PT tests and measures for Cardiopulm Flashcards
Angina pain scales:
1
2
3
4
mild
moderate
moderately severe
most severe
ABI
checks for peripheral artery disease
divide the highest ankle by the highest arm
ABI interpretation
<1.4
1.0-1.4
0.8-0.99
0.4-0.79
<0.4
rigid and check for peripheral artery
normal
mild blockage
moderate blockage
severe blockage
If BP cuff is too small
false high reading
Hypertensive crisis
> 180 and/ or >120
S1
first heart sound
closure of mitral and tricuspid valves
S2
2nd heart sound
closure of aortic and pulmonary valves
S3
vibrations of the distended ventricle walls
normal in healthy young children
S4
pathological vibration of ventricular wall
associated with HTN, stenosis, hypertensive heart disease and MI
Heart murmurs
vibrations longer duration than the heart sounds
soft, blowing or swishing
Tracheal and bronchial normal breath sounds
loud, tubular sounds normally heard over the trachea
inspiratory phase is shorter than expiratory
slight pause in between
Bronchial sounds heard over distal airways is considered abnormal
Vesicular breath sounds
high pitched, breezy sounds normally heard over distal airways
inspiratory phase is longer than expiratory phase and no pause
Adventitious breath sounds
abnormal sounds heart with inspiration and/or expiration
Crackle (formerly rales)
high-pitched popping sound more often with inspiration
Can be associated with restrictive and obstructive disorders
movement of fluid/secretions (wet)
or sudden opening of closed airways (dry)
Occur at latter half of inspiration during atelectasis, fibrosis, pulmonary edema or pleural effusion
Crackles with secretions usually low pitched and heard during inspiration and/or expiration
pulmonary edema may produce fine crackles
crackles heard at base of lungs with interstitial lung disease, atelectasis, pneumonia, bronchiectasis, pulmonary edema
Pleural friction rub
dry, crackling sound during inspiration and expiration
inflamed visceral and parietal pleurae rub together
heard over spot where patient feels pleuritic pain
Rhonchi
continuous low-pitched sounds
snoring and gurgling during inspiration and expiration
Stridor
high-pitched wheeze heard inspiration or expiration
Bronchial breath sounds can be heard in what condition?
pneumonia
Decreased or diminished sounds indicate
severe congestion, emphysema or hypoventilation
Absent breath sounds indicate
pneumothorax or lung collapse
Normal lung, transmission of spoken sounds is usually
muffled
Increase in loudness or distinctness in spoken sound over lungs indicate
consolidation
atelectasis or firbrosis
Whispered breath and spoken sound are somewhat more valuable than breath sounds when detecting
pulmonary consolidation
infarction
atelectasis
Bronchophony
clarity with 99
Egophony
spoken long E sounds like nasally A
Whispered pectoriloquy
whispered words 1,2,3 recognized
Overweight BMI
25-29.9
Obesity class I BMI
30-34.9
Obesity class II BMI
35-39.9
Extreme obesity Class III BMI
> 40
Normal capillary refill time
<2 seconds
Abnormal capillary refill time
> 2 seconds
Claudication is a cardinal symptom of
Claudication occurs when
peripheral artery disease
skeletal muscle oxygen demand during exercise exceeds blood oxygen supply
Initial claudication distance score for test
Absolute claudication distance score
pain free
max distance when test is terminated due to pain
Grading scale for claudication pain
1
2
3
4
definite discomfort or pain but only of initial or modest levels
moderate discomfort or pain from which the patient’s attention can be diverted
intense pain from which the patient’s attention cannot be diverted
excruciating and unbearable pain
Pain in butt or hip obstruction of
aorta and iliac arteries
Pain in calf obstruction of
femoral and popliteal arteries
Pain in ankle and foot obstruction of
tibial and fibular arteries
HR in infant
Child
adult
100-130
80-100
60-100
Amplitude of pulse
3+
2+
1+
0
large or bounding
normal or average
small or reduced
absence
Obstructive impairment
decreased expiratory flows
FEV1/FVC <70%
asthma, emphysema, chronic bronchitis
Restrictive impairment
reduced lung volumes and relatively normal expiratory flow rates
FEV1/FVC is normal or >80%
interstitial lung disease, pleural disease, chest wall deformities, obesity, pregnancy, neuromuscular disease, tumor
SpO2<___ in acutely ill patients.
or <___ in chronic lung disease patients
activity should be stopped and discussed with physician
90%
85%
Rate pressure product
index of MI oxygen consumption and coronary blood flow
RPP=HR SBP
RPE of 13-14 represents ____% max HR.
11-13 corresponds to
70
upper limit of prescribed training during early cardiac rehab
RPE can be substituted for HR when
ability to monitor HR is compromised
pts begin exercise program without exercise test
HR response is altered
physical activities other than cardiorespiratory endurance activity are assessed
clinical status or medical therapies change
RR:
newborn
1 year
10 years
adult
33-45
25-35
15-20
12-20
Normal respiratory rhythm
COPD respiratory rhythm
inspiration is half as long as expiration
longer expiration phase
6 min walk test is at least ____ feet.
100
Can patients use medications, O2, and an AD during the 6 min walk test?
yes
How many walks are recommended with at least 15 min rest in between for the 6 min walk test ?
3
What do you record as part of the 6 min walk test?
distance walked and number of stops
Increased risk of diabetes, dyslipidemia, HTN, CVD associated with circumference of > ____ in in men and > in in women.
40
35
Percent of max HR formula for lower target heart rate (THR)=
HRmax x55%
Percent of max HR formula for upper target heart rate (THR)=
HRmax x 90%
Karvonen formula
Lower THR
[(HRmax-HRrest) x 40%] + HRrest
Karvonen formula
Upper THR
[(HRmax-HRrest) x 85%] +HRrest
Normal cardio response to exercise with SBP
linear increase with SBP 8-12 mmHg per MET
Normal cardio response to exercise with DBP
no change or moderate decrease in DBP
Normal cardio response to exercise with RR and tidal volume
increased
ACB technique
forced expiratory technique
Three phases: breathing control, thoracic expansion exercises, and forced expiratory technique.
Autogenic drainage
varying expiratory airflow without postural drainage positions or coughing.
Theory is to improve airflow in small airways to facilitate movement of mucus
May not be suitable for young children and patients not motivated or easily distracted.
AD procedure
Controlled breathing at 3 volumes:
unsticking phase: breathe in through nose, hold, exhale.
collecting phase: breathe normally with periodic holds
evacuating phase: deeper inspirations from low volumes with breath holding and huff
Huff doesnt produce the same airflow velocity as a cough but the potential for
airway collapse is less
Huffing can be reinforced with a quick
adduction of arms to self-compress the chest wall
Huff is contraindicated for
those with elevated intracranial pressure or known aneurysm
reduced coronary perfusion like a recent MI
and more
High-frequency airway oscillation devices
what is it
acapella and flutter
handheld devices that combine positive expiratory pressure and high frequency airway vibrations to mobilize mucus secretions
Postural drainage positions are contraindicated for
those with intracranial pressure >20 mmHg
pulmonary edema with CHF
among others
Trendelenburg is contraindicated for
uncontrolled HTN
distended abdomen
Postural drainage for Apical segments L and R upper lobes
sitting, leaning back 30-40 degrees
Postural drainage for Posterior segment R upper lobe
prone on L side with bed horizontal and head and shoulders raised on a pillow
Postural drainage for Posterior segment L upper lobe
prone on R side with head of bed elevated to 45 degrees
Postural drainage for lingula L upper lobe
supine on R side with foot of bed elevated 12 inches
Postural drainage for anterior segments R and L upper lobes
supine in bed horizontal
Postural drainage for R middle lobe
supine on L with foot of bed elevated 12 inches
Postural drainage for L and R lower lobes
prone with bed horizontal
Postural drainage for anterior basal segments L and R lower lobes
supine with foot of bed elevated 18 inches
Postural drainage for posterior basal segments L and R lower lobes
prone with foot of bed elevated 18 inches
Postural drainage for lateral basal segments lower lobes
sidelying with foot of bed elevated 18 inches
white or gray sputum
COPD, asthma
yellow or green sputum
lung abscess
bronchiectasis
chronic bronchitis
cystic fibrosis
Brown or black sputum
smoking
black lung disease (coal inhalation)
Pink or bloody
pulmonary edema
lung cancer
pulmonary embolism
bronchiectasis
CF
TB
Rust
pneumococcal pneumonia
Fetid odor
bacterial infections
lung abscess
bronchietasis
Thick/tenacious consistency
asthma
CF
Frothy
pulmonary edema
Increased volume
chronic bronchitis
bronchiectasis
pulmonary edema
pneumonia
TB
smoking
exposure to pollution