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PCE - Cardiopulmonary-Vascular > Treatment > Flashcards

Treatment Flashcards

1
Q

How long are typical outpatient cardiac rehab programs

A

12 weeks

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2
Q

3 Overall goals of cardiac rehab

A
  1. Restore optimal function
  2. Prevent progression of underlying processes
  3. Reduce risk of sudden death and re-infarction
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3
Q

Exercises to avoid in cardiac rehab

A
  1. No valsalva
  2. Extensive upper body activity
  3. Isometric/static exercises
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4
Q

FITT prescription for Cardiac rehab

A

F: 3-5 days per week,
I: 60-80 % of HRR, talk test, RPE (around 4-6),
• Do not use HRR for those on beta blockers or pacemakers
• for pacemakers stay 30 bpm below level that it starts at OR 10-15 bpm below onset of abnormal symptoms or angina
T: work up to 45-60 minutes in 5-10 minute intervals
T: whole body dynamic movement

Should include 5-10 min warmup and cool down

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5
Q

What is the equation for HRR

A

(HR max-resting HR) x intensity % + resting HR

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6
Q

What do beta blockers do?

What are they used for?

A
  • Decrease: pulse, myocardial contraction force, myocardial O2, conduction velocity between SA and AV node

USES: CAD, angina pectoris, hypertension, irregular heart rhythms

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7
Q

Important consideration when using Beta blockers?

A

blunted response to HR and BP, decreased resting BP and with exercise, postural hypotension, dose and time related, decreased ischemia with exercise, increased exercise capacity in people with angina
USE RPE! Not age predicted hr range

Ensure gradual warm up and cool down

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8
Q

What does nitrate and nitroglycerin do?

Uses?

A

Relaxes smooth muscle in blood vessels, increases blood flow and decreases workload & O2 supply of heart muscles

USES: treat angina, CHF, acute MI

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9
Q

Important considerations when taking nitrate and nitroglycerin?

A

Increased resting HR and possible exercise heart rate
Decreased resting BP and maybe exercising BP, may cause postural hypotension with postural changes,
Increased exercise capacity with angina pts

ensure warm up and cool down: nitro doses 3-5 minutes apart

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10
Q

What needs to be said to those using nitro

A

storage, expiration date, cool dry space, prime before taking first dose: sit down, take dose, wait 5 minx3 then go to hospital or return at lower rate

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11
Q

what does ACE stand for? (in ACE inhibitors?)

A

angiotensin converting enzyme

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12
Q

What do ACE inhibitors do?

Uses?

A

block conversion of angiotensin I to II
prevents vasoconstriction
Decrease peripheral resistance
Increase urine output

USES: HTN, CHF and CVD, MI, kidney function in diabetics

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13
Q

Important considerations when taking ACE inhibitors

A

Increase exercise tolerance in clients with CHF
Decreased resting and exercising BP
gradual warm up and cool down

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14
Q

What do anticholesterol agents do?

Two types?

A

Decrease mortality in heart disease patients even if cholesterol is normal,
Decrease cholesterol levels (especially LDL) and triglycerides

Niacin and statins

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15
Q

Important consideration if taking niacin?

A

postural hypotension, need gradual warm up and cool down),

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16
Q

Side effects of statin?

A

Muscle aches and joint stiffness

17
Q

What do antiplatelet agents do?

Uses?

A

Decrease platelet aggregation at site of tissue damage

USES: reduces risk of MI, TIA, brain attacks or ischemic strokes

18
Q

Are there effects of antiplatelet angents on pulse or BP

What are the contraindications to exercise with these drugs

A

No

None

19
Q

Important considerations when taking antiplatelet agens

A

caution with bruising, or increased bleed

20
Q

What are the indications for oxygen therapy?

A
  • SaO2 less than 90% or PaO2 less than 80 mm Hg
  • Decrease work of breathing
  • acute MI or to decrease myocardial work
  • short term post-surgery for recovery
  • RT for O2 greater than 40%, acute respiratory distress, transport with O2, and artificial airway (trach)
21
Q

What are the 3 main systems for oxygen therapy?

A

LOW FLOW SYSTEM: supplemental O2 to tidal volume
- nasal prongs (6 L max), simple mask, partial rebreathing, and non-rebreathing mask

HIGH FLOW: enough O2 to supply the entire tidal volume
- venturi face mask, face tent, tracheostomy mask

1 L/MIN = 24 % O2 * goes up by 4% every L increase

22
Q

What is the purpose of incentive spirometry

A

patients with atelectasis; provides visual input/incentive goal (NO evidence use of IS to prevent post-op complications)

23
Q

What is the method and contraindications to incentive spirometry

A

METHOD: Sustained inspiratory effort ~3 sec, relaxed expiration; attempting to achieve max inspiration to TLC

CONTRAINDICATIONS:

  • cognitive impairment
  • patients unable to deep breathe effectively due to pain
  • diaphragmatic dysfunction, or opiate analgesia
  • Patients unable to generate adequate inspiration with a vital capacity <10 mL/kg or an inspiratory capacity <33% of predicted normal
24
Q

What is the purpose of inspiratory muscle training

A

retrain muscles of inspiration (diaphragm, external intercostals, etc.) in populations needing it (evidence support for COPD, CHF, endurance athletes, SCI)

25
Q

What is needed in order to conduct inspiratory muscle training

A

Reliable measure of max inspiratory pressure + max expiratory pressure (pulmonary tests); can use a resistive trainer, threshold trainer (COPD, CHF, athletes), or normocapnic hypernea (athletes, SCI)

26
Q

Prescription for inspiratory muscle training

A

Start w/ 5 min, progress over 2-3 weeks to 2x15 min or 1x30 min sessions, 4-5 days/week, begin at 20-30% MIP and progress to 50% MIP as tolerated, fit individuals can progress to 70% carefully

27
Q

What must you monitor when doing inspiratory muscle training

A

vitals for signs of cardioresp distress

28
Q

Contraindications to inspiratory muscle training

A 
Acute respiratory failure
cognitive impairment (cannot keep it clean)
29
Q

What is shunting

A

normal perfusion but no ventilation (alveoli is collapsed and the capillary is expanded)

30
Q

What is dead space unit?

A

normal ventilation with poor perfusion (capillary is completely collapsed and the alveoli is enlarged)

31
Q

What is silent unit?

A

no ventilation or perfusion (both are collapsed)

32
Q

What is normal ventilation?

A

Greatest in dependent regions

33
Q

What is abnormal ventilationi

A

Best in non-diseased areas

34
Q

What is the effect of mechanical vent on ventilation

A

Air follows path of least resistance, usually best in non- dependent region

35
Q

What is normal perfusion

A

Greatest in dependent regions

36
Q

What is abnormal perfusion

A

Unless restricted will flow to gravity dependent regions

37
Q

What is the effect of mechanical vent on perfusion

A

Increased pressure can restrict blood flow to non- dependent regions

38
Q

Treatment principle in normal VQ matching

A

Lower regions of lungs have greatest surface area therefore best VQ matching in upright lung

39
Q

Treatment principle in abnormal VQ matching

A

Generally place the affected area in non- dependent position to increase VQ matching (bad lung up)

PCE - Cardiopulmonary-Vascular (14 decks)

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