Week 2 CP and CV Exam and Interventions

Question 1

what are some good tests and measures we can use on our Pulmonary and cardiac patients

Answer 1

vitals, 6MWT, 6mWT, 2MWT, seated step test, graded treadmill testing, ergometry, recumbent, self-reported measures, angina Dan dyspnea scales, RPE and claudication scales. describe the seated step test

Question 2

describe the seated step test

Answer 2

stage I: alternate placing one foot onto step or bar at 6inches, rate 1/sec
Stage II: 12 inches
Stage III: 18 inches
Stage IV: 18 inch step and add alternating arms
Monitor: HR, BP, at 2 minutes below 75% max HR, continue for 5 minutes, after 5 minutes, if under 75% then progress to the next stage.

Question 3

what kinds of vitals are we looking for with the eval

Answer 3

Brady/tachy,
HTN, hypotension (orthostatic, a-fib/flutter, HF, dehydration)
oxygen dependence

Question 4

what are some CVP benefits of exercise for the AA

Answer 4

decrease HTN
increase HDL 
decrease CAD 
decrease platelet aggregation 
decreased angina and ischemia 
decreased oxygen requirement 
decreased respiratory s/s 
decreased hospitalizations 
increased glucose utilization 
increase weight management 
increased tolerance and ADLs, 
improved QOL

Question 5

what kinds of modifications do we need to make for exercise to meet goals and adapt to the patients needs

Answer 5

equipment, intensity and duration, need for supplemental oxygen

Question 6

what do we need to know about supplemental oxygen

Answer 6

make sure they bring their own oxygen to the clinic, and asses to make sure saturation does not fall below 90%
also, know that some devices may limit the delivery and mobility (like a big heavy canister)

Question 7

what do we need to know about pacemakers

Answer 7

the mode of pacing can affect exercise

exercise tolerance will depend on pacemaker, their dependence and their disease.

Question 8

can a fixed rate pacemaker elevate HR to accommodate for higher demands

Answer 8

no

Question 9

can a pacemaker set on dual mode allow HR to vary according to demand

Answer 9

yes

Question 10

what are some complaints of patients with pacemakers

Answer 10

c/o lightheadedness, syncope, low BP, decreased activity tolerance.

Question 11

what are some considerations for defibrillators (ICD)

Answer 11

monitor HR and rhythm for abnormalities and activates when it is needed to convert to a normal rhythm with a shock.

Question 12

can pacemakers and ICDs be combined

Answer 12

yes

Question 13

what is the biggest things we need to know with an ICD

Answer 13

threshold that delivers the shock

Question 14

what happens if the HR rises above the rate

Answer 14

they should sit down, instructed to cough or valsalva to cause vagal stimulation and decrease the HR and prevent the shock

Question 15

what are significant psychological effects with ICD in patients 90% of the time

Answer 15

depression and anxiety