Quiz 1 Flashcards
what is clinical reasoning?
the result of intentional “pondering” and the sum of all critical decsion-making processes that are associated with clinical practice
clinical reasoning enables practitioners to…
take the “best” action in a specific context
clinical reasoning permeates clinical practice by…
informing decisions
t/f: clinical reasoning promotes individualized care
true!
what are heuristics?
mental shortcuts that allow ppl to solve problems and make judgements quickly and effectively
what are the 3 dimensions of clinical reasoning?
remember/review (knowledge)
refine (cognition)
reflect (metacognition)
what is the knowledge dimension?
strong, discipline-specific knowledge base derived from theory/research and personal experience
what is the cognition dimension?
reconciling clinical data with the clinician’s existing knowledge in the moment
what is the metacognition dimension?
considering the patient’s response after an encounter bringing the clinician to the realization that knowledge and skills may be insufficient and adjustments are required or hypothesis is confirmed (think about thinking)
what is self-reflection?
constant, thoughtful, self-reflection
what is the single most important attribute found among expert clinicians that is deemed to be the most important skill for developing clinicians?
self-reflection
what is the hypothetico-deductive reasoning model?
clinical data used to generate a hypothesis through further inquiry
what are the 2 types of reasoning under the hypothetico-deductive reasoning model?
inductive and deductive reasoning
what is inductive reasoning?
moving from specific to general
ie: all basketball players in your school are tall, so all basketball players must be tall
what is deductive reasoning?
moving from generalizations to a specific conclusion
ie. you’re so tall so you must be a basketball player
who is the hypothetic-deductive reasoning model primarily used by?
novices and experts in challenging situations
what is the knowledge reasoning integration model?
parallel developments of knowledge acquisition and clinical reasoning expertise that requires domain specific knowledge and an organized knowledge base
clinical reasoning involves the integration of _____, _____, and _____
knowledge, reasoning, metacognition
who uses the knowledge-reasoning integration model?
primarily experts
what is the intuitive reasoning model?
knowledge used unconsciously in inductive reasoning
intuitive knowledge is related to past experiences with specific cases
who are the only people that can use the intuitive reasoning model?
experts
what is the pattern recognition model?
direct and automatic retrieval of info where new cases are categorized in relation to previously experiences clinical cases
the pattern recognition model is characterized by ____ and ____
speed and efficiency
who frequently uses the pattern recognition model?
experts in typical clinical situations
what is the hypotheses-oriented algorithm for clinicians (HOAC)?
a graphically represented step-by-step guide to assist clinicians in problem solving
what is narrative reasoning?
a frame used to understand the patient’s perspective and experiences of their problem to understand the context of the problem
what components are a part of the narrative model?
the patient’s attitudes, understanding, beliefs, emotions, and expectations
what are the 4 cognitive paradigms?
hypothetico-deductive reasoning
pattern recognition
knowledge reasoning integration model
intuitive reasoning
are cognitive paradigms more practitioner driven or patient driven?
practitioner driven
what are the 5 interactive paradigms?
narrative reasoning
multidisciplinary reasoning
collaborative reasoning
ethical reasoning
teaching as reasoning
(all very similar to narrative reasoning)
t/f: the interactive paradigms build consensus b/w clinician and patient
true!
what are the 5 biases?
confirmation bias
availability bias
attentional bias
anchoring bias
selective exposure bias
what is confirmation bias?
configuring info that confirms to existing beliefs
what is availability bias?
the 1st thing that comes to mind and sticking with it
what is attentional bias?
paying attention to some things and ignoring others
what is anchoring bias?
relying too heavily on the 1st thing that you learn
what is selective exposure bias?
seeking info that only confirms our bias
what are biases?
systematic error in thinking that effects decisions and judgement
when does the examination begin?
when the patient walks into the waiting area
what is forward reasoning
pattern recognition which is good for speed and accuracy
what is backward reasoning?
a hypothesis guided reasoning
what are the 3 steps in the PT exam?
initial impressions and observations
data gathering
diagnosis and treatment planning
what are concept maps good for identifying?
problems most important to the patient
largest barriers to the next level of function
problems most affected by the PT
what is the intervention portion?
selection of specific procedures/interventions after appraising the evidence to select the most appropriate treatment
what are some things that can provide guidance for the PT intervention?
guidance from colleagues, mentors, and past experiences in addition to evidence
what are the key components in successful outcomes?
collaboration w the patient
emphasis on patient empowerment
use of standardized outcome measures
what are the 2 types of reflection?
reflection in action and reflection on action
what is the think aloud process?
speaking your process out loud to identify your thought process, assist in taking corrective action, and facilitate the metacognition process
what are the 9 points for reflection?
- initial data gathering/interview
- generation of initial hypothesis
- examination
- evaluation
- plan of care
- interventions
- reevaluation
- outcomes
- mentor feedback
what is the PT examination?
the vigorous pursuit of valid, reliable, and clinically relevant data that’s comprehensively obtained and used to inform intervention and provide an objective measure of progress toward functional outcomes that are meaningful to the patient
what is the primary objective of examination?
to establish an accurate PT diagnosis which guides intervention
t/f: the PT diagnosis is a work in progress and is an ongoing process
true!
when applying a low dose intervention, the patient gets worse, what 2 things can you do?
decrease 1 variable and/or monitor and if good repeat
when applying a low dose intervention, the patient gets slightly better, what should you do?
repeat
when applying a low dose intervention, the patient gets dramatically better, what should you do?
monitor
when applying a low dose intervention, the patient shows no change, what should you do?
increase 1 variable and repeat if good
what tools are in our toolbox as PTs?
- diagnostic imaging
- lab test values
- patient’s response to medication
- patient’s response to performance measures
- patient’s response to self-report measures
- patient’s response to last intervention
- evidence-based standards
- therapist experience, intuition
what is the prognosis?
the predicted optimal level of improvement in function and the amount of the time needed to reach that level
when is the prognosis established?
at the onset of treatment
can the prognosis be modified over time?
yes!
what are the essential components of the plan of care (POC)?
- goals and expected outcomes
- prognosis
- general statement of the interventions to be used
- proposed duration
- frequency required to reach the goals
- anticipated discharge plans
when should the PT exam be performed?
at the start of care
at regular intervals throughout care
at the times of each visit
at the conclusion of care
the PT exam should be used to ____, _____, or _____ the POC
guide, modify, alter
what is the history?
a systematic gathering of data from both the past and present related to why the individual is seeking the services of the PT
how is the history obtained?
through the gathering of data, consultation with other members of the team and through review of the individual’s medical or PT record
what components should be gathered in the history?
the patient’s history of present illness and past medical history
what is an open-ended question?
a question that elicits more than a one-word response that should be used at the beginning of the interview
what kind of question allows a “patient-guided” response?
open-ended
what is a closed-ended question?
a question that warrants a “yes” or “no” answer or other specific options
what kind of question allows for a “therapist-controlled” response?
closed-ended
what is the funnel technique?
start the interview with open-ended questions then move towards more closed-ended questions
what is the most efficient method of collecting data?
using the funnel technique
are follow up questions open or closed ended?
they can be either!
what is the purpose of follow up questions?
to clarify responses or data
what is the paraphrasing technique?
when the therapist repeat info to gain clarity
what is the review of systems?
the search for info regarding all major body systems using a series of questions or checklists to identify symptoms, medical conditions, and/or adverse medication events that may mimic conditions that are amenable to PT intervention
what are some examples of general review of systems questions?
is there any unexplained
- weight loss/gain?
- fever, chills, sweating?
- nausea, vomiting, loss of appetite?
- dizziness, lightheadedness, or falls?
- fatigue?
- weakness?
- numbness or tingling?
- malaise
- changes in cognition or mental activity?
what are some examples of questions about the musculoskeletal system?
any unrelated/unexplained:
- joint pain, swelling, or stiffness?
- muscle weakness?
- muscle wasting?
- pain that never changes?
what are some examples of questions about the neuromuscular system?
any unrelated/unexplained:
- coordination/balance problems?
- changes in vision/hearing?
- involuntary movement/tremors?
- severe headaches?
what are some examples of questions about the cardiovascular and pulmonary system?
any unrelated/unexplained:
- heart palpitations?
- chest pain/heaviness?
- SOB?
- coughing or hoarseness?
- cold/blue fingers or toes?
what are some examples of questions about the integumentary system?
any unrelated/unexplained:
- rashes/other skin changes? - new/changing moles?
- sores that won’t heal?
- changes in nail beds?
what types of questions should you ask about pain?
location, description, frequency, duration, intensity, pattern, aggravating factors, relieving factors, anxiety/depression
what are the 2 broad categories of pain etiologies?
organic and non-organic
what are the organic pain etiologies?
somatic, vascular, neuropathic, and visceral
what are the non-organic pain etiologies?
affective/behavioral (depression/anxiety)
what is the systems review?
a brief exam of anatomical and physiological status of all body systems
what things would be examined in the cardiovascular and pulmonary system?
HR, BP, respiratory rate, edema
what things would be examined in the musculoskeletal system?
gross symmetry, gross strength, gross ROM, height, and weight
what things would be examined in the neuromuscular system?
gross coordinated movements, balance, gait, locomotion, bed mobility, transfers, motor function (control and learning)
what things would be examined for cognition?
consciousness, orientation to person place and time, cognition, expected emotional/behavioral responses, learning preferences
what things would be examined in the integumentary system?
skin integrity, pliability (texture), presence of scar formation, skin color, moles and blemishes
what things would be examined for communication?
language, ability to produce and understand speech, communication of thought and feelings
what things would be examined in the endocrine system?
type 2 diabetes, thyroid conditions
what is the pathophysiology of edema?
hydrostatic pressure pushes fluid against the interior walls of the capillaries caused by BP
OR
osmotic pressure putting fluid pressure against the exterior walls of capillaries causing fluid to enter them at the venule end
is hydrostatic pressure greater at the arteriole or capillary end?
arteriole end
what is edema?
fluid remaining in the interstitial spaces due to injury, infection, insufficient heart or vessels, or insufficient lymphatic system causing an imbalance b/w osmotic and hydrostatic pressure
t/f: increase capillary permeability in edema may be triggered by an inflammatory response
true
what is venous insufficiency?
valve insufficiency leading to a backflow of blood and pooling of fluids due to the effects of gravity
the overload in the venous and capillary systems cause fluids to leave vessels and enter the interstitial space
80% of leg ulcer are due to _____ insufficiency
venous
what is lymphedema?
insufficient lymphatic system that causes chronic fluid buildup in the interstitial space
what is post-injury edema?
edema caused by fractures, contusions, sprains, muscle/tendon/ligament tears or ruptures, burns, or cuts
what is osteomyelitis?
a bone infection
what is dactylitis?
swelling of the toes
what are the IFEE signs of infection?
induration
fever
erythema
edema
what is induration?
dense edema causing hardness or firmness
what is erythema?
redness
what are additional signs of infection other than IFEE?
purulent exudate (pus) and pain
what are the s/s of traumatic edema?
erythema, warmth, non-pitting edema, and local tenderness
what are the s/s of lymphatic edema?
pitting or non-pitting edema, soft or hard, local tenderness along the lymph canal
what are the s/s of venous edema?
skin is thick and shiny, pitting edema, distal swelling in extremities
where does lymphedema occur?
in the upper and lower extremities
who is more prone to lymphedema?
women who’ve had a mastectomy w/resection of the lymph nodes and/or damage of lymph nodes by radiation
what are the s/s of lymphedema?
edema, pain, numbness, paresthesia, heaviness, fibrosis
what are the limitations in lymphedema?
proprioception, AROM, strength, manual dexterity, lifting, and other functional skills
where is the apex (inlet) of the axilla?
connected to the neck
where is the base (outlet) of the axilla?
the armpit
what makes up the anterior wall of the axilla?
pec major, subclavius, pec minor, clavipectoral fascia, and suspensory ligament of the axilla
what makes up the posterior wall of the axilla?
subscap, lats, and teres minor
what makes up the medial wall of the axilla?
upper 4-5 ribs, intercostal spaces covered by serratus anterior
what makes up the lateral wall of the axilla
coracobrachialis and biceps
what is intermittent claudication?
ischemia with exercise causing pain and cramping often in the gastroc and glutes
if the pain is eliminated with rest, what should you suspect?
claudication
is intermittent claudication synonymous to neurogenic claudication?
no!
edema pitting scale
0: no putting
1+: mild pitting; 2 mm depression that disappears rapidly
2+: moderate pitting edema; 4 mm depression that disappears in 10-15 seconds
3+: moderately severe pitting; 6 mm depression that may last more than 1 minute
4+: severe pitting edema; 8mm depression that can last more than 2 minutes
what are some accessory organs?
hair follicles, glands, nails
what are the functions of the integumentary system?
protection, temp regulation, nutrient storage, sensory reception, excretion/secretion, synthesis
what is the storage component of the integumentary system?
adipose tissue stores lipids
what is secretion/excretion component of the integumentary system?
salt, water, and organic wastes are excreted
mammary glands produce and secrete milk
what does the integumentary system synthesize?
melanin, keratin, and vit D
what are some common conditions affecting the integumentary system?
aging, cardiopulmonary and vascular changes, pressure, neuropathy, trauma, inflammatory skin disease, and neoplastic skin disease
what are some effects of aging?
wrinkles, skin dehydration, slower healing, diminished temp regulation, decreased immunologic responses, decreased UV protection, impaired sensory perception and pain threshold, decreased immune responsiveness, decreased sweat production, gray hair, atypical skin pigmentation, decreased skin thickness, increased susceptibility to pathological conditions, and decreased hair and nail growth
what causes wrinkles?
elastic tissue becomes less resilient and the fat layer and supportive tissues beneath the dermis decrease in thickness
why does the skin become dehydrated with age?
sebaceous (oil) glands and sweat glands decrease in activity
why does healing slow down with age?
blood supply to the dermis is diminished
why is there a decreased immunological response as you age?
decreased # of Langerhan’s cells
why does skin have decreased UV protection as you age?
decrease in melanocytes
why is there impaired sensory perception and pain threshold in aging?
decreased # of nerve endings and distorted structure of nerve endings
why is there a decrease in temp regulation as you age?
decrease is sweat production and loss of subcutaneous fat
why does hair gray and skin get atypical pigmentation with age?
decreased # of functional melanocytes
what are you looking for in an integumentary screening?
presence of edema, scar tissue, skin discoloration, nail abnormalities, integrity, and signs of infection
what is arterial insufficiency?
loss of vascular flow to lower extremities leading to tissue death
often seen in the foot and ankle
what is venous insufficiency
results from venous hypertension, venous thrombosis, varicose veins, or poorly functioning valves, obstruction within venous systems.
what is venous stasis?
results from increase in capillary leakage of fibrinogen secondary to venous hypertension
what is white cell trapping?
trapped cells occlude capillaries leading to ischemic damage
what is a pressure injury?
localized injury to the skin and/or underlying soft tissue usually over a bony prominences.
intense or prolonged pressure or pressure in combination with sheer can cause what?
a pressure injury
what is dermatitis?
acute/chronic inflammation, itching, and scaling of the epidermis
what is staph aureus?
skin boil
what is impetigo?
staph aureus/streptococcus pyogenes
what is cellulitis?
a bacterial infection of the skin that affect the dermis and subcutaneous fat
what is ring worm?
a fungal infection of the skin that causes a round shaped mark
no this is not an actual worm
what causes Lyme disease?
a tic bite that causes neuro and muscular symptoms
what are the 3 most common types of neoplastic skin diseases?
- basal cell carcinoma
- squamous cell carcinoma
- malignant melanoma
what is the ABCD rule with skin lesions?
A-asymmetry of the pigmented lesion
B-borders that are irregular
C-color (dark black to dark brown to red)
D-diameter over 6mm
what is a keloid scar?
a raised scar that doesn’t stay within the boundary of the og wound
what is senile purpura?
purple bruising due to aging
what is the difference b/w a blister and a callus?
a blister is a fluid filled bubble on the skin caused by friction b/w the skin and another surface
a callus is an area of hardened skin the often occurs due to friction b/w bone and skin
don’t SCIP the skin screen! what does SCIP stand for?
Scar
Color
Integrity
Pliability
what does the 6 minute walk test measure?
cardiorespiratory endurance, gait speed, and functional mobility
what does reliability mean?
reproducible and dependable
what is reliable patient behavior?
consistent responses under given conditions
what is a reliable examiner?
able to measure repeated outcomes w/consistent scores
what is a reliable instrument?
performs with predictable consistency under set conditions
what is test-retest reliability?
an instrument can measure a variable w/consistency against itself under repeated consistency
what is intrarater reliability?
stability of data recorded by one individual across 2 or more trials
what is interrater reliability?
agreement b/w 2 or more examiners who measure the same group of subjects
what needs to be established first, intrarater reliability or interrater reliability?
intrarater reliability
what is a good reliability coefficient?
greater than .75
what is generalizability?
ability to apply data obtained from one population to all/other populations
what is validity?
a test that measures what it is intended to
are valid measures considered to be reliable?
yes!
are reliable measures considered to be valid?
not all the time
what is content validity?
items that make up an instrument adequately sample the universe of content that defines the variable being measured
test contains all elements of the variable being tested
what is face validity?
instrument appears to test what it’s supposed to and is a plausible method for doing so
what is criterion-related validity?
outcome of one instrument, the target test, can be used as a substitute for an established reference standard (gold standard) test
high correlation b/w the target test and the criterion
criterion test and target test measure the same thing
what is concurrent validity?
it establishes validity when 2 measures are taken at relatively the same time, most often when the target test is considered more efficient/less costly than the gold standard test
the degree to which 2 tests agree on the same phenomenon (ie. self report vs clinician rating)
what is construct validity?
the ability of an instrument to measure an abstract construct and the degree to which the instrument reflects the theoretical components of the construct
does the measure relate to things that we would expect?
what is predictive validity?
the outcome of the target test can be used to predict a future criterion score/outcome
ie. gait velocity in predicting discharge location
why is the ability of an instrument to detect change over time important?
bc it assess the effects of an intervention, the score must change in proportion to the patient’s status change
what is minimal detectable change (MDC)?
VERY IMPORTANT CONCEPT
the amount of change in a variable that must be achieved to reflect a true difference b/w 2 time points
the smallest amount of difference that passes the threshold of error
determines if a change is meaningful
what is minimally clinically important difference (MCID)?
VERY IMPORTANT CONCEPT
the smallest difference that signifies an important difference in a patient’s condition
the smallest difference a patient perceives as beneficial
should the MDC or MCID be larger?
the MCID
which is the more important change: MDC or MCID?
MCID
what are the 4 possible outcomes of a diagnostic test?
- true positive
- false positive
- false negative
- true negative
what is sensitivity?
the ability to get a positive result when a condition is truly present
what is specificity?
negative result when the condition is truly absent
SpPin and SnNout
SPecificity, Positive test rules IN a diagnosis
SeNsitivity, Negative test rules OUT a diagnosis
a high post-test probability allows us to ____ the diagnosis when a test is positive and ____ it when the results is negative
confirm, abandon
what are post-test probabilities?
revised likelihood of the diagnosis based on the outcome of a test that increases our confidence in the diagnosis
t/f: likelihood ratios always refer to the likelihood of the disorder being present
true!
what is a positive likelihood ratio?
how many times a positive test is likely to be seen in those with the disorder than those w/out it
a good test with have a ____ positive likelihood ratio
high
what does a positive likelihood ratio indicate?
that the disorder is likely to be present with a positive test
what does a high LR+ mean?
the disorder is likely present with a positive test
what does a low LR- mean?
the disorder is not likely present with a negative test
what is a negative likelihood ratio?
how many times more likely a negative test will be seen in those w/ the disorder than those w/it
a good LR- test will have a ____ LR
low
what does a negative likelihood ratio indicate?
that the disorder has a low likelihood of being present with a negative test
a LR+ of >___ and a LR- of <____ has relatively important effects
5, 0.2
a LR b/w ____ or ____ may be importatn
2-5, 0.2-0.5
t/f: values close to 1.0 in LR have unimportant effects
true!
are cardiovascular and lung problems or LBP more prevalent?
cardiovascular and lung problems
why do we do cardiovascular and pulmonary screenings?
to see if it’s an active issue
what is congestive heart failure (CHF)?
the heart is unable to pump a sufficient amount of blood to the body to supply its needs
what can CHF lead to?
pulmonary congestion, edema, and hypertension
what is left sided heart failure?
L ventricle fails to pump enough blood to meet the body’s needs
what does left sided heart failure lead to?
pulmonary edema !!!!
muscle weakness, tachypnea, renal changes, and cerebral hypoxia and sequela
pulmonary edema varies based on…
position, activity, emotional/psychological stress
what is right sided heart failure?
failure of the R ventricle to pump blood to the lungs causing congestion in the R atrium and throughout the venous system
what right sided heart failure lead to?
peripheral edema !!!!
venous congestion of the organs, dependent edema, jugular vein distension, abdominal pain and distension, weight gain, and liver congestion
what is dependent edema?
any position where a limb is hanging down and is under the influence of gravity that often occurs in the ankle or pre-tibia (anterior tibia)
which sided failure is easy to identify? why?
right sided heart failure is easier to recognize bc left sided is more just breathing difficulties
what are the essential components of the cardiovascular screen?
HR, BP, SpO2, respiration rate, and edema (especially pitting)
what are the average resting heart rates?
adults: 60-100 bpm
children (1-8): 80-100 bpm
infants (<1): 100-120 bpm
highly trained athletes: 40-60 bpm
at the initial encounter, the assessment of HR and RR should last ____ and then after that it should last _____
1 minute, 30 seconds
what is tachycardia rate in adults?
> 100 bpm
what is bradycardia rate in adults?
<60 bpm
what is regular pulse rhythm?
felt at typical intervals
what is irregular pulse rhythm?
felt at variable intervals
what are the 6 vital signs?
pulse (HR, rhythm, and force)
respiration (rate, rhythm, and depth)
BP
temp (core)
pain
walking speed
what is a 0 pulse force?
absent (unpalpable)
what is a 1+ pulse force?
weak or diminished (barely palpable)
what is a 2+ pulse force?
normal (easily palpable)
what is a 3+ pulse force?
increased force (very easily palpable)
what is a 4+ pulse force?
bounding (unable to obliterate w/palpation pressure
fever leads to _____ in the periphery, which leads to _____ in BP, which makes the heart pump _____
vasodilation, decrease, harder
measure of arterial blood
O2 carried in arterial blood by hemoglobin is measured as PaO2 (partial pressure of oxygen)
pulse oximetry
measures arterial blood oxygen saturation (% of O2 combined with Hgb)
reported as SpO2
measured at the peripheral pulse (usually a finger)
what are normal SpO2 values?
96-100%
SpO2 less than ___ warrants further testing
90%
what is hypoxemia?
deficient oxygenation of the blood
what is hypoxia?
diminished availability of O2 to tissues
what is anoxia?
complete lack of O2
what are some causes of reduced blood O2 saturation?
alterations in heart function
impaired ability of the lungs to oxygenate blood
anemia (reduced Hgb)
hypoventilation
diffusion impairments that affect blood-gas exchange
what are the 2 light sources in the pulse ox device?
red and infrared
measurement of pulse ox allows…
indentification of hypoxemia
monitoring of tolerance of activity
evaluates patient’s response to treatment
what are average respiration rates?
adult: 12-20 breaths/min
child (1-8): 15-30 breaths/min)
infant(<1): 25-50 breath/min
highly trained athlete: 8-10 breaths/min
what are tachypnea rates?
> 20 breaths/min
what are bradypnea rates?
<12 breaths/min
what are regular breathing rhythms?
breaths observed at typical intervals
what are irregular breathing rhythms?
breaths observed at variable intervals
what are the 3 components of a pitting edema screen
is it…
1. new?
2. bilateral?
3. pitting?
what are the essential components of a pulmonary screening?
- SpO2
- breathing pattern
- posture
- respiration rate
what is dyspnea?
difficulty/uncomfortable breathing that may be described as SOB and may see accessory breathing
what is orthopnea?
difficulty breathing when lying flat
how is orthopnea measured?
in the # of pillows needed to be able to breath kore comfortably
what is paroxysmal nocturnal dyspnea?
episodes of sudden dyspnea and orthopnea usually at the same time each night that often wakes the patient and subsides with sitting or standing
what is apnea?
absence of breathing (frequently while sleeping) caused by obstruction or dysfunction of the NS
is chest breathing or diaphragmatic breathing the goal in PT?
diaphragmatic breathing
what are some accessory muscles?
SCM, lev scap, scalenes, pec major
why does leaning forward on something help with breathing?
allows for stabilization so accessory muscles can work to elevate the ribs and thorax, increases abdominal pressure (pushes the diaphragm up for better strength of contraction)
what can SpO2 readings help gives insights into?
possible pulmonary conditions like COPD
you need regular participation in physical activity that…
- involves large muscles groups
- challenges the cardiorespiratory system
what is VO2 max?
max O2 consumption that measures the body’s capacity to use O2 measured in mL/kg/min
what 5 factors does VO2 depend on?
- transport of O2
- O2 binding capacity of the blood
- cardiac function
- O2 extraction capability
- muscular oxidative capacity
what is endurance?
the ability to work for prolonged periods of time and to resist fatigue
what is muscle endurance?
ability of an isolated muscle group to perform repeated contractions over period of time
what is CV endurance?
ability to perform large muscles dynamic exercises over long periods of time
what determines the need/demand of myocardial O2 consumption?
- HR
- systemic BP
- myocardial contractility
- afterload
what is afterload?
ventricular force need to open the aortic valve at the beginning of systole
afterload is determined by ___ ventricular wall tension and _____ wall tension
left, aortic
what is myocardial O2 supply dependent on?
- O2 content
- Hgb O2 dissociation
- coronary blood flow
what is coronary blood flow determined by?
- aortic diastole
- duration of diastole
- coronary artery resistance
- collateral circulation
what happens if the myocardial demand for oxygen exceeds the supply?
ischemia
where is the main supply of O2 during exercise coming from?
increased coronary blood flow
what is deconditioning?
decrease in max O2 consumption that results from prolonged bedrest due to illness, bedrest w/o disease, lifestyle, or aging
what are 4 examples of fitness field tests?
- 1 mile walk test
- 6 minute walk test
- 1.5 mile run
- 12 minute run
what are 4 fitness tests?
- field tests
- treadmill tests
- cycle ergometry
- step tests
what are the advantage of field testing?
easy to administer to a large group at one time with little equipment needed
what are the disadvantages of field testing?
it can be near the max in ppl w/low aerobic fitness
there is a potential to be unmonitored for test termination criteria, BP, or HR
it may not be appropriate for sedentary individuals or those at risk for CV/MSK complications
when should you stop a test?
- onset of angina/angina-like symptoms
- drop in SBP of >/=10mmHg with an increase in work rate
- SBP drops below the value obtained at rest in the same position before the test
- increase in SBP>/=250 mmHg and/or DBP>115 mmHg
- SOB, wheezing, leg cramps, or claudication
- signs of poor perfusion: lightheadedness, confusion, ataxia, pallor, cyanosis, nausea, cold/clammy skin
- HR doesn’t increase with exercise
- noticeable change in heart rhythm
- subject requests to stop
- physical/verbal manifestation of severe fatigue (inability to talk)
- failure of testing equipment
