Cardiovascular physical therapy (exerpts) Study online at quizlet.com/_3055t
1.
1+
Pitting edema scale - Barely perceptible identation ( 0 - 1/4 inch pitting)
2.
2+
Pitting edema scale - Easily identified depression; returns to normal within 15 seconds. (1/4 > 1/2 inch pitting)
3.
3+
Pitting edema scale - Depression takes 15- 30 seconds to rebound rebound (1/2 > 1 in ch pitting)
4.
4+
Pitting edema scale - Depression lasts for ≥ 30seconds (> 1inch pitting) pitting)
5.
40-60% of functional capacity
Patients with CHF should exercise at low intensity and with interval training (increasi ng duration with frequent frequent rest rest periods). periods). W hat intensi ty level level should sh ould CHF exercise in terms terms of percentage of functional capacity?
40-70% of VO2max, 2-3 times/day, 37days/week
A walking wa lking program is recommended recommended for for patients with PVD. what intensity should it be?
7.
60-80% of V02 max
How is 70 - 85% of HR max correlates to VO2 max?
8.
60% of HR range
An RPE value of 12 - 13 (Somewha (Somewha t hard) correspond to to how much percentage percentage of HR range?
6.
9.
85% of HR range
10. Anoxia 11. Anterior
12. Antiarrhythmics Antiarr hythmics
obliterans
Aspi rin 14. Aspirin
ECG changes with MI A PT working i n a hos pital is as ked to to treat a patient with known cardiac problems. When he looks at the ECG strips in the chart, he sees Q waves in leads V1 - V4; what condition is the PT suspecting?
(atherosclerosis): Chronic, occlusive arterial disease of medium and large siz ed vessels, the result of peripheral peripheral atherosclerosis. - Associated with hypertension and hyperlipidemia; hyperlipidemia; patient may may als o exhibit CAD, Cerebrovascular Cerebrovascular disease, diabetes diabetes - Pulses: decreased or absent - Color: pale on elevation,dusky red red on dependency - Early stag es: Intermitte Intermitten n claudication. cl audication. Pain describe described d as burning,searing,aching burning,searing,aching , tightness or cramping - Late stages: Ischemia and rest pain; ulcerations and gangrene, trophic changes - Affect A ffect primarily primarily the lower ex tremities. tremities. Identify Identify the followin g medication based on description? - Decreases platelet aggregation; may prevent prevent myocardial myocardial infarction, consider consi dered ed a blood thinner.
15.
Beta-adrenergic blockers blockers
Identify Identify the followin g medication based on description? - reduce myocardial demand by reducing heart rate and c ontractility; control arrhythmias, chest pain, reduce blood pressure e.g., propanolol[inderal]
16.
CAD, MI, aortic stenosis, chronic hypertension
S4 is associated with ventricular filling and atrial contraction. it occurs just before S1. Which conditions conditions is S4 associated with?
Calcium channel blockers blockers
Identify Identify the followin g medication based on description? - Inhibit flow of calcium ions, decrease heart rate, decrease contractility,dilate coronary a rteries, rteries, reduce reduce BP, co ntrol arrhythmias, chest pain. e.g., Cardizem, Procardia,diltiazem
18.
Cheyne-Stokes respirations
Defined as a period of apnea (no breathing) las ting for 10 - 60 seconds followed by gradually increas ing depth depth and frequency frequency of respirations; accompanies depression of frontal lobe and diencephalic dysfunction. May also be seen in a dvance dvance left sided heart failure
19.
Clubbing
Curvatu Curvature re of the fingernails with s oft tissue enlargement at base of nail; Associated with chroni c oxygen deficiency, heart failure
20.
Compression therapy is contraindicated
ABI Index Index value = 0.79 - 0.50; Compression Compression therapy recommendation? recommendation?
An RPE value of 16 (Hard) correspond correspond to how much percentage of HR range? Complete Complete lack of o xygen
MI
13. Arteriosclerosis
17.
Identify the following medication based on description? - Four main classes., Alter conductivity, restore normal normal heart rhyth,control arrhythmias, improve improve cardiac output output e.g., quinidine, procainamide
21.
Compression therapy is contraindicated
ABI Index Index value < 0.50; Compression Compression therapy recommendation?
22.
Compression therapy is contraindicated
A therapist obtains obtains a value of 0.49 of a measure of the AnkleBrachial index. What does this value repr represents esents in terms terms of using compression compression therapy? therapy?
23.
Compression therapy is contraindicated
A therapist obtains obtains a value of 0.78 of a measure of the AnkleBrachial index. What does this value repr represents esents in terms terms of using compression compression therapy? therapy?
Compression therapy with caution
A therapist obtains obtains a value of 0.92 of a measure of the AnkleBrachial index. What does this value repr represents esents in terms terms of using compression compression therapy? therapy?
24.
25.
26.
Compression therapy with caution
ABI Index Index value = 0.99 - 0.80; Compression Compression therapy recommendation?
Congestive Congestive heart fai lure (CHF)
Defined Defined as a condition condition in w hich the heart is unable to maintian adequate adequate ciruculation of the blood to to meet meet the the metabolic metabolic needs of the body. body. Wh en with this con dition edema edema is present present is called?
27.
Congestive Left heart failure
Gallop or S3, is an abnormal heart rhythm with three sounds in each cycle. It occurs soon after S2. Which condition is S3 is a ssociated with? with?
28.
Cyanosis
Bluish co lor related to decreased decreased cardiac o utput utput or cold; especially lips, fingertips, nail beds
29.
30.
DBP ≥ 110mmHg, decrease in SBP > 10 mmHg, significant ventricular/atrial arrhythmias, 2nd-3rd degree AV Block, s/s of exercise intolerance
If a patient is exercising in a Inpatient Cardiac Cardiac Rehabilitation Reh abilitation program, what conditions would lead to exercise discontinuation?
Decreased stroke volume, volume, cardi ac output and ejection fraction, but also also increased end diastolic ventricular pressures
Impaired ventricular function results in:
31.
Deep vein thrombophlebitis (DVT)
Defined as clo t formation formation a nd acute inflammation in a deep vein vein - Usuall y occurs in low er extremity extremity,, associated with venous stasis (bed rest, lack of leg exercise) - Hyperactivity Hyperactivity of blood coagulation, and vascular trauma trauma - Early ambulation is prophylactic, h elps eliminate venous stasis
32.
Diabetic angiopathy
Defined as inappropirate elevation elevation of blood glucose levels levels and an d accelerated accelerated atherosclerosis - Neuropathy a majo r problem - Neurotrophic Neurotrophic ulcers, may lead to gangrene gan grene and amputation amputation
33.
Diastole
The period of ventricu ventricular lar relax ation a nd filling of blood
34.
Digitalis Digitalis (card iac glycosides)
Identify Identify the followin g medication based on description? - Increases co ntractility and decreased decreased heart rate (bradycardia) - Mainstay in the treatment of CHF (e.g., digoxin)
35.
Discontinous
When performing performing Exercise Tolerance Test (ETT) to determine functional capacity of an individual, How ETT should be performed for patients with more pronounced CAD?
36.
Discontinue activity, elevate limb and apply cold packs
A patient is presenting with an y of the the sign s of lymph overlad: overlad: discomfort, aching or pain in proximal lymph areas (axillar or inguinal), change in skin color as a result of activities being perform in the rehab session. What should the PT do?
37.
Diuretics
Identify Identify the followin g medication based on description? - Decrease myocardial w ork (reduce (reduce preload preload a nd afte a fterload) rload) - Control hypertension hypertension (e.g., (e.g. , furosedide [lasix],hydrochlorothiazide[Esidrix]
38.
Do not apply compression
A PT is workin g a hospital ho spital and he's given orders to apply compression compression to a patient with chronic venous insufficiency as part of mana gement of LE edema. edema. The PT looks at the chart and reads the ABI index to be < 0.8 (mild arterial diseas e) with evidence of cellulitis or infection. What's Wha t's the Next thing thing to do? do?
39.
40.
Do not apply compression therapy
A therapist wants to apply compression compression therapy as part of management of edema on a patient with chronic venous insufficiency. The therapist perform performss an an Ankle-Brachia l test. the the values is 0.68,which is < .80 according according to the index values. What should this therapist do with regards to compressi compression on therapy?
Do not remove A PT is trying to control external external any cloth or bleeding bleeding (a rterial rterial bleed) for for a football towel, towel, and a dd player who has severely injured. The PT additional layers, attempts to stop the bleeding by putting a and elevate the clean cl oth or towel over it and apply a part if possible possible firm pressure. pressure. The PT notices that the unless it's blood is soaki ng through the cloth or deformed or towel. What's the next thing he s hould causes pain do to contain the bleeding? when ele elevated vated
41.
End diastolic volume volume
The amount of blood in the ventricles ventricles after diastole (≈ 120mL)
42.
End systolic volume volume
The amount of blood in the ventricles ventricles after systole (≈ 50mL)
Exercise is contraindicated
Wha t can be safely assumed in term of exercise in individuals with: poor LEFT ventricular ventricular function, isch emic changes on ECG (ST segment depression > 1mm) during ETT, Functional capacity < 6 METs, uncontrolled hypertension hypertension or arrhythmias?
44.
Falsely elevated, arterial disease, diabetes
ABI Index Index value > 1.2
45.
Grade 1
A patient presents presents with intermitte intermittent nt claudication claudication when walking on the treadmill. When asked with regards to his pain in LE, he states it is minimal discomfort. What g rade this represent represent in the intermittent intermittent claudication sc ale?
46.
Grade 2
A patient presents presents with intermitte intermittent nt claudication claudication when walking on the treadmill. When asked with regards to his pain in LE, he states it is moderate discomfort, and his attention can be diverted diverted with con versation. versation. What Wha t grade this represent in the intermittent claudication scale?
43.
47.
Grade 3
A patient presents presents with intermitte intermittent nt claudication claudication when walking on the treadmill. When asked with regards to his pain in LE, he states states he cannot continue because the pain is intense (Patient 's attention attention cannot cann ot be diverted diverted). ). Wha t grade this represent represent in the intermitte intermittent nt cla udication sca le?
48.
Grade 4
A patient presents presents with intermitte intermittent nt cla udication w hen walking wal king on the treadmill. treadmill. Shortly after the patient stops the treadmill treadmill and states tha thatt his pain is excrutiat excrutiating ing a nd unbearable. What grade this represent in the intermittent claudication scale?
49.
Heart failure
Defined as a condition in which whi ch the heart is unable to to maintian adequate adequate ciruculation of the blood to meet the metabolic needs of the body.
50.
Heteroptics
Cardiac transplantation is used in end-stage myocardial disease e.g., cardiomyopathy,ischemic heart disease, valvular disease. When transplan tation involves leaving the natural heart and piggy-backing the donor heart this is called?
51.
HR > 115bpm
In patients with CHF, exercise HR sh ould be limited limited to RHR + 10-20bpm. What exercise HR is generally contraindicated in individuals with Congestive heart fail ure? ure?
52.
HR increases directly proportional to exercise intensity, Rate related related shortening of QT i nterval, decrease R wave and increase Q wave, arrhythmias rare: single PVCs, ST segment depression < 1mm
What Wha t are ECG changes chan ges with wi th exercise in healthy individuals ?
53.
Hypercalcemia
Increased concentration of calcium ions increases heart actions
54.
Hyperkalemia
What Wha t condition condition migh t be suspected suspected in the follow ing description? - increased concentration of potass potass ium ios decreased the rate and force of heart contraction - ECG changes s uch as: Widened PR intervals intervals,, QRS and tall T waves?
55.
Hypocalcemia
decreased decreased concentration of calcium ions decreases heart actions
56.
Hypokalemia What Wha t condition migh mightt be suspected suspected in the following description? - decreased decreased concentration of postass ium ions produce
57.
hypokalemia
leg cramps may a lso result from from diuretic diuretic use that reduce reduce K ion concentration. this condition is called:
58.
Hypoxemia
Abnormally low amount of oxygen in the blood (O₂sat < 90%)
59.
Hypoxia
Low oxygen level in the tissues
60.
Increase duration first, and then intensity
As trainin g progress in rehabilitation, you should:
Inferior MI
ECG changes with MI A PT working i n a hos pital is ask ed to to treat treat a patient with known cardiac problems. When he looks at the ECG strips in the cha rt, he sees Q waves in leads II, III, III, AVF. What conditions is the PT suspecting?
61.
62.
63.
64.
65.
Interval training or discontinous protocol at moderate level
Exercise training for patient with PVD may result in improved improved functional functional capacity, improved improved peripheral peripheral blood flo w and muscle oxidative capacity. wh at type type of training/protocol is recommended recommended??
Lateral MI
ECG changes with MI A PT working i n a hos pital is ask ed to to treat treat a patient with known cardiac problems. When he looks at the ECG strips in the cha rt, he sees Q waves in leads 1, AVL. What condition condition is the PT suspecting?
Left heart failure or forward HF)
Left sided heart failure
Defined as w he blood is n ot adequately adequately PUMPED into s ystemic ystemic circulation;du ci rculation;duee to an inability inabil ity of LEFT ventricle to pump,increases pump,increases in ventricular end-diastolic pressure and left atrial pressure with: - Increas ed pulmonary pulmonary artery pressures, pressures, a nd pulmonary edema - Pulmonary signs & symptoms: cough, dyspnea, orthopnea(shortness o f breath breath (dyspnea) which occurs when lying flat) - Weakness, fatigue fatigue
66.
Mild arterial disease, intermittent claudication
ABI Index Index value = 0.99 - 0.80
67.
Mild peripheral artery disease
A therapist obtains obtains a value of 0.92 of a measure of the Ankle-Brachial index. What does this value represents?
68.
Moderate arterial disease, and pain at rest
ABI Index Index value = 0.79 - 0.50
69.
Moderate peripheral A therapist obtains obtains a value of 0.56 of artery disease a measure of the Ankle-Brachial index. What does this value represents?
70.
Moderate peripheral A therapist obtains obtains a value of 0.50 of artery disease a measure of the Ankle-Brachial index. What does this value represents?
71.
Moderate peripheral A therapist obtains obtains a value of 0.74 of artery disease a measure of the Ankle-Brachial index. What does this value represents?
72.
Modified Buerger Allen Allen exercises
Name of these exercises for PVD patients (arterial (arterial disease) - Postural exercises + a ctive plantaflexion and dorsiflexion of the ankle
73.
Modified Buerger Allen Allen exercises, and resistive calf exercises
What Wha t LE exercises are recommende recommended d for patients patients of PV D (arterial disease)?
74.
Modify exercis exercise e prescription
- HR < THR for a given exercise intensity - RPE < for a given exercise in tensity (exercise is preceived as easier) - Symptoms Symptoms of ischemia (i.e., angina) do not appear at a given exercise intensity If any of this conditions occurs in your plan of care, you should:
75.
Myocardial perfusion imaging
Diagnostic test use to diagnose and evaluate ischemic heart disease, myocardial infraction
76.
Nitroglycerin
Identify Identify the follow ing medication medication based on description? description? - Decrease preload preload through peripheral peripheral vas odilation, reduce reduce myocardial oxygen demand - Reduce Reduce chest discomfort (angin a) - may als o dilate coronary arteries, improve improve coronary blood flow (nitrates)
77.
Normal
ABI Index Index value = 1.0 - 1.20
These signs & symptoms are associated with wha t type type of heart failure (right/left)? - Fatigue, cough - Shortness of breath, Dyspnea on exertion - Orthopnea, Paroxysmal Nocturnal Dyspnea (PND) - Dia phoresis phoresis - Cheyne-Stokes Cheyne-Stokes respirations (advanced failure)
78.
Normal
A therapist obtains obtains a value of 1.0 of a measure of the Ankle-Brachial index. What Wha t does does this value represents? represents?
79.
Orthopnea
Inability to breathe when in a reclining position
80.
Orthotopic
Cardiac transplantation is used in end-stage myocardial disease e.g., cardiomyopathy,ischemic heart disease, valvular disease. When transplantation i nvolves removing removing te diseased heart and replacing it with a donor heart, this is called?
81.
Pallor
Absence of rosy color in lightskinned individuals, associated with decreased decreased peripheral peripheral blood flow, PVD
82.
Paroxysmal nocturnal dyspnea
Sudden inability to breathe occurring during during sleep
83.
Percussion test
What Wha t test test dete determines rmines the compet competence ence of greater saphenous vein?
84.
Percussion test
What Wha t test test is being explained? - In standing, palpate one segment of vein while percussi percussing ng ven approximately approximately 20 cm hig her. If pulse wave is flet by lower han d, the intervening intervening vals are incompetent incompetent
Persisten dyspnea, dizziness or confusion, angina, severe leg claudication, excessive fatigue, pallor, cold sweat, ataxia, pulmonary rales
Signs & Symptoms Symptoms of Exercise intolerance
86.
Poor arterial perfusion
A PT examines a patient in the clinic. The PT notices that the superficial temperature of one of the LE is lower compared to opposite side. This condition can be attribut attributed ed to:
87.
Posterior MI
ECG changes with MI A PT working i n a hos pital is as ked to treat a patient with known cardiac problems. problems. Wh en he looks at the ECG strips in the chart, he sees Large R waves in leads V 1-V3, ST segment depr depression ession V1, V2, or V3. W hat conditions is the PT suspecting?
85.
88.
Pressures > 45mmHg
When using compression compression pumps wha t pressures pressures are contraindicated as they can cause lymphatic collapse?
89.
Raynaud's disease
Episodic spasms of small arteries arteries a nd arterioles. Abnormal vasocons triction triction reflex exacerbated by exposure to cold or emotional emotional stress. Tip of fing ers develop develop pallor, cyanosis, n umbness umbness and tingling
90.
Raynaud's disease or phonomenon
Defined as episodic spasm of small arteries arteries and a nd arterioles arterioles - Abnormal vasoconstrictor reflex exacerbated by exposure to cold or emotional emotional stress; tips of fingers develop pallor, cyanosis, numbness, and tingling - Affects largely females - Occlusive diesease is not usually a factor
91.
Resistive calf exercises
Wha t is the MOST effective effective method of increasing blood flow in LE in patients with PVD (arterial disease)?
92.
Resistive exercise is contraindicated
A patient would like to beging beging a resistive traini training ng program. Patient has a diagnosis of poor left ventricular function, ischemic changes on ECG during during exercise tolerance test (ETT) and his functional capacity is less than 6 mets. Wha t can be said with regards to perform resistive exercise program?
93.
Resting SBP > 200mmHg Wha t conditions conditions a re considered considered or Resting DBP > Absolute contraindica contraindica tions to 110mmHg, 110mmHg, Orhosthati c participation in Inpatient BP drop > 20 mmHg and/or Outpatient cardiac with symptoms, ST rehabilitation program? segment segment depression > 2mm, uncontrolled diabetes: glucose level 300mg/dL 300mg/dL pr > 250mg/dL with ketones present
94.
Right heart failure or backward HF
Defined as when blood is not adequately RETURNED from the systemic circulation to the heart;due to failure or RIGHTventricule, RIGHTventricule, i ncreased pulmonary artery pressures, with: - Peripheral edema: weight gain, venous stasis - Nausea, a norexia norexia
95.
Right sided heart failure
These signs & symptoms are associated with what type of heart fail ure (right/left)? (right/left)? - Nausea, anorexia - Weight gain, a scites, scites, Right upper quadrant pain - Increased right a rterial rterial pressure pressure (RAP), Central Central venous pressure pressure (CVP) - Jugular venous distention - Peripheral edema
96.
Rubor
Dependent Dependent redness w ih PVD
97.
Severe Severe arterial di sease
ABI Index Index value < 0.50
98.
Severe Severe arterial di sease, critical limb ischemia, and for rest pain
A therapist obtains obtains a value of 0.48 of a measure of the the Ankle-Brachia l index. Wh at does this value represents? represents?
Significant tachycardia occurs at lower level of exercise, Exertional arrhythmias arrhythmias during exercise and recovery, recovery, ST segment segment depress ion > 1mm below below baseline baseline
Wha t are ECG changes chan ges with wi th exercise in individuals with CAD Myocardial Ischemia?
100.
Stemmer's sign
Dorsal skin folds folds of the ltoes or fingers are resistant to lifting Indicative of fibrotic changes and lymphedema
101.
Stop exercise
A patient is taken to to the cardiac rehabiliation inpatient center to exercise. If any of the following occurred, what is the next thing to do with regards to exercise? - Patient's DBP ≥ 110 mmHg - Decrease in SBP > 10 mmHg - Significant ventricular or atrial dysrhythmias - 2° or 3° heart block - signs & symptoms of exercise intolerance, including: including: angina ,marked ,marked dyspnea, and electrocardiogram changes suggestive of ischema such as: ST depressi depression on > 1mm
99.
Strenous activities activities such a s jogging, and ballistic ballistic movements
Activities that that are CONTRAINDICATED to patients with l ymphedem ymphedema a a s they are likely to exacerbate this condition a re:?
103.
Superficial vein thrombophlebitis
Defined as cl ot formation formation a nd acute inflammation in a superficial vein. Localized pain; usually in saphenous in a deep vein
104.
Swan-Ganz catheter
What Wha t the the name of the central line catheter that that is inserted through through vessels into right s ide of heart,and it is used to to measure - Central venous pressure (CVP) - Pulmonary artery pressure (PA) - Pulmonary capilla ry wedge pressures pressures (PCWP)?
105.
Systole
The period of ventricular contraction
106.
Thromboangiitis obliterans
(Buerger's (Buerger's diseas e): Chronic, inflammatory vascular occlusive disease of small arteries and also veins - Occurs commonly in young adults, largely males, who smoke. - Begins distally and progresses proximally in both upper upper and low er extremities - Patient exhibit paresthesias or pain, cyanotic col d extremity,diminished extremity,diminished temper temperature ature sensation, fatigue, risk of ulceration and gangrene
107.
Trendelenburg's test
(retrograde (retrograde filling test) What test is being explained ? - Patient is positioned in supine with legs elevated 60° (empties venous blood) - Tourniquet Tourniquet is then placed on proximal thigh (occludes venous flow in the superficial veins) - Patient is then asked to stand - Examiner notes if veins fill in normal pattern. Should take approximately 30 seconds.
102.
108. Venous
filling filling
time
109. Venous
insufficiency
What Wha t test test is being explained? - Patinet in s upine, upine, pas sively elevate elevate LEs to approximately 45° for 1 minute, then place in dependent dependent position. - note time for veins to refil - delayed filling (> 15 seconds) is indicative of venous venous in sufficiency A therapist perfor performs ms a venous filling time test. test. Veins takes 25 seconds to refill. This venous filling time may be indicative of what condition?
110. Ventricular
111. Weight 112. Work
assi st devices (VADs)
gain, gain, edema in LE
trunk and limb girdle muscles muscles first, then limb muscles muscles from p roximal to distal dista l with compression bandage on
Defined as an implanted device device (accessory pump) pump) that improves tissue perfusion perfusion a nd maintians cardiogenic circulation;used with severely involved patients e.g., cardiogenic shock unresponsive to medications, medications, severe ventricu ventricular lar dysfunction Exercise may exa cerbate CHF, therefore check for delayed reponses reponses of: What Wha t sequence sequence of exercise exercise is in dicated for patients patients with lymphedema? lymphedema?
