PT Cardiopulm Interventions

Question 1

HRR/ Karvonen formula for target HR

Answer 1

Low THR = [(HRmax-HRrest)x 0.4) + HRrest

High THR = [(HRmax-HRrest) x 0.85) + HR rest

Question 2

Estimating HR max

Answer 2

220 - age

Question 3

Target heart rate: Percent of max HR method

Answer 3

Low THR = HRmax x 0.55

High THR = HRmax x 0.90

Question 4

Intensity/ Duration recommended for adults (not training for athletic competition)

Answer 4

Moderate intensity over longer duration

Due to potential hazards and adherence problems associated with high intensity activity.

Question 5

Chronic adaptations to aerobic exercise re: blood lactate

Answer 5

Increased blood lactate at maximal exercise; decreased at submaximal exercise

Question 6

Chronic changes in body heat transfer due to aerobic training

Answer 6

Improved body heat transfer due to larger plasma volume and more responsive thermoregulatory mechanisms.

Question 7

Active Cycle of Breathing technique

Answer 7

3 phases:

1. Breathing control (gentle, relaxed)
2. Thoracic expansion exercises (deep, slow inhalations with passive exhalation. Possibly include percussion/vibration during exhalation)
3. Forced expiratory technique (1-2 huffs, possibly with brisk adduction of upper arms to compress the thorax)

Question 8

Autogenic Drainage

Answer 8

Uses controlled breathing to improve airflow in the small airways and facilitate the movement of mucus.
*Requires patience to learn, so not appropriate for children/ easily distracted/ not motivated.
*No equipment or assistance required
3 phases:
1. Unsticking
2. Collecting
3. Evacuating
Average treatment: 30-45 minutes

Question 9

Huffing

Answer 9

Beneficial because keeps airways open (greater potential for airway collapse with coughing)

Question 10

High-frequency airway oscillation (Acapella, Flutter)

Answer 10

Combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions in the airways.

10-20 reps with device followed by 2-3 coughs or huffs.

Question 11

Procedure for percussion or vibration

Answer 11

1. Place patient in postural drainage position
2. Cover skin with thin material (T-shirt, towel, gown)
3. Percuss/ vibrate

Question 12

Changes in vital signs with airway clearance techniques

Answer 12

Moderate changes in respiratory rate and/or pulse rate are expected.

Question 13

Precautions/ Contraindications for Diaphragmatic Breathing

Answer 13

Mod-severe COPD
Marked hyperinflation of the lungs
Paradoxical breathing patterns
Patient demonstrates increased dyspnea or work of breathing with diaphragmatic breathing.

Question 14

Fowler’s and Semi-Fowler’s position

Answer 14

Fowlers: HOB elevated 90 deg
Semi: HOB elevated 45 deg
Pillows under knees to maintain lumbar curve

Question 15

Flow resistive breathing

Answer 15

Form of Inspiratory Muscle Training

• Patient inspires through a mouthpiece with adjustable diameter.
• Decreasing diameter increases resistance to inhalation (if breathing rate, tidal volume kept constant).

Question 16

Threshold breathing

Answer 16

Form of Inspiratory Muscle Training

• Requires buildup of negative pressure before flow occurs through a valve that opens at critical pressure
• Provides consistent and specific pressure regardless of how slow/quick patient breathes.

Question 17

Clinical signs or inspiratory muscle fatigue (and order of appearance)

Answer 17

1. Tachypnea
2. Reduced tidal volume
3. Increased PaCO2
4. Bradypnea and decreased minute ventilation

Question 18

Manometer

Answer 18

Device used to measure patient’s maximum inspiratory pressure.

Question 19

Paced breathing

Answer 19

Strategy to decreased work of breathing and prevent dyspnea during activity.
Allows anyone who experiences SOB to become less fearful of activity and exercise

Question 20

Exhale with effort

Answer 20

Strategy to prevent patient from holding their breath

• Inhale during resting/ less active phase of activity
• Exhale during movement/ more active phase.

Question 21

When to terminate exercise during cardiac rehab (angina)

Answer 21

Angina of 1/4 severity is the recommended endpoint to cease activity.

Question 22

1 MET

Answer 22

Energy expended while sitting quietly.

Question 23

RPE 12-16 (“somewhat hard to hard”) corresponds to ___ % maximal capacity

Answer 23

40-85%

Question 24

MET values for light, mod, vigorous activity

Answer 24

Light <3
Mod 3-6
Vigorous >6

Question 25

Recommended fluid intake to maintain hydration

Answer 25

1 pint of fluid for each pound of body weight lost