however pressure decreases so the individual may become light-headed
58
What are precautions in taking/administering nitroglycerine?
Patients MUST SIT DOWN when taking and after taking Nitro in your clinic to avoid falling down
59
Describe the importance of radius in managing resistance to blood flow
Resistance impedes flow so when the radius increases, it makes the resistance to flow decrease which then lessens possible hypertension and doesn't cause the unnecessary hard pumping of blood
60
Describe the effects of thiazide diuretics on blood volume, blood vessel diameter
(reduce volume) decrease in volume → decrease in wall stretch → decrease in BP
61
Describe the effects of calcium channel blockers on blood volume, blood vessel diameter
(vasodilation) increase in radius → decrease in resistance → increase in blood flow
62
Describe the effects of nitroglycerine on blood volume, blood vessel diameter
(vasodilation) increase in radius → decrease in resistance → increase in blood flow
63
Describe the effects of ACE inhibitors on blood volume, blood vessel diameter
(vasodilation) increase in radius → decrease in resistance → increase in blood flow
64
Describe the Poiseuille equation for resistance to blood flow
R = (8ηL) / (πr^4) where R=resistance and r=radius.
65
Why is radius so important in the Poiseuille equation for resistance to blood flow.
The "r^4" term means that even a small change in the radius of a blood vessel can drastically affect the resistance to blood flow. For example, if the radius is halved, the resistance increases 16 times.
66
How and why does smooth muscle contractility change during exercise?
smooth muscle contractility primarily changes through increased blood flow, which leads to mechanical stretching of the vascular smooth muscle, causing vasodilation (relaxation) to accommodate the increased blood volume, thereby optimizing blood delivery to working muscles
67
Identify factors that affect precapillary spinchters
local tissue oxygen levels, carbon dioxide levels, metabolic byproducts like lactic acid, hydrogen ion concentration (pH), inflammatory chemicals like histamine, body temperature, blood pressure, and the presence of certain signaling molecules like nitric oxide (NO) and endothelins
68
Differentiate active and reactive hyperemia
Reactive hyperemia: a temporary increase in blood flow to a tissue following a period of blood flow restriction (like applying a tourniquet)
Active hyperemia: the increased blood flow to an organ or tissue due to increased metabolic activity during exercise or other active processes, essentially meeting the tissue's higher oxygen demand
69
Speak to blood flow occlusion via reactive and active hyperemia
Reactive Hyperemia
- Passively induced
- Occlude blood flow → 0 flow
- Resolve occlusion → blood flow exceeds control level with magnitude and duration to occlusion
- Vasodilator mechanisms comes into play
- PT applications: trigger point therapy - what we did in the circle where we held each other's trigger points for 90 seconds and then released (thumbs picture)
Active Hyperemia
- Exercise induced
- Ms that become highly active require increase blood flow
- ↑ metabolic activity → ↑ smooth ms relaxation → vasodilation
- ↑ O2 needs → vasodilation
70
Speak to the important functions of the postcapillary venules and arterioles
Microcirculation: local control of blood flow
- Acute control
- Metabolic metabolism: ↑ tissue metabolism → ↑ metabolites → vasodilation
- Hypoxia" reduced oxygen supply or increased oxygen demand → vasodilation
Metarterioles and precapillary sphincters open and allow Hb-O2, dissolved O2 into capillaries for diffusion
Blood flow intermittently through capillaries - vasomotion based on contraction/relaxation of arteriolar smooth muscle
Diffusion: Principle mechanisms of microvascular exchange
71
Describe capillary anatomy and related function
Capillary wall = is 1 endothelial cell thick (intima)
- True capillaries lack smooth muscles
- Endothelial cells have actin/myosin
~ Can alter shape
~ Are being shown to be increasingly important in affecting local vasodilation
72
Describe small artery anatomy
Tunica adventitia: thicker outer layer of connective tissue containing fibroblasts
Tunica Media: consisting of around 10 layers of smooth muscle cells with elongated nuclei
- Have actin and myosin in smooth ms
Tunica intima: composed of simple squamous epithelium of endothelial cells
- Endothelial cells make up the innermost layer of cells or arteries, arterioles, capillaries
73
Identify where vasodilation begins and to where it spreads
During exercise, vasodilation begins in the smallest arterioles closest to the capillaries in the contracting muscles
- can ascend to the larger arteriole elements including the feed arteries
74
Describe capillary wall
Capillary wall = is 1 endothelial cell thick (intima)
- True capillaries lack smooth muscles
- Endothelial cells have actin/myosin
~ Can alter shape
~ Are being shown to be increasingly important in affecting local vasodilation
75
Describe Endothelial Lining
Endothelial lining is one cell thick the endothelial structures of capillaries varies depending on organ and its function
- Fenestration's: large openings (GI tract)- organs transporting a lot of fluid
- Gap junctions: large gap between endothelial cells in bone marrow, liver and spleen
- Tight junctions: in most body tissues
76
Describe Diffusion
Diffusion: principle mechanisms of microvascular exchange
- Rate of diffusion depends on
1) Solubility of substance in tissues
2) Temperature, surface area available
~ Inversely related to molecular size and diffusion distance; large molecules do not diffuse fast or at all (ex: albumin)
~ O2, CO2, and H20 diffuse rapidly
77
Identify all 4 pressures that help push or pull fluid into or out of the interstium (Which is greatest/least and why, as well as how they cause fluid movement?)
Outward forces
Pc - hydrostatic capillary pressure + 30 mmHg
I - Interstitial oncotic pressure + 30 mmHg
** Total outward forces: 33 mmHg
Inward forces
Pi - Hydrostatic interstitial pressure -3.0 mmHg
I- capillary oncotic pressure -26 mmHg
** Total inward forces: - 29 mmHg
78
Explain ascites in patients with cirrhosis
Etiology 1
Decreased albumin synthesis (in liver) causes hypoproteinemia
Decreases oncotic BP, which has a normal inward force of 28mmHg
Fluid is not collected at venous end of capillaries
If not picked up by lymphatics → edema
Etiology 2
Portal HTN (>8mmHg - 20mmHg) → ascites
Scar tissue in liver compresses blood vessels → decreased venous flow
Increased portal venous pressures → protein exudates
Albumin production → decreased fluid return to blood venous → ascites
79
Name at least four negative consequences of high venous blood pressure in the liver
Bad liver: venous flow doesn't deliver
Venous circulation from abdomen returns through the liver
Factors affecting the liver cause backflow/pressure - esophageal varices and rectal varices (H)
Clinician may palpate - enlarged liver or spleen, peripheral edema
80
Describe Signs and symptoms of pure R vs. L heart failure
RH failure: periphery
Peripheral and abdomen swelling
LH failure: lungs
Dyspnea, trouble moving, ADLs difficult
81
Describe the conduct and interpretation of the venous filling test
Observe and mark dorsal veins on dependent feet elevate legs at 45° for 1-min return to sitting with legs dangling and immediately begin timing how long it takes the veins on the foot that was elevated to match the veins on the foot that was not elevated.
82
Identify % blood volume in venous system at any one time
65-75% of circulating blood volume in veins at any one time
83
Describe 7 ways in which venous return can be increased or augmented
- Venoconstriction (increases CO)
- Skeletal Muscle Pump
- Thoracic Pump (respiration)
- Abdominal Pump (muscle contraction --> increased blood flow to Heart)
- Supine/Elevated Leg Posture (negates downward G forces)
- Vis-a-Fronte (force acting from front)
- Vis-a-Tergo (force acting from behind)
84
Identify how a PT would discover a patient with POH
Supine for 2-3 minutes - measure BP, HR
Sit or stand - measure BP at 1 minute and at 3-5 minutes for diagnosis
85
Define POH in mmHg and time for classic and delayed POH
POH @ 3-5 minutes
Shown by a drop of systolic blood pressure by 20 mmHg or diastolic blood pressure of 10 mmHg
86
Describe the renin-angiotensin system, specifically the role of renin, angiotensin I and II
Renin is an enzyme produced in the juxtaglomerular cells of the kidney. A decrease in the pressure at the renal artery, an activation of the sympathetic nerve fibers to the kidney, or a decrease in the amount of sodium passing through the distal tubule of the kidney, will prompt the release of renin.
The release will convert renin to angiotensin I and angiotensin I is converted to angiotensin II in the lung and other organs. Angiotensin II is a potent vasoconstrictor and will also stimulate the release of aldosterone from the adrenal gland. Aldosterone will increase sodium absorption at the kidney, thus allowing for fluid retention and increasing plasma volume (125).
87
How/where does Atrial natriuretic peptide (ANP) work?
Atrial natriuretic peptide (ANP) is a peptide hormone which reduces an expanded extracellular fluid (ECF) volume by increasing renal sodium excretion. ANP is synthesized, and secreted by cardiac muscle cells in the walls of the atria in the heart.
88
How/where does Brain natriuretic peptide (BNP) work?
Brain natriuretic peptide (BNP), also known as B-type natriuretic peptide, is a hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume. BNP is named as such because it was originally identified in extracts of pig brain.
89
How does vasoconstriction at the kidneys occur and how might it be treated pharmacologically
the activation of the sympathetic nervous system releases norepinephrine onto the smooth muscle of the renal arterioles, causing them to constrict and reduce blood flow to the kidneys
Treat: managing blood pressure with vasodilators (medications like ACE inhibitors or ARBs)
90
Speak to baroreceptor sensitivity as it relates to prolonged bed rest (diff types of baroreceptors)
- Baroreceptors are more sensitive to rapidly changing pressure than a stationary pressure
- Quickly from supine → sit stimulates the baroreceptors and rather than allow a decrease in BP, they initiate an increase
- Baroreceptors become less sensitive when patients have been supine for more than 1-2 days
- PT needs to retrain them - or take it slowly
91
Describe how and why blood flow changes in muscles before exercise.
Vasoconstriction according to DOC, but is debatable. Peripheral vasoconstriction of skin. Massive sympathetic discharge and inhibition of parasympathetic tone.
92
Describe how and why blood flow changes in muscles during exercise.
Vasodilation - local vasodilator substances are produced and these local effects override sympathetic effects allowing arterioles and capillaries to increase in #.
Total Peripheral Resistance decreases and blood flow increases by 15-20x above rest
93
Describe how and why blood flow changes in muscles following exercise.
Vasodilation but heading back to normal
Psychological stress and physiological stress decrease and system gradually returns to normal
PT Application → DON'T SUDDENLY STOP EXERCISE, DO ACTIVE COOL DOWN
94
What is retrograde flow, and when and why does it occur?
a fluid moving in the opposite direction of its normal flow, essentially "backward" movement; it occurs when there's a pressure gradient change causing the fluid to reverse its direction (or an obstruction/damaged valve)
Can be seen with deep vein thrombosis, aortic valve regurgitation, or during certain phases of the cardiac cycle depending on pressure dynamics
95
What is pulsatile flow, and when and why does it occur?
a rhythmic, pulsating movement of fluid, like blood in the circulatory system, where the flow rate repeatedly increases and decreases due to the pumping action of the heart, causing a wave-like pattern in the pressure and velocity of the fluid
Occurs when rhythmic pressure variations are present (blood flow fluctuates between periods of high and low pressure with each heartbeat; essentially, it happens whenever a fluid is propelled by a pulsating source, leading to a wave-like movement in the flow.)
96
What is the relationship between VO2, HR, skin/muscle blood flow from rest→max exercise?
Before
- Prob decreases (SNS vasoconstriction)
During
- Increases as a result of local factors
- K+, adenosine, decreased PaO2, increased PCO2, increased temperature, vascular endothelial factors
- Increases to dissipate heat up to ~ 80% VO2max and in response to core temp but levels off at 38 degrees
97
Describe how and why blood flow changes to skin before exercise (Submax).
Skin blood flow decreases (SNS vasoconstriction)
98
Describe how and why blood flow changes to skin during exercise (Submax).
Skin blood flow increases from K+, adenosine, Dec. PaO2, Inc. PCO2, Inc. temperature, vascular endothelial factors
Skin blood flow Inc. up to 80% Vo2max***
Skin blood flow Inc. in response to core temp but levels off at 38*F
99
Describe how and why blood flow changes to skin following exercise (Submax).
Skin blood flow can Inc after submaximal exercise is finished to dissipate heat
100
Describe how and why blood flow changes to skin with maximal exercise (~80% VO2Max).
w/ a normal temp control system, proper fluid intake & training blood is shunted back to the muscle so that exercise can continue
Sympathetic vasoconstrictor activity now supersedes local control
101
Explain exercise retrograde flow
Exercise Retrograde flow is when blood flow actually flows backwards through the circulatory system during exercise
- Occurs because of increased muscle contraction and and pressure
- Usually occurs in veins
- Not a good thing - May impact vessel health
