PT Procedural Interventions Flashcards

Question

Pursed-lip breathing (PLB)

Answer 1

Helps reduce RR, dyspnea, and maintain small positive pressure in bronchioles to prevent airway collapse. Semi-fowler's is good position to start in.

Answer 2

Intended to improve regional ventilation and prevent and treat pulmonary complications after surgery. To prevent or decrease asymmetrical chest wall motion. PT applies firm pressure at end of exhalation to chest wall overlying area to be expanded. Pt inhales deeply and slowly expands rip cage under PT's hands. PT reduces pressure during inhalation.

Answer 3

Maintain max inspiration for 3 or more seconds. Often used in airway clearance.

Answer 4

Can provide relief of dyspnea to patients with lung disease. Allows pec muscles to assist in elevating rib cage during inspiration.

Answer 5

Supine with head above trunk and LEs. Decreases weight of abdominal contents on diaphragm.

Answer 6

Supine with HOB elevated to 45 degrees and pillows under knees. Often used for patients with congestive heart failure or other cardiac conditions.

Answer 7

``` Medically stable post MI Stable angina pectoris Coronary artery bypass surgery Heart transplant Other cardiac surgery (like valve or pacemaker) Compensated heart failure Cardiomyopathy PAD High risk for coronary artery disease with diabetes, dyslipidemia, hypertension, or obesity End stage renal disease ```

Answer 8

Unstable angina Resting SBP > 200 mmHg or resting DBP > 110 mmHg Orthostatic BP drop of > 20 mmHg with symptoms Aortic stenosis Acute systemic illness or fever Uncontrolled arrhythmias 3rd degree AV block without pacemaker Active pericarditis or myocarditis Recent embolism Thrombophlebitis Resting ST segment depression or elevation > 2 mm Uncompensated congestive heart failure Orthopedic or metabolic conditions that would prohibit exercise

Answer 9

Can begin rehab when medically stable by the referring physician: No new or recurrent chest pain in 8 hours No new signs of uncompensated heart failure (dyspnea at rest with bilateral basilar crackles) -No new significant, abnormal heart rhythm or ECG changes in 8 hours -Stable creatine kinase and troponin levels

Answer 10

Ask pt to report any chest discomfort, dyspnea, or faintness Discontinue exercise if: -HR >130 bpm or >30 bpm above resting HR -DBP > or equal to 110 mmHg -Decrease in SBP > 10 mm Hg -Significant ventricular or atrial dysrhythmias -2nd or 3rd degree heart block -Angina, marked dyspnea, and ECG changes suggesting ischemia

Answer 11

Active UE and LE exercises may begin 24 hours after bypass graft surgery and 2 days after infarction Active exercises progress from sitting to standing (1-4 METs) UE exercises should not stress incisions of post-surgical pts

Answer 12

Mode: Progressive, supervised level walking (2-3 METs) to walking up/down steps or treadmill walking (3-4 METs) Intensity: - RPE < 13 - Post infarction: HR < 120 bpm or < 20 above resting HR - Post surgery: < 30 bpm above resting HR Duration: 3-5 min bouts, progressing to 10-15 min of continuous activity Frequency: - First 3 days: 3-4x/day - After 3 days: 2x/day with increased duration Progression: Activity can progress if... -Adequate increase in HR -Adequate rise in SBP (10-40 mmHg) -No new dysrhythmias or ST changes on ECG -No cardiac symptom (palpitations, dyspnea, angina, excessive fatigue) Total inpatient treatment usually lasts 3-5 days

Answer 13

Walks 5-10 min continuously or 1000 feet 4x/day Walk up and down one flight of stairs indep Know safe HR and RPE limits for exercise Recognize abnormal signs and symptoms suggesting intolerance to activity

Answer 14

ECG when starting a phase II program. Physical examination should include medical history, cardiovascular disease risk, BMI or wast-hip ratio, resting ECG and BP, auscultation of lung sounds, palpation and inspection of extremities for arterial pulses, edema, and skin integrity. Examination of chest and leg wounds in patients after CABG or PTCA. Orthopedic and neuromuscular status.

Answer 15

For low risk pts with known stable coronary artery disease, 6-12 sessions of ECG and BP monitoring and medical supervision recommended to ascertain desirable exercise levels. For pts at moderate to high risk and/or unable to self-regulate or understand recommended activity levels, continuous ECG and BP monitoring and medical supervision recommended until safety is established, usually more than 12 sessions. Discontinue exercise for any of the following adverse responses: - Plateau or decrease in HR with increase in work - SBP plateaus or falls with increase in work or > 250 mmHg - DBP >115 mmHg - ST segment depression > 1 mm - 2nd or 3rd degree heart block - Ventricular dysrhythmias - Angina or other symptoms of cardiovascular insufficiency

Answer 16

Mode: Rhythmic activities that use large muscle groups and can be performed continuously and safely. Intensity: HR - Can use target HR zones or resting HR + 20 bpm METs - Must determine max MET during exercise test. Lower METs = [(MaxMETs - Rest METs) x 40%] + RestMet Upper METs = [(MaxMETs - Rest METs) x 85%] + RestMet Duration: 15-20 min during first month (initial training phase) 25-30 min during next 3-4 months (improvement stage) Interval training (bouts of 3-5 min duration followed by equal rest periods). May be appropriate for those who can't exercise continuously. Can continue to increase endurance as fitness and confidence improves Frequency: 3-5 days/week

Answer 17

RPE of 12-16 corresponds to 65% to 85% maximal capacity RPE of 11-13 is an appropriate upper limit during the initial phases of outpatient cardiac rehab RPE of 14-16 may be appropriate for higher intensity training later in rehab if no signs of ischemia or serious dysrhythmias

Answer 18

``` Indicated if presence of respiratory impairments including dyspnea, hypoxemia, hypercapnia, reduced exercise tolerance or a decline in ability to perform ADLs due to: Chronic bronchitis Emphysema Asthma Interstitial lung disease Bronchiectasis Cystic fibrosis Lung cancer Chest wall disease Neuromuscular disease (Parkinson's, ALS, MS) Pro-op and post-op lung resection, transplant, or volume reduction Ventilatory dependency ```

Answer 19

``` Ischemic cardiac disease Congestive heart failure Acute cor pulmonale Severe pulmonary hypertension Significant hepatic dysfunction Metastatic cancer Renal failure Severe cognitive deficit that interferes with memory and compliance Visual, hearing, or orthopedic impairments may require exercise modification ```

Answer 20

``` Medical hx Nutritional assessment Spirometry Resting ABG Arterial O2 sat by pulse oximeter Chest xray Resting ECG Exercise test (6MWT or graded exercise test) Complete blood count Height and weight Resting BP, HR, and RR Temperature Breathing pattern Auscultation of lung sounds Auscultation of breath sounds Palpation and inspection of extremities for arterial pulses, edema, and skin integrity Orthopedic and neuromuscular status Functional status Anxiety and depression ```

Answer 21

Remind pt not to hold breath and to exhale during exertion phase of activity Clinical monitoring includes: -Signs and symptoms of exercise intolerance -HR and BP -ECG if pt has heart disease -RPE and dyspnea -O2 sat via pulse oximeter

Answer 22

Mode: Rhythmic activities that use large muscle groups and can be performed continuously and safely Intensity: Determined primarily by patient tolerance and safety. Guidelines include: > or equal to 50% peak oxygen consumption determined from exercise test -Use dyspnea rating reported at submax exercise level during exercise test -60-80% of peak work rate achieved determined from exercise test -RPE of 4-6 on 0-10 scale or 12-16 on 6-20 scale -Maintain O2 sat > 90% Duration: - Minimum of 30 min of accumulated exercise per session - Interval training (bouts of 30 sec to 3 min followed by rest) for those who cannot exercise continuously Frequency: 3-5 days/week