Unit 2 Flashcards
PAD
Peripheral Artery Disease
Caused by atherosclerosis lesions in the arteries of the lower extremities that restrict blood flow distally
PAD
third leading cause of cardiovascular morbidity
PAD
Who is more affected from PAD
men and women equally
Who is at highest risk for PAD
The older you get the more risk, as well as African Americans
most potent risk factor for developing PAD
cigarette smoking
Signs and symptoms of __ include
- pain in legs with exertion
- hair loss
- cold or numb toes
- absent pulses in the feet
- smoot shiny skin
- muscle atrophy
PAD
PAD diagnostic test
ABI
Normal range for ABI
.9-1.0
.4-.69 is in what range for PAD
moderate disease
severe disease for PAD is classified by what ABI value
less than .4
mild disease range for ABI test
.7-.89
Normal BP range
<120, AND <80
elevated BP range
120-129, AND <80
Stage 1 Hypertension
130-139, OR 80-89
Stage 2 hyper tension
> 140, OR >90
Hypertensive Crisis
> 180 AND/OR >120
What population is most impacted from HTN
non-hispanic black adults
90% of cases as essential hypertension are caused from what things?
genetics, age, stress, obesity, DM, insulin resistance, alcohol abuse, sedentary lifestyle, high salt, low potassium
Why does HTN increase with age?
people become increasingly exposed to factors like inflammation and stress, as well as renal disorders which put them at risk for greater chance of HTN, as well as more changes to the body’s vaculature
the relationship between BMI and BP is ___
linear
Hypertension can cause issues like ___ failure, and____ resistance
renal failure, and insulin resistance & stress
With hypertension you will need clinical clearance from ?
PCP
Hypertensive BP values before exercise for aerobic activity
below 200/110 mm HG
Hypertensive BP values before exercise for strength training
below 180/110 mm HG
when do you stop exercise for a hypertensive client (BP values)
BP exceeds 250/115 OR isf SBP drops >10 mm Hg from baseline
Exercise prescription of someone with HTN
aerobic training most days of the week with 2-3 days of resistance training
considerations for exercise with HTN
post exercise hypotension, Valsalva maneuver, medication impact
CVA (cerebrovascular accident)
stroke
sudden death of brain cells following ischemia or hemorrhage
stroke
risk factors for stroke
inactivity, smoking, hypertension
occurs when blood flow to part of the brain is obstructed leading to loss of brain function or death
stroke
stroke resulting from thrombosis or embolism
ischemic
stroke caused by a rupture of a vessel in the brain and leaking of blood into the brain tissue or cerebrospinal fluid
hemorrhagic stroke
How long should an exercise test last?
8-12 minutes, 1-3 minute stages. Ramped protocol (increase in workload throughout)
what is the ramped recommendation for exercise testing?
1 MET per minute
example of isometric contraction during exercise testing
gripping handrails or handlebars
should isometric contractions be included in exercise testing
no, avoid all isometric contractions
what modality should be utilized during exercise testing?
large muscle groups, unless the patient has orthopedic or peripheral limitations
Room temperature during exercise testing
72 degrees Fahrenheit, with less than 60% humidity
- informed consent
- review patients medical history
- obtaining resting vital signs
- test explanations
these are all part of what phase of exercise testing
pre-test
during the pretest of exercise testing how should vital signs be obtained
at rest, with supine and standing BP to check for orthostatic hypotension
these are ____ contraindication of exercise testing
- uncontrolled cardiac dysrhythmia
- symptomatic severe aortic stenosis
- acute systematic infection
- suspected or known dissecting aneurysm
- unstable angina
- recent MI within the past 2 days
ABSOLUTE
These are ___ contraindication of exercise testing
- left main coronary stenosis
-moderate stenotic valvular disease
-electrolyte abnormalities
-arterial HTN ( >200,>110) at rest
-tachy or brady
hypertrophic cardiomyopathy
NM, MS, or rheumatoid disorders exacerbated by exercise
-High degree AV block
-ventricular aneurysm
-uncontrolled metabolic disease (diabetes)
-chronic infectious disease
-mental or physical impairment making exercise inadequate
relative
examples of relative contraindication of exercise testing include
- left main coronary stenosis
-moderate stenotic valvular disease
-electrolyte abnormalities
-arterial HTN ( >200,>110) at rest
-tachy or brady
hypertrophic cardiomyopathy
NM, MS, or rheumatoid disorders exacerbated by exercise
-High degree AV block
-ventricular aneurysm
-uncontrolled metabolic disease (diabetes)
-chronic infectious disease
-mental or physical impairment making exercise inadequate
example of absolute contraindication of exercise testing include
- uncontrolled cardiac dysrhythmia
- symptomatic severe aortic stenosis
- acute systematic infection
- suspected or known dissecting aneurysm
- unstable angina
- recent MI within the past 2 days
how much should HR increase with each increasing MET through exercise testing
10 + 2 beats per minute
during an exercise test you should obtain maximal
BP, HR , RPE, and ECG readings
Bruce Protocol
most common treadmill test
3 minute stages that increase in speed and grade each stage
Modified Bruce Protocol
designed for individuals who are unable to exercise vigorously
shorter stages and increase more progressively
commonly used to assess myocardial ischemia
What exercise testing method is commonly used to test myocardial ischemia
Modified bruce protocol
modified balke protocol
submax protocol with constant speed and increasing grade
normally exceeds 8-12 minutes
terminate at a predetermined RPE
Modified Naughton protocol
commonly used in patients with CAD
highly effective in detecting ischemic abnormalities following MI
exercise test commonly used in patients with CAD
Modified Naughton Protocol
cycle ergometer testing is good for what population of patients
those who have ambulatory, orthopedic, or peripheral limitations
what is a better option for arm ergometer testing
pharmalogical stress testing
what respiratory issues are the leading cause of death in children
pneumonia and upper respiratory tract infectionts
a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases
COPD
COPD has a direct relationship between disease severity and ______ ____
management cost
tobacco smoke, and environmental exposure can cause great risk for ___
COPD
hypersecretion of mucus from hypertrophied submucosal glands and goblet cells lead to chronic cough and sputum production
chronic bronchitis
chronic inflammation increases small airway resistance through airway narrowing and loss, and destroys the lung parenchyma, reducing both the lung’s elastic recoil and the tethering between acini and small airways
emphysema
most common risk factor for COPD
smoking of tobacco and/or marijuana
exaggerated inflammatory response due to chronic exposure to noxious gases and particulate
COPD
results when the alveoli, alevolar cuts, and respiratory bronchioles become irreversibly damaged
emphysema
air hunger, increase effort, or chest tightness
dyspnea
most common extra pulmonary manifestation of COPD
skeletal muscle function
a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation
asthma
the prevalence for asthma is __ higher for ____ than for ___
1.5 times higher for females than for males
an exaggerated inflammatory response following exposure of the airway to triggering stimuli such as dust or pollen, viral infection, or airway drying
asthma
asthma vs. copd
asthma: onset early, not typically smokers, often with allergies, stable disease course
COPD: onset after 40 years, heavy smokers, lots of mucus, infrequent allergies, progressive disease course
type of asthma that’s a contraction of airway smooth muscles and swelling of the airway epithelium
acute asthma
type of asthma with significant airway remodeling over time
chronic asthma: characterized by membrane thickening and mucus
Bronchoconstriction during exercise because exercise is one of many possible triggers of their existing asthma
EIA: exercise induced asthma
exercising at a high intensity or in a cold environment is the trigger for an inflammatory response that induces airway constriction and difficulty breathing
EIB: exercise induced bronchoconstriction
_____ contraindication to cardiopulmonary exercise testing
- Patient requests to stop
- Drop in systolic BP of > 10mm Hg when accompanied by other evidence of ischemia
- Moderately severe angina
- Increased nervous system symptoms
- Signs of poor perfusion
- Technical difficulties (will the results be valuable?)
- Sustained ventricular tachycardia
- ECG with ST segment elevation without a diagnostic Q wave
ABSOLUTE
Absolute contraindication of exercise testing include
Patient requests to stop
Drop in systolic BP of > 10mm Hg when accompanied by other evidence of ischemia
Moderately severe angina
Increased nervous system symptoms
Signs of poor perfusion
Technical difficulties (will the results be valuable?)
Sustained ventricular tachycardia
ECG with ST segment elevation without a diagnostic Q wave
_____ contraindication to cardiopulmonary exercise testing
- Drop in systolic BP of > 10mmHg with no evidence of ischemia
- ECG ST-segment or QRS changes such as ST depression
- Arrhythmias other than sustained ventricular tachycardia
- Fatigue, SOB, wheezing, leg cramps, claudication
- Development of bundle branch block or conduction delay
- Increased chest pain
- Hypertensive response (Sys > 250; Dia > 115)
Relative
best field testing options for cardiopulmonary patients
6- minute walk test, incremental shuttle walk test, endurance shuttle walk test
maintain oxygen saturation over
88%
Exercise prescription for Respiratory patients
3-5 day (7 days obese) aerobic: 20-60 minute bouts
2-3 days RT: 1-3 sets, 8-12 reps
work flexibility and posture 2-3 days a week
scuba diving, outdoors, cold weather, and swimming should all be avoided with what condition
asthma
Normal BMI rangs
18.5-25
overweight BMI
25-30
Class I obesity BMi
30-35
Class II obesity BMI
35-40
Class III Obesity BMI
over 40
the average annual weight gain in adults has been estimated to be about ____
2.2-4.4 pounds
Fasting plasma glucose for diabetes
over 126
oral glucose for diabetes
over 200
hemoglobin a1c for diabetes
over 6.5%
genetic diabetes
Type I
most popular form of diabetes
typeII
Type ____ diabetes symptoms
Age ≥ 45 years
BMI ≥ 25 kg/m2 or central adiposity (defined by waist circumference)
Habitual physical inactivity
Having a first-degree relative with DM
African American, Latino, Native American, Asian American, or Pacific Islander race/ethnicity
If a female, delivering a baby weighing > nine pounds or having a past diagnosis of GDM
Having polycystic ovary syndrome
Presence of HTN
Presence of a low level of HDL cholesterol
Presence of a high TG level
Previous diagnosis of IGT or IFG
A history of vascular disease
type II
inflammation of one or more joints
arthritis
arthritis is more common in
women
most common form of arthritis
osteoarthritis
degradation of joints
osteoarthrities
arthritis that is a results of a chronic autoimmune disorderq
rheumatoid
Ra is more common in
females
RA typically affects ____ joints
synovial
cardinal signs of ____
- redness
- swelling
- pain
- heat
arthritis
the gel phenomenon is associated with which form of arthritis
osteo : affects hands, hips, knees, spine, and pain worsens throughout the day
