Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiopulmonary PT > Risk Stratification/exercise prescription > Flashcards

Risk Stratification/exercise prescription Flashcards

1
Q

What is risk stratification

A
  • Medical decision making
  • The constellation of activities eg. labs, interview, clinical testing used to determine a person’s risk for experience a particular condition and the need or lack thereof for preventive intervention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is risk determined

A
  • Known presence of disease (CVD, CHD)
  • Number of risk factors (1 or >1)
  • Presence of signs or symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First step in risk management determination: know disease, what are the known diseases we are concerned with?

A
  • Cardiovascular: Cardiac (MI, CAD), Peripheral vasculature, Cerebrovascular
  • Pulmonary: COPD, asthma, Interstitial lung disease, cystic fibrosis
  • Metabolic: diabetes, kidney disease
  • These can eventually affect the heart
  • *USE CLINICAL JUDGMENT – some people have these well managed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk factor categories

A
  • age
  • family history
  • smoking
  • HTN
  • Dyslipidemia
  • impaired fasting glucose
  • obesity
  • Sedentary lifestyle
  • high HDL = negative risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Age as a risk factor

A
  • Men > 45
    women > 55
    give +1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Family history as a risk factor

A
  • MI, revascularization procedure or sudden death before 55 in father/other 1st degree male relative of 65 in mother of 1st degrees female relative
  • +1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

smoking as a risk factor

A
  • current smoker or those who have quit within the last 6 months +1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

HTN as a risk factor

A
  • systolic BP>140mmHg or diastolic >90 mmHg
  • confirmed on at least to consecutive occasions or currently on HTN meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dyslipidemia as a risk factor

A
  • LDL >130
  • HDL <40
  • on lipid lowering meds
  • total cholesterol >200
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

fasting blood glucose as a risk factor

A

fasting blood glucose >100 confirmed by measurement on a least two separate occasions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

obesity as a risk factor

A
  • body mass index >30 or waist girth >102for men (40 inch)
  • and 88 cm (34 inches) for women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

sedentary lifestyle as a risk factor

A
  • not participating in at least 30 minutes of moderate-level activity at least 3 days/week for 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

High HDL as a risk factor

A
  • HDL of > 60 can subtract a point
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What other signs and symptoms should you look and listen for

A
  • Pain, discomfort in the chest, neck, jaw, arm, or other areas that may be result of ischemia
  • SOB at rest or with mild exertion
  • Dizziness or syncope
  • Orthopnea or PND
  • Ankle edema in gravity dependent positions
  • Palpitations or tachycardia
  • Intermittent claudication
  • Known heart murmur
  • Unusually fatigue or SOB with usual activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does it mean if they have a known CV disease in logical model for risk classification of CVD

A

High risk patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What classification if a patient has no known CVD but has major signs and symptoms

A
  • high risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What classification does a patient get if they have no known CVD, no major signs or symptoms, but have >2 number of CVD risk factors

A

Moderate risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What classification do I give someone if they have no known CVD, no major signs and symptoms, and <1 risk factor

A

low risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Low risk individuals for CVD

A
  • Individuals who are asymptomatic with no more than one risk factor threshold
  • If there vitals are okay and normal response to exercise = don’t need to take them all the time
20
Q

moderate risk individuals for CVD

A

Those who meet the threshold for 2 or more risk factors

21
Q

High risk of CVD

A
  • Those with known cardiovascular,pulmonary or metabolic disease or significant signs and symptoms
  • Check vitals initially, every visit and before they leave
22
Q

Exercise testing: maximal exercise testing

A
  • VO2 max or maximal oxygen consumption, refers to the maximum amount of oxygen that an individual can utilize during intense or maximal exercise
  • This test is the gold standard cardio-respiratory fitness
  • Not done in clinic
23
Q

Submaximal exercise testing

A
  • Has a predetermined end point (based on heart rate or BP targets) unless signs and symptoms occur or the goal is achieved
  • Has a determined end point
  • Get them to a percentage of the max heart rate
  • Could use BP and have a set end point
  • Outpatient will have different end points than inpatient
  • RPE could also be an endpoint
24
Q

Types of sub-maximal testing

A
  • Cycling tests
  • Submaximal treadmill tests
  • 6 minutes walk test
  • 12 minute run/walk test
  • Functional activity (in acute care the tests are functional activities)
25
Q

Why sub maximal exercise testing?

A
  • Assess current performance/patient status
  • Fitness
  • Functional limitations
  • Look at change over time
  • Examine the effect of PT intervention medications
26
Q

Submaximal exercise predictive responses (what can be used to measure

A
  • Resting vital signs: an indicator of fitness and health. Does your patient have reserve for activity
  • Target vital signs (endpoints of activity)
  • Heart rate recovery
  • Heart rate variability
  • Rate pressure product
  • Self-perceived rating scales (borg/borg dyspnea scale)
27
Q

Patient should not exercise if pulse rate is

A
  • > 120 -130
  • <40 bpm
28
Q

In acute care when should you terminate exercise
1. pulse rate
2. respiration
3. SBP
4. DBP
5.SPO2
6. arrhythmias
7. RPE

A
  1. 20-30 above resting
  2. talk test
  3. > 200
  4. > 110
  5. <88
  6. > 6/min
  7. 11-12 (6-20 RPE) ~3 (0-10) RPE
29
Q

HRR

A
  • heart rate reserve
  • (HRR) = Max HR - resting HR)
  • BP - is there enough room to work
  • How much room
  • Max systolic-resting systolic
30
Q

Normal response to exercise for vital signs

A
  • Blood pressure increases about 10 mmHg per MET (moderate activity 3-5.9 METs)
  • HR increases about 10-15 bpm per MET
  • Many individuals will have abnormal responses related to deconditioning and disease
31
Q

Max heart rate/target training heart rate

A
  • TTHR = 220-age x 65% (low end of range) and TTH = 220 - age x 85% (high end of range)
32
Q

heart rate reserve method for training heart rate

A
  • Heart rate reserve = [(HRmax-RHR)x%]-HR resting
  • THR (low end) = [(HRmax-HRresting)x60%] + HR resting
  • THR (High end) = [(HR max-HRresting)x80%] +HR resting
  • Using this method, deconditioned individuals can still benefit from work as low as 50% of HRmax or heart rate reserve method. Start low, progress as patient tolerates
33
Q

Heart rate recovery

A
  • A measure of how quickly your HR returns to normal after you stop exercising
  • A shorter recovery generally indicates better CV health health and links to lower risk of developing cardiovascular disease
  • Generally 18 beats or higher is - recommended
34
Q

Grading scale for heart rate recovery in one minute

A
  • Generally 18 beats or higher is recommended
    <12 bpm in one minute is an indicator of poor cardiovascular health and increased risk for disease
    0-12 = poor
    12-24 = average
    24-36 = good
    36-48 = excellent
    48-60 = superior
35
Q

Heart rate variability

A
  • A measure of the impact of your autonomic nervous system
  • HRV is a measure of variance between heartbeats or RR intervals
  • Higher variability indicates better fitness fitness
    Indicates effective autonomic nervous system input
  • High = sympathetic and parasympathetic nervous system work well together
    Rest your HR gets slower
  • Lower = sympathetic nervous doesn’t get rest possibly due to stress
36
Q

How does HRV work

A
  • Brain → ANS
    ANS:
  • Exercise and stress → sympathetic NS activation → decreased HRV: fatigue and reduced performance
  • OR rest and recovery → parasympathetic NS activation → growth and repair, increased HRV: readiness, increased performance
37
Q

Rate pressure product

A
  • Cardiovascular product or double produce RPP = SBP x HR
  • There is stable angina
  • They are seeing a physician but no evidence of tissue death
  • Given nitroglycerin
  • Ask how often do you take it and do you have it?
  • Used to predict the workload that corresponds with the onset of angina/claudication
38
Q

General indications for stopping exercise testing

A
  • Onset of angina or angina like symptoms (If they are aware they have angina and it increase to moderately severe/increasing chest pain)
  • Drop in systolic BP of >10 mmHg from baseline despite an increase in workload
  • Excessive rise in BP
    (Systolic pressure >200 mmHg or diastolic >110 mmHg
    SOB, Wheezing, leg cramps or significant claudication)
  • Signs or poor perfusion: lightheadedness, confusion, ataxia, pallor, cyanosis, nausea, cold, clammy skin
  • Presence of arrhythmias other than sustained ventricular tachycardia
  • Failure of HR to increase with increase intensity
  • Subject request to stop
  • Physical or verbal manifestations or severe fatigue
  • Failure of testing equipment
39
Q

health related components of fitness and describe

A
  • Cardiorespiratory endurance:
    The ability of the circulatory and respiratory system to supply oxygen during sustained physical activity
  • Body composition: The relative amounts of muscle, fat, bone, and other vital
    parts of the body
  • Muscular strength: The ability of muscle to exert force
  • Muscular endurance: The ability of muscle to continue to perform without fatigue
  • Flexibility: The range of motion available at a joint
40
Q

Skill related components of fitness

A
  • Agility: the ability to change the position of the body in space with speed and accuracy
  • Coordination: the ability to use the senses, such as sight and hearing, together with body parts in performing task smoothly and accurately
  • Balance: the maintenance of equilibrium while stationary or moving
  • Power: the ability or rate at which one can perform work (force or speed)
  • Reaction time: the time elapsed between stimulation and the beginning of the reaction to it
  • Speed: the ability to perform a movement within a short period of time
41
Q

Exercise prescription

A
  • Frequency: most days/week
  • Intensity: based on RPE, target training heart rate range, patient response
  • Time: start at an amount that the patient can tolerate
    Can be accumulated throughout the day
  • Type: a safe activity that is enjoyable and or meaningful to the patient. - Lifestyle activities
  • No two exercise prescriptions are the same
42
Q

BORG scale

A
  • 6-9 very light about 50-60% Max HR
  • 10- 12: noticable breathing deeper but comfortable ~60-70% HR max
  • 13-14: aware of breathing harder more difficult to hold a conversation ~70-80% max HR
  • 15-16: getting uncomfortable about 80-90% max HR
  • 17-20 maximum exertion, hard about 90-100%
43
Q

Should not exercise if patients respiratory rate is

A

> 30 breaths per minute

44
Q

What does a low HRV mean

A
  • sympathetic system is predominant,
  • This indicates that the body is under stress from exercise, psychological or physical stressors.
45
Q

What does a high HRV mean

A
  • parasympathetic is functioning
  • A high HRV indicates better fitness and improved ability to manage and recover from physical and psychological stress.

Cardiopulmonary PT (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions