PHYS NORMS AND EX SAFETY Flashcards

1
Q

CONTRA-INDICATIONS TO HIGH INTENSITY EXERCISE

A

-unstable angina (pain at rest)
-decompensated heart failure (worsening edema, fatigue, SOB at rest)
-acute cardiac event within 6 weeks (MI, VTACH/VFIB, PACEMAKER/DEBFIB PLACEMENT, CABG)
-MI within last 6 weeks
-PE within last 6 weeks
-severe valve stenosis (mitral or aortic) or valve stenosis with history of syncope without corrective surgery
-severe pulmonary hypertension (mean pulm arterial pressure >55 mmHg)
-proliferative or severe non-proliferative diabetic retinopathy (risk vision loss)
-CVA within last 6 weeks (esp hemorrhagic)
-cerebral aneurysm of any size, if untreated
-cerebral aneurysm of any size, if treated within 6 weeks
-rhabdomyolysis within 6 weeks
-hydrocephalus if treated with shunting
-physician ordered “no strenuous activity” restrictions

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2
Q

PRECAUTIONS TO HIGH INTENSITY EXERCISE

A

LIMB SPECIFIC; AVOID HIGH INT REHAB INVOLVING AFFECTED LIMB:
-fracture
-osteomyelitis
-avascular necrosis
-osteosarcoma
-bone metastases
-DVT within 6 weeks with anticoagulation

-abdominal precautions or chronic conditions (hernia) (avoid Valsalva) * have pts count, talk out loud, or participate in patterned breathing to avoid Valsalva

-severe OP or compression fracture (avoid spinal flexion and rotation) ** note that avoiding all activity is not good

-moderate or severe non-proliferative diabetic retinopathy (avoid valsalva and maintain BP <150/100)

-aortic aneurysm (no lifting >75 lbs, avoid valsalva, maintain BP <150/100)

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3
Q

Joint replacement precautions

A

-HIR to the affected limb immediately after surgery
-monitor pain, swelling, and incision healing to determine progression or modification
-if pain is limiting factor –> load the joints distal and proximal to the joint replacement
-can also perform HIRT in non-WB positions

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4
Q

WBAT precautions for HIRT

A

-apply HIR principles to affected limbs through closed chain activities (within patient’s tolerated limits)

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5
Q

Surgically stabilized fractures precautions:

A

ex: ORIF

-immediately apply HIR principles to open-chain exercises involving the non-affected areas of the limb
-strengthen the adjacent areas and try not to stress the actual incision

-may be able to introduce HIR principles to affected area of limb after 2 weeks

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6
Q

Acute or chronic pain HIRT precautions

A

-alternate sides or types of activity to avoid excessive pain increases; work within non-painful ranges

-try an ECCENTRIC focus
ex: stand up using their arms, then have them sit back down without their arms while focusing on quad control
-usually CONCENTRIC portion is more painful

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7
Q

Cognition precautions to HIRT

A

-modify environment

-monitor your patient’s energy levels - schedule when they are at their highest mental and physical energy levels

-simplify/minimize verbal info - 1-step commands, visually demonstrate exercises, ask patient to copy your movements

-have a back up plan –> plan for more exercises or activities than you anticipate needing during session so you can change up the task to keep your patient engaged

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8
Q

PA considerations moderate non-proliferative diabetic retinopathy:

A

-limit increases in BP
-avoid valsalva
-avoid jarring activities like boxing

-maintain BP below 150/100

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9
Q

PA considerations proliferative diabetic retinopathy:

A

-limit increases in BP
-avoid valsalva
-avoid jarring activities like boxing
-avoid high impact activities or activities that raise intra-ocular pressures: high impact aerobic dance, weightlifting, jogging, boxing, racquet sports, scuba diving, trumpet playing, rollercoasters, head-down activities

-encourage low impact activities: swimming, walking, low-impact aerobic dance, stationary cycling, endurance exercise

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10
Q

Possible CI’s of cancer:

A

-bone metastasis sites –> concern for pathological fractures
-tumors in targeted strength training area

-consider that meds could affect long bone strength

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11
Q

MSK CI’s

A

-recent fractures < 6 weeks

-unstable fxs

-osteomyelitis: no high intensity strength training on involved limb

-AVN: not on the involved limb

-wounds with exposed tendon or muscle on involved joint

-compression fxs (maintain neutral alignment of the joint)

-weight bearing restrictions with graft or fx sites (open chain, iso only)

-Marfan syndrome (CT disorder)

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12
Q

Possible surgical contra-indications:

A

CRANIOTOMY (< 6 weeks)
o No bending over
o No lifting >10 pounds
o No Valsalva

ABDOMINAL PRECAUTIONS (< 6 weeks)
o No sit-ups/crunches
o No Valsalva
o No lifting >10 lbs

STERNAL PRECAUTIONS (< 6 weeks) (ex: after CABG)
o No UE high-intensity
o No Valsalva
o No lifting >10 lbs

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13
Q

Medications: possible precautions

A

STEROIDS side effects:
-HTN
-immunosuppression
-OP
-muscle weakness and myopathy
-thin skin and poor wound healing

BETA-BLOCKERS side effects:
-hypotension
-bradycardia
-drowsiness

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14
Q

NORMAL RESTING HR

A

ADULTS: 60-100 BPM

PEDS: 76-85 BPM

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15
Q

NORMAL RESTING BP

A

WOMEN: 110/70 mm Hg

MEN: 120/80 mm Hg

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16
Q

NORMAL EXERCISE MAX BP

A

250/115 mmHg (with monitoring)

Clinical (without monitoring) below 200 SBP, below 110 DBP

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17
Q

NORMAL RESTING RR

A

Resting: 12-18

Distressed resting: RR: 20+

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18
Q

NORMAL RESTING BP

A

SBP
less than 120

AND

DBP
less than 80

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19
Q

ELEVATED RESTING BP

A

SBP
-120-129

AND

DBP
less than 80

20
Q

HTN STAGE 1 BP RESTING BP

A

SBP:
130-139

OR

DBP:
80-89

21
Q

HTN STAGE 2 BP RESTING BP

A

SBP:
140 OR HIGHER

OR

DBP:
90 OR HIGHER

22
Q

HYPERTENSIVE CRISIS RESTING BP

A

SBP:
HIGHER THAN 180

AND/OR

DBP: HIGHER THAN 120

23
Q

VO2 max values for different populations

A

Below 20 mL/min/kg - substantially impaired

Near 20 mL/min/kg- impaired

  • Deconditioned middle age
    adults: 30-40
  • Conditioning (months): 45-55
  • High level endurance
    athletes: 70
  • High level cross country
    skiers: 80
  • Sedentary young adults: 45
  • Sedentary middle age adults:
    35
  • Post MI: 22
    ◦ Up ~20% with training
  • Severe pulmonary disease: 13
24
Q

What is one MET

A

-a metabolic equivalent; how much oxygen is consumed per minute at rest

-3.5 ml O2 consumed/kg of body weight/min (VO2)

-also 1 kcal/kcal/hour

VACCUM: 3.5
DANCING: 6.5
JOGGING: 7.0
BICYLING: 8
RUNNING A 7 MIN MILE : 14 MET

25
Pulmonary function tests:
TV: 0.5 L at rest FVC: 3-5 L - max air you can forcibly remove from your lungs after forcibly inhaling FEV1: 2.5-4 L -the maximum amount of air that the subject can forcibly expel during the first second following maximal inhalation FEV1/FVC: > 80% in healthy adults -indicates how much air you can forcefully exhale
26
What happens to the hemoglobin-O2 dissociation curve during exercise?
It shifts to the right -Hb has a decreased affinity for oxygen so that oxygen can be available in circulation for exercise EXERCISE: increase temperature, increase co2, decrease pH, increase 2,3-DPG -decreased hemoglobin affinity for oxygen at higher intensities of exercise
27
Normal ABG values:
* pH: 7.40 (7.2-7.6) * pCO2: 35-45 mmHg * pO2: 80-100mmHg
28
CLASS I NYHA classification of heart failure
MILD No symptoms and no limitation in ordinary physical activity, ordinary PA does not cause undue fatigue, rapid/irregular heartbeat or SOB
29
CLASS II NYHA classification of heart failure
MILD Slight limitation of PA comfortable at rest, but ordinary PA results in fatigue, rapid/irreg heartbeat, or SOB
30
CLASS III NYHA classification of heart failure
MODERATE marked limitation of PA, comfortable at rest, but less than ordinary activity causes fatigue, rapid/irregular heartbeat (palpitation) or SOB (dyspnea)
31
CLASS IV NYHA classification of heart failure
SEVERE -unable to carry out any PA without discomfort, fatigue, irregular/rapid HR or SOB present at rest -if any PA undertaken, discomfort rises Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.
32
What is an ejection fraction and what is a normal ejection fraction value?
-Ejection fraction is measured as a percentage of the total amount of blood in your heart that is pumped out with each heartbeat NORMAL: >55%
33
normal percent body fat men/women
MEN: 15-18% WOMEN: 22-25%
34
BMI CLASSES AND VALUES
UNDERWEIGHT <18.5 NORMAL 18.5-24.9 OVERWEIGHT 25-29.9 OBESITY CLASS I 30-34.9 OBESITY CLASS II 35-39.9 EXTREME OBESITY CLASS III >40
35
Normal blood glucose levels, pre-diabetic, and diabetic:
NORMAL -60-100 mg/dL PRE-DIABETIC -100-125 mg/dL DIABETIC -126+ mg/dL
36
Oral Glucose tolerance test levels:
NORMAL <140 mg/dL PRE-DIABETES 140-200 mg/dL DIABETES >200 mg/dL --> less ability to metabolize glucose
37
Blood glucose levels (mg/dL) during exercise:
<100 -run risk of hypoglycemia (DO NOT EXERCISE) 100-250 -able to exercise >250-300 -warrants caution ketones in the urine -NO EXERCISE
38
NORMAL RBC COUNT MEN AND WOMEN
MEN: 4.7-5.5 mm^3 WOMEN: 4.1-4.9 mm^3
39
WB CELLS and exercise precauations/contraindications
EXERCISE AS TOLERATED: 3900-11000 mm^3 CAUTION WITH EXERCISE <3900 with fever mm^3
40
Hemoglobin and Hematocrit contra-indications
HEMOGLOBIN (mg/dL) -NORMAL: 14.4-14.6 males, 12.2-14.7 females <8 discuss with MD 8-10 decreased ex tolerance 10-12 low impact, low intensity resistance exercise HEMATOCRIT (%) -males: 43-49% -females: 38-44% 30- reduced capacity for exercise begins 25-30- markedly reduced exercise tolerance <20- no exercise
41
Platelet value possible contraindications:
150000-400000- normal <10,000 and/or temperature >100.5 - no exercise 10000-20000- no resistance, non-impact >20k- low impact, resistance (keep in mind fall risk)
42
INR possible contra-indicatons:
**someone on coumadin (anticoagulant) 0.9-1.1: normal w/out anticoagulation 2-3: normal if on anticoagulation therapy >5: evaluate mobility and assess safety for discharge planning (risk of bleeding) >6: discuss with MD (risk of bleeding)
43
What does a high/low INR mean?
When the INR is higher than the recommended range, it means that your blood clots more slowly than desired (bleeding risk) A lower INR means your blood clots more quickly than desired.
44
Normal Response to exercise:
-increased RR -rise in SBP -minimal or no change in DBP --> change should be less than 10 mmHg -rise in HR --> blunted by beta blocker meds and age -following exercise, within 5 minutes of rest --> BP returns to within 10 mmHg --> HR to within 10 BPM of resting value
45
WHEN TO STOP EXERCISE
CARDIO: -SBP > 250 mmHg with EKG monitoring -SBP 200-220 without EKG monitoring -sudden drop in SBP >10 mmHg -Failure of SBP to rise -DBP >115 mmHg with EKG monitoring -DBP 100-110 without EKG monitoring -Decrease in heart rate below baseline NEURO: -dizziness/lightheadedness -confusion -ataxia -shaking/tremors INTEGUMENT: -cyanosis or pallor -diaphoresis or cold/clammy skin PAIN: -leg cramps or severe claudication (ms. pain due to lack of oxygen) -chest/arm/jaw pain -moderate to severe angina RESP: -moderate-severe dyspnea -abnormal breathing -drop in o2 sats >10% below baseline or <88% (does not recover within 5 min of rest) ENDOCRINE/GI: -suspected hypoglycemic response -nausea or vomiting