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Diag Pro Unit 5

SPC Diagnostic Procedures Unit 5 Exam 3

What are the 3 testing methods of a Cardio-Pulmonary Stress Test? 1. Testing to evaluate a patients general fitness 2. Testing to evaluate the effects of exercise on a patients oxyhemoglobin desaturation 3. Testing to evaluate a patients exercise tolerance
Indications for a Cardio-Pulmonary Stress Test? 1. Assist in diagnosing physical disorders, (i.e. dyspnea on exertion) 2. Quantify level of impairment and determine respiratory and/or cardiac limitations. 3. Evaluate effectiveness of treatment 4. Evaluate patients cardiovascular fitness
General contraindications of cardio-pulm stress test? 1. Limiting Neurological disorders (alzheimer's/dementia) 2. Limiting neuromuscular disorders (lou gehrigs disease) 3. Limiting Orthopedic disorders (quadriplegia)
Pulmonary contraindications of cardi-pulm stress test? 1. FEV1 <30% of predicted 2. PaO2 <40mmHg 3. PaCO2 >70mmHg 4. Severe Pulmonary Hypertention
Cardiovascular contraindication os cardio-pulm stress test? 1. CHF 2. MI (with in 4 weeks) 3. 2nd or 3rd degree heart block 4. A or V Tach 5. Uncontrolled Hypertension 6. Unstable Angina 7. Systemic or Pulmonary Emboli
Preliminary Evaluation for cardio-pulm stress test would include? 1. Complete medical history 2. Ask patient amount of normal physical activity tolerated w/ any symptom of distress 3. Complete physical 4. 12 lead EKG 5. PFT
What is the 6 min. walk test? The patient walks as far and as fast as possible for 6 minutes, the further patient is able to travel the more fit they are.
What is important to know of a 6 min. walk test? 1. Patient should walk as a comfortable pace 2. Make sure SpO2 is adequate prior to start 3. Make sure patient is able to walk on their own w/o difficulty.
How is the harvest test preformed? 1. Patient steps onto a 20" platform then back down 30x a min for 5min 2. Patient rest for 1min 3. Pulse is take for 30sec to get their Recovery HR 4. The lower the rate the greater degree of fitness
Pulse-Ox & ABG's pre/post exercise are for what? 1. Evaluate effects of exercise on oxyhemoglobin 2. ABG's to determine need for sup O2 3. Needed for home reimbursement O2 4. SpO2 evaluate level of oxygenation
Advanced stress tests are more what? More Available but come with: More contraindication, hazards, physiologic monitoring, control over patients exercise workload
What is Constant Work Rate/Steady State 1. Once the target heart rate is reached the patient is in a steady state and the timed portion of the test begins. 2. Patient continues to exercise to maintain a target heart rate for 5-8 minutes.
Formula for Maximum Heart Rate 220 - age
Formula for Target Heart Rate? Maximum HR x 75%
Steady state test are most useful in determining what? VO2max (Maximum O2 Consumption)
Steady State is used more often with what? Cardiac Stress Test
Steady state will be repeated when and why? Months later to test is exercise tolerance has improved
What are the 2 advanced stress tests? Constant Work Rate/Steady State & Incremental Work Rate
With Non-steady state workload levels increase in what? Brief increments usually 1-3 mins
With non-steady state what is taken at the end of each workload level? Physiologic parameters (EKG, BP, & exhaled gas analysis)
With non-steady state patient continues until what? patient has adverse reactions to exercise
How should a non-steady state test end? 8-10min after it was started. When the tests is completed the subject should perform a cool down period, which is continued exercise at a minimal workload for at least 2min, or stop exercising entirely and rest in a supine position.
What is the most commonly performed stress test? Non-Steady State
Non-steady state is designed for what? 1. Test patients exercise limits 2. Determine value of patients VO2 max
VO2 max should be taken whe? Point of exhaustion of physiologic distress
What is a Ramp type test? Variation of the incremental work rate test with the increase in workload being smooth and continuous instead of incremental with plateaus
What are the 3 types of equipment used for Exercise stress testing? 1. Treadmills 2. Arm Ergometers 3. Cycle Ergometers (Mechanical & Electromechanical)
How are treadmills used for Exercise Stress testing? Use the patients weight as well as the speed and incline of the treadmill to develop workload.
Disadvantages of using a treadmill for stress test? 1. Can be difficult to set a specific workload.  2. Can be difficult to measure patient’s BP while walking 3. Can be difficult to obtain ABG while on treadmill 4. Can be noisy 5. Take up a lot of space 6. Danger of patient falling
Advantages of cycle ergometers? Cycle ergometers are cheaper, smaller, quieter, and present less of a chance of the subject falling than treadmills.
Mechanical Ergometers? 1. Workload adjustments have to be made manually 2. Pedaling rate is 50-60 cycles per minute 3. Easy calibration
Electromechanical Ergometers? 1. Electronically controlled flywheel.  2. Workload changes made automatically 3. Easier to do ramp testing with 4. Pedaling rates of 40-80 cycles per min 5. Calibration is more difficult
Arm Ergometers? Used when patient has limited or no use of lower extremities (hemipalegia) VO2max and Vemax are 50%-70% less than with a cycle ergometer
What devices are used to measure lung volumes during C/P Stress testing? 1. Pneumotachometers 2. Gas Mixing Chambers 3. Spirometers 4. Gas Analyzers 5. Douglas bag
Pneumotachometers with C/P Stress Testing? The most common device for measuring lung volumes during a stress test, they measure O2 & CO2 used and exhaled
Gas mixing chamber with C/P Stress Testing? Have a capacity of 5-6 liters. Sometimes used instead of volume collecting devices. Generally made of clear plexiglass and have baffles.
Spirometers with C/P Stress Testing? Used to manage collection & measurement of patient's exhaled gas. 
Gas analyzers with C/P Stress Testing? Analyze the patient's exhaled O2 and CO2. Usually, 2 separate analyzers (O2 and CO2) are used or a mass spectrometer can be used to analyze them both with one analyzer. 
Douglas with C/P Stress Testing? Used to ensure a well mixed sample of exhaled gas is collected to measure the O2 and CO2.
What is the main cause of ECG recording problems during exercise? Motion artifact
What allows for the best cardiac rhythm? 12 lead EKG monitoring with special artifact filters
Significant changes in patients ST segment should be identifiable up to the patients what? Max HR
A sudden drop in BP should be an indication for what? TO STOP THE TEST
BP monitoring is done when? Before, During, and After the test
Muscular work requires the use of what for energy? ATP
3 Mechanisms required to meet the needs of muscle cells as they work? Transport, Exchange, Metabolism
Transport is accomplished through the flow of ? 1. Pulmonary Ventilation 2. Cardiovascular Circulation
Exchange take place though? Diffusion of Substances
What 2 types of respiration is exchange? 1. External Respiration 2. Internal Respiration
What is external respiration? Movement of substances between the atmosphere, the lungs, and into the pulmonary capillary blood.
What is Internal Respiration? Movement of gas between the capillary blood and the tissue cells within the muscles or organs.
Normal metabolism requires what to produce what? Requires O2 to produce ATP
Normal metabolism is called what? Aerobic Metabolism
What waste products are produced? CO2 & H2O
Normal resting metabolism is performed through combined processing of what? Carbohydrates & Lipids
Aerobic metabolism involves burning what? Carbohydrates for energy
Aerobic Metabolism Formula glucose + O2 = ATP + CO2 & H20
What is the key stage in aerobic metabolism? Oxidative Phosporylation
O2 buned is what? VO2
CO2 produced is what? VCO2
RQ formula VCO2/VO2
Normal Resting value for VCO2? 200 ml/min
Normal Resting value for VO2? 250 ml/min
Normal RQ 0.8
Anaerobic Metabolism Occurs when energy is produced even when the tissues lack the oxygen required to complete oxidative phosphorylation
Which produces less ATP Anaerobic or Aerobic? Anaerobic which is much less efficient
Compare moles of ATP with Anaerobic and Aerobic? 1. Anaerobic- 2mol ATP per 1mol of glucose 2. Aerobic- 38mol ATP per 1mol of glucose
Problems with Anaerobic Metabolism? 1. Lactic Acid build up 2. Lactic acid -> acid/base imbalance -> lactic acidosis 3. Lactic acid -> ^ CO2 production 4. Burden on lungs to blow off added CO2 5. Lactic acid -> delayed onset muscle soreness
VO2 increase directly with? Level of muscular work being performed
VO2 increases until? Exhaustion occurs and max level is reached call VO2max
VO2max The largest amount of O2 a patient can consume during exercise
VO2 max for normal adult? 1700ml/min
VO2 max for trained athlete? 5800ml/min
What are METS? Multiples of resting oxygen consumption.  One MET is the amount of oxygen produced at rest.  As mentioned earlier, normally the body consumes 250 ml per minute of oxygen at rest.  This 250 ml per minute is one MET.
Deadspace ratio decreases with what? Exercise
T/F VCO2 increase as more O2 is consumed? True
VCO2 can increase up to how much the resting value at max exercise? 20x
What is the anaerobic threshold? When anaerobic joins aerobic producing ATP
T/F Anaerobic and Aerobic working together is the greatest O2 consumption level that can be reached? True
In normal adults the anaerobic threshold occurs when? At 50%-70% of VO2 for the patient, 90% for trained athletes
What happens to RQ when the Anaerobic threshold is reached? Lower VO2 and higher VCO2 --> RQ from .8 to 1.0
Asthma induced Cardio-pulm stress test? FVC measured via spirometry before and after to determine bronchospasm was induced to exercise.
Normal Cardio-pulm stress test interpretation 1. VO2max normal range 2. Vemax 70% of MVV 3. MVV can be 35x the FEV1 4. SPO2/PaO2 normal range 5. VD/VT normal or decreased 6. HRmax close to predicted
Poor Conditioning cardio-pulm stress test interpretation 1. HR max achieved at lower than predicted workload 2. VO2 max is low 3. VeMax/MVV ratio is low (fatigue)
Pulmonary Disease cardio-pulm stress test interpretation 1. Low VO2 2. High veMax/MVV 3. Low SPO2/PaO2 4. Normal or increase VD/VT 5. Normal HR max at appropriate workloads
Cardiovascular disease disorder cardio-pulm stress test interpretation 1. HR max achieved before AT 2. MR max increase to max at lower workloads 3. S/T segment changes on EKG 4. VeMax/MVV ratio is low
Differences between Poor Conditioning & Cardiovascular? 1. History & other test results 2. S/T segment changes 3. BP changes during test (large drops)
Created by: Langhout1418
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