Gerontology Module 5
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| What is the formula for VO2? | • VO2 = CO x (a - vo2 diff)
– VO2 = oxygen consumption
– CO = cardiac output; product of HR and SV (stroke volume)
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| What is the formula for arteriovenous oxygen difference? | (a - vo2 diff) --> this value decreases with age, Indicating peripheral tissues receive less O2 for energy
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| How does oxygen consumption change with age? | ↓ peripheral blood distribution, ↓ arterial oxygen, ↓ hemoglobin levels, and a loss of activity in tissue enzyme systems
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| What is cardiac output a product of? | HR and SV -• Normal CO at rest is 4 to 6 liters per minute – Increases linearly with workload
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| What is an increase in CO with exercise due to? | an increase in both HR and SV
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| What contributes to age-related decline in VO2max? | A decline in max CO - – Factors include body size, physical fitness level, and condition of heart structures involved with CO
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| What is the amount of blood ejected by the left ventricle at each heartbeat? | Stroke Volume – Difference between end-diastolic and end-systolic blood volume
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| What impacts SV response? | Body position – SV is lower in sitting or standing versus in supine
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| What is the Frank-Starling mechanism? | SV increases with an increase in the volume of blood filling the heart (the end diastolic volume) when all other factors remain constant. -• Increasing SV during heavy exercise
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| What is the amount of blood volume pumped out of the left ventricle and amount of resistance in the peripheral system? | Blood pressure!
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| What happens if amount of blood pumped out (CO) falls? | – Total peripheral resistance is high then BP remains
relatively stable
– Opposite relationship is also true
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| What happens if CO and BP increase and decrease at the same time? | – Person is likely to suffer from a hypertensive or hypotensive episode
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| What is the resting HR affected by? And how much does the Max HR decline per year? | • Resting HR is affected by body composition, level of fitness, and environmental factors; Maximal HR declines by ~1 bpm / year
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| What is the clinical implication of HR changes? | Older adult reaches a higher intensity of exercise at lower HR vs. younger adult; Decline in HRmax is not influenced by exercise training
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| What is oxygen consumption DIRECTLY related to? | Exercise intensity! – Exercise intensity ↑ so does O2 consumption
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| How is physical work capacity measured by? And what occurs with age? | Measured by VO2max - declines with age - by 75, older adults demonstrate a VO2max that is below level required for ADLs
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| What is the CV response to activity and exercise with an ↑ Left Ventricle Hypertrophy? | ↓ Blood flow to body
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| What is the CV response to activity and exercise with an ↑ Valve stiffness and stenosis? | ↓ or hindered blood flow to body
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| What is the CV response to activity and exercise with a ↓ Blood vessel diameter and stiffness? | ↑ resistance to blood flow
↑ Response time to activity peripherally
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| What is the CV response to activity and exercise with a ↓ Baroreceptors Response? | ↑ Risk for orthostatic hypotension
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| What is the CV response to activity and exercise with a ↓ Pacemaker cell response? | ↓ or hindered blood flow to body
↑ response time to activity
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| What is the CV response to activity and exercise with a ↓ Cardiac Output? | ↓ blood flow to body
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| What is the pulmonary response to activity and exercise with Thoracic kyphosis, costo-vertebral joint stiffness →↓ ribcage expansion? | ↓ Lung expansion ↑ work to breath
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| What is the pulmonary response to activity and exercise with ↓ respiratory muscle strength? | ↑ work of breathing ↓ strength of cough
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| What is the pulmonary response to activity and exercise with ↓ surface area of lung tissue? | ↓ oxygenation of blood
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| What is the pulmonary response to activity and exercise with ↓ airway diameter and stiffness? | ↑ Resistance to air flow
↑ response time to activity
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| What is the pulmonary response to activity and exercise with ↓ lung compliance / ↑ lung stiffness? | ↑ work of breathing
↑ response time to activity
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| What is the pulmonary response to activity and exercise with Altered lung volumes and capacities? | ↓ oxygenation of blood / air trapping
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| What type of heart failure involves Inefficient CO due to impaired contraction of ventricles? | Systolic dysfunction HF
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| What type of heart failure involves Inefficient CO due to inability of ventricles to accept blood ejected from atria | Diastolic dysfunction HF - primary cardiac dysfunction with aging - 60% of pts with HF have this
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| What is the most frequent pathological finding among older adults who die during exertion? | Coronary artery disease (CAD)
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| What condition is Acute coronary artery plaque disruption, plaque rupture or erosion, with acute thrombotic occlusion common in? | CAD
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| What condition has ↑ wall stress from ↑ HR and BP, and exercise-induced coronary artery spasm in diseased artery segments? | CAD - Increased flexing of atherosclerotic epicardial coronary arteries, lead to plaque disruption and thrombotic occlusion
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| What does vigorous exercise do to pts with CAD? | provokes acute coronary thrombosis by deepening existing coronary fissures, augmenting catecholamine-induced platelet aggregation, or both
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| What contributes to coronary thrombosis after plaque rupture or erosion in CAD? | ↑ thrombogenicity
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| What can reduced coronary perfusion in CAD be exacerbated by? | a ↓ in venous return 2nd abrupt cessation of activity
– explains clinical observation that collapse occurs immediately after exercise
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| What is a differential dx associated with CAD? | • Angina: Chest pain associated with CAD
– Stable: predictable, occurs during exercise or stress
– Unstable: Unexpected, occurs at rest, more severe and prolonged
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| What are the 3 characteristics of pain related to angina? | Pain gradually increases, cannot be pinpointed with one finger and is deep
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| What are the 4 grades of the angina scale? | • Grade 1: Light Discomfort
• Grade 2: Light – Moderate Discomfort
• Grade 3: Moderate – Severe Discomfort
• Grade 4: Severe Discomfort – “most excruciating pain”
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| What is condition has SBP↓>20mmHg, DBP↓>10mmHg, occur within 3 minutes of supine to standing, and has symptoms including: dizziness, faintness and lightheadedness? | Orthostatic hypotension
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| What is the etiology of orthostatic hypotension? | • Volume depletion • Venous pooling
• Medications
• Dehydration
• CNS or PNS disease • Endocrine disorders • Metabolic disorders
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| What condition has SBP > 140 mmHg/DBP > 90 mmHg? | Hypertension - Measured on at least 2 separate occasions at least 2 weeks apart, diagnosed with HTN, and / or on HTN medication
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| What are the interventions for HTN? | • Medications
• Weight loss
• Diet
• Smoking cessation • Exercise
• Alcohol restriction
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| What condition is an Acute inflammatory condition with occlusion of superficial (SVT) or deep (DVT) vein by thrombus? | Acute Thrombophlebitis
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| What is an inflammation along the length of veins? | SVT (superficial)- Redness, heat, aching, no generalized edema
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| What is a painful and tender extremity, slight fever, “tight” feeling, warmth? | DVT - Possible tachycardia, distended superficial veins, LE > UE, may lead to Pulmonary Embolism to pulmonary artery
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| What condition has Venous thromboembolism (VTE), deep vein thrombosis (DVT) with or without pulmonary embolism (PE)? | Pulmonary Embolism - – ↑ exponentially with age and in hospitals or NSH, especially in COPD, cancer or orthopedic surgery
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| What do massive pulmonary emboli result in? | hemodynamic collapse and often death
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| What do medium sized emboli present with? | pleuritic chest pain, dyspnea, tachypnea, tachycardia, hemoptysis, and hypoxemia
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| What condition has Lipid deposition on intimal layer of arteries results in occlusion, with the LE affected more than UE? | Peripheral artery disease (PAD) - Causes skeletal muscle changes, motor nerve injury, loss of type II fibers – Muscle weakness
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| What condition shows signs of Pain, pallor, paresthesias, paralysis, pulselessness, Claudication: occurs in 50% narrowing of vessel lumen, and Pain, ache, cramping, fatigue, occurs with activity relieved with rest? | PAD - presents with pain in Low back, buttocks, thigh, calf, foot
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| What are the 5 stages of the PAD scale? | 1. No Pain
2. Minimal discomfort or onset of pain 3. Mild pain
4. Moderate pain
5. Severe (Unbearable) pain
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| What condition results from Plaque formation > erosion of vessel wall stretching of layers of artery resulting in formation of sac? | Aortic Aneurysm - can be Asymptomatic or substernal, back, neck, groin, or mid- abdominal pain; Midline pulsating abdominal mass
– Able to feel heart beat when lying down;
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| Where can chest pain occur in aortic aneurysms? and what can cause SUDDEN DEATH? | Chest pain especially in supine, radiates to neck, low back, and shoulders – Cough, dyspnea; SUDDEN DEATH from ↑ in BP ↑ likelihood of rupture
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| What does smoking cessation cause? | • Smoking cessation reduces over-all mortality and morbidity rates
– Post one year risk of CHD is reduced by half
– Post 15 years the risk is similar to non-smokers
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| How does depression present as a risk factor for heart disease? | Those who had a history of depression were 4 times more likely to experience an MI in next 14 years vs. non-depressed; Individuals who were depressed were 4x more likely to die w/in 6 mo after experiencing an MI compared to those who were not depressed
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| What are the 2 most common revascularization procedures? | CABG and coronary artery angioplasty
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| How is a CABG performed? | blood flow is rerouted through a new artery/vein that is grafted around failed sections of coronary arteries; Use Vein from LE or radial/mammary artery– Chest opened via sternum, heart-lung bypass machine used during surgery to circulate blood and add O2
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| What is the rehab after a CABG? | • Post-opinhospital,PTinitiatemobilityandexercise training
• Released from hospital, recovery ~ 4 to 6 weeks followed by cardiac rehabilitation program
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| If your pt has Sudden SOB, dizziness, palpitations > 6 minutes, ↑ swelling of feet/ankles, chest pain (different from incision), Extreme fatigue or weakness, and Fever > 100 deg, persistent drainage incision, redness around incision site, what do you do? | Contact Physician!! Other sx's include: Change in pulse > 20 bpm unrelated to exercise, Weight gain of 3lbs./day in 2-3 days, No improvement in client condition
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| What procedure involves a Catheter-guided balloon opens a narrowed coronary artery increases blood flow to heart muscle? | Percutaneous Transluminal Coronary Angioplasty – Stents are placed in 70-90% of all procedures – Stent = wire mesh tube that expands to hold artery open – Placed at narrowed section of artery – Cells lining blood vessel grow through and around the stent
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| What reduces buildup of scar tissue and prevents re-blockage of the artery in a Percutaneous Transluminal Coronary Angioplasty? | • Drug-eluting stents polymer coating slowly releases drug
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| What occurs post-op Percutaneous Transluminal Coronary Angioplasty? | • Patients begin walking within 12 to 24 hours s/p procedure
• Study showed that exercise more effective than angioplasty
• 90% of exercisers were free of heart problems within one year vs. 70% who had angioplasty
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| What is a Battery-powered device that sends weak electrical impulses to heart re-establish rhythm? | Pacemaker - – Single-chamber = stimulates either atrium or ventricle chamber
– Dual-chamber = sends electrical impulses to both atrium and ventricle
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| How are pacemakers rate-responsive? | – ↑ HR when system is stressed eg, exercising – Adjust HR when person is at rest
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| What would PTs do with pts post-op pacemaker? | • Performupper-bodyROMexercises:
– Avoid any strength-training exercises that may cause pulling at incision site for at least 12 weeks s/p surgery
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| What is a Computerized device that monitors HR and rhythm to Detect arrhythmias, and sends energy to heart to re-establish rhythm? | Implantable Cardioverter defibrillators (ICDs) - Physician programs ICD to deliver electrical impulses for treatment of arrhythmias, cardioversion, defibrillation - Avoid heavy pulling or lifting motions / strenuous activities for 6 weeks
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| What are the types of ICDs? | Single-chamber-1 lead to right ventricle; Dual-chamber = leads attached to right atrium/ventricle; Biventricular = treat delay in heart ventricle contractions by sending electrical impulses w/ leads to both ventricles – syncs ventricles to pump together
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| What are some Pacemaker/ICD considerations during therapy? | • Maintain at least a 10% safety margin between exercise HR and rate cutoff for implanted device
• Use RPE scale in conjunction with HR to monitor exercise intensity
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| What types of malfunctions can occur with Pacemakers/ICDs? | • Malfunction:
– Syncope, lightheaded, palpitations, resting HR > 90
BPM, irregular ECG
• Stop exercising immediately and contact physician if patient experiences inappropriate shocks, chest pain or extreme fatigue or dial 911
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| What are ablations used to treat? | Treat arrhythmias; Performed surgically or non-surgical (involves directing energy (radiofrequencies) to the heart muscle) - Destroys a small area of heart tissue responsible for rapid and irregular heartbeats - scars in heart take 6-8 wks to heal
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| Which drug class reduces afterload by reducing vasoconstriction and water/sodium retention? | ACE inhibitors
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| Which drug class counteracts over-activity of SNS and blunts HR & BP response? | β-Blockers
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| Which drug ↑ contractility and CO, prolongs PR interval and is used for 1st degree av blocks? | Digoxin
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| Which drug class ↓ preload by reducing BV (blood volume)? | Diuretics
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| Which drug class ↓ resting and exercise HR and how does it effect exercise capacity? | Beta-blockers - ↓ or no effect in those without angina
↑ in those with angina
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| Which drug class ↑ resting HR and has ↑ or no effect on exercise HR? How does they effect exercise capacity? | Nitrates - ↑ in those with angina; No effect in those without angina; ↑ or no effect in those with CHF
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| Which drug class has variable effects on HR and what are their effects on exercise capacity? | Calcium channel blockers - ↑ in those with angina; No effect in those without angina
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| What drug has a ↓ HR in those with A- Fib / possibly CHF HR not significantly altered in those with sinus rhythm? And what is its effect on exercise capacity? | Digitalis - ↑ only in those with A- Fib or in those with CHF
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| What drug class has ↑ or no effect on resting and exercise HR? And what is its effect on exercise capacity? | Vasodilators - No change, except ↑ or no change in those with CHF
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| What drug class has no change in resting and exercise HR? | ACE (Angiotensin- converting enzyme) inhibitors - No change, except ↑ or no change in those with CHF
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| What are CK or CK-MB test results? | 0-3 ng/ml (Total = 38-120 ng/ml)
CK-MB begins to rise 4-8 hours after the MI; CK-MB returns to normal range after 48-72 hours
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| What are the troponin test results? | < 0.4 ng/ml; Does not provide an earlier detection of Acute MI; Peaks between 14-36 hrs after onset of Acute MI; Remains elevated for 1-2 weeks after Acute MI
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| What are HDL test results? | 40 mg/dL or better (higher the better)
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| What are LDL test results? | < 100 mg/dL with High risk CVD
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| What are C-reactive protein test results? | 3.0 mg/L = High Risk; 1.0 to 2.9 mg/L = Intermediate
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| What test evaluates the presence and severity of CAD and includes Chemically induced, treadmill test or combo of both tests? | Nuclear Cardiology Stress Testing - • Imaging of heart at rest and after stress test
• “Nuclear” test = small amount of a radiopharmaceutical is injected into vein to tag muscles of heart viewed by a gamma camera
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| What is does the treadmill test involve during nuclear cardiology stress testing? | • Treadmill test:
– BP, EKG monitors heart rhythm
– Symptoms are monitored by a cardiologist
– Radioactive agents are used to show blood flow to the heart
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| What occurs during a Nuclear Stress Test? | • Stress images are compared to rest images
• Significant blockage is present in coronary arteries a perfusion defect will show
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| What are the possible results of a nuclear cardiology stress test? | • Test (+) for ischemia = defect in stress but rest images appear normal
• Test (+) infarct = matching defects in both stress and rest
• Test (-) or Normal = no defects in either test
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| Which type of ventricular failure includes dyspnea, dry cough, dizziness, ↓ exercise tolerance, tachycardia, muscle weakness, renal changes, fluid retention, pallor, cyanosis and crackles in the lungs? | Left ventricular failure
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| Which type of ventricular failure has peripheral edema, jugular vein distension, ↓ exercise tolerance, fatigue, cyanosis, liver engorgement, and anorexia or weight gain? | Right ventricular failure
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| What type of testing is an Assessment of exercise capacity performed on treadmill or stationary cycle ergometer? | Cardiovascular testing - Untrained subjects will usually terminate cycle exercise 2nd to quadriceps fatigue at a VO2 ~ 20% below their treadmill peak VO2- Cycle ergometry requires subject to maintain pedal speed at a desired level, usually 60 rpm
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| What exercise is preferred in subjects with gait or balance instability, severe obesity, or orthopedic limitations or when simultaneous cardiac imaging is planned during cardiovascular testing? | Cycle ergometry
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| What protocol involves 5 stages, starting at Stage I = 1.7 mph 10% grade for 3 minutes up to Stage V = 5.0 mph 18% grade for 3 minutes? | Bruce protocol - Bruce Treadmill Test is an indirect test that estimates VO2 max - Survival rate in patients who failed to complete stage 1was only 78% at 36 months
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| What is the most common manifestation of exercise induced Myocardial ischemia? | ST segment depression
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| Which type of test Involves only stage 1 of SST, Tester chooses one of 4 CV stages in which to start patient based on which will be least taxing for patient, and HR and BP monitored initially, at 2 and 5 minutes of stepping, and 2 minutes after stepping? | Modified chair step test for elderly - • Examinee is seated with adjustable step placed in front
• Feet are alternately lifted/placed on step w/ cadence of 24-30 steps/min
• Ht of step is gradually increased in by of 3-6 in every 1-3 min up to 18 in
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| Which assessment was Developed as an alternative to treadmill testing and is Used with variety of populations i.e. frail, Alzheimer’s, and can Measure outcomes before and after treatment in people with moderate to severe heart and lung disease? | 6MWT
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| Which test predicts morbidity and mortality from heart or lung disease? | 6MWT - Pts w/ distances < 300m (984 ft) have a poorer short- and long term survival rate
– For every 100-foot ↑ in gait distance walked, estimated survival was ↑ by ~ 11% relationship between post-rehab walk distance and survival was highly significant
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| What equipment is needed for 6MWT? | Level walking surface, stopwatch, Tape measure, track / loop walkway, portable chair, Borg RPE, Stethoscope & BP cuff; Monitor BP, HR & RPE before, during & after test
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| How do you administer a 6MWT? | • Patient walks for 6 minutes
– Inability to walk for 6 min, test is stopped & distance
& time are recorded
• Patient can take as many rest breaks p.r.n.
– examinee may use an assistive device and noted
• Total distance walked is recorded
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| What assessment is Useful in measuring exercise capacity for moderate-to-severe CP disease, amputees, and frailty but May not adequately stress cardiopulmonary function for mild cardiopulmonary disease? | 2MWT - Level walking surface, timer, pulse oximeter
• pt walks at as brisk a pace as able; PT walks w/ the pt, no talking during the test • Distance is recorded • pt should not sit during test (unless medically indicated) = may stop and rest
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| What test Measures CardioPulmonary response to exercise monitoring ECG, HR, BP, and RR, where expired air can be analyzed? | Bicycle Ergometer Test - Test consists of 6 to 9 minutes of continuous cycling with gradual incremental ↑ intensity and speed - Older adult bicycle seat uncomfortable – Modify seat for comfort
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| What are the tests and measures in an HF exam? | Subjective: weight gain, orthopnea, paroxysmal nocturnal dyspnea, observation: JVD distension, Auscultation: lung, heart, peripheral edema, vital signs and 6MWT
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| What is the decompensation for weight gain? | >2 lbs weight
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| What is the decompensation for orthopnea? | Increase in number of pillows used for sleeping
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| What is the decompensation for Paroxysmal Nocturnal dyspnea? | Waking from sleep with SOB
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| What is the decompensation for JVD distension? | JVD distension when HOB is at 45°
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| What is the decompensation for auscultation? | Lung Onset of crackles or increase in level heard in lung fields
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| What is the decompensation for the heart? | Onset or increase in intensity of S3
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| What is the decompensation of peripheral edema? | Easily identified depression (EID)
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| What is the decompensation for vital signs? | HR rest > 100, rest SBP > 160 mmHg; DBP > 100 mmHg
SpO2 < 90% or decrease of ≥ 5%
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| What is the decompensation for the 6MWT? | > 300 meters
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| What are the 2 most common measures for quantifying severity of dyspnea with exercise? | Borg CR10 Scale and VAS (visual analog scale)
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| What does the Borg CR10 involve? | • Borg CR10 is a valid, reliable measure
– Uses 0 to 10 category-ratio scale is not linear
– More specific in quantifying dyspnea in moderate severity – Used in pulmonary rehab
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| What does the VAS involve? | • VAS = dyspnea consists of vertical or horizontal line 100 mm in length
– “Not breathless at all” to “Extremely breathless”
– Patient places a mark on line to denote dyspnea level
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| What is one unit for Borg CR10 and 10-20 units for VAS? | MCID
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| What does ausculation find? | Adventitious lung sounds classified as either discontinuous “crackles” or continuous “wheezes”
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| What type of breath sound occurs on inspiration and May indicate pneumonia, pulmonary fibrosis, COPD, or pulmonary edema? | Crackles
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| What type of breath sound occurs during expiration and indicates some sort of airway obstruction, i.e. bronchoconstriction, bronchitis? | Wheezing
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| What is the best test for dx'ing COPD? | Spirometry (FEV1/FVC)
– FEV1 = amount of air which can be forcibly exhaled from lungs in first second of a forced exhalation
– FVC = Exhale as hard as possible after taking deepest – COPD< .70
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| What are some test results of COPD? | • Auscultation = wheezing, whistling, gurgling, or rattling sounds
• Observation = Cyanosis, clubbing of fingers or toes indicates
longstanding lung disease
• Imaging = X-ray and CT scans of lungs
• Blood tests- = measure amounts of O2 and CO2
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| Which category of the GOLD Spirometric Classification for COPD has FEV1/FVC < 0.7 FEV1 > 80% predicted and the pt is Unaware that lung function declining? | I. Mild COPD
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| Which GOLD Spirometric Classification for COPD has FEV1/FVC < 0.7 50% < FEV1 < 80% predicted and Symptoms progress, SOB during exertion? | II. Moderate COPD
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| Which GOLD Spirometric Classification for COPD has FEV1/FVC < 0.7 30% < FEV1 < 50% predicted and SOB increases and COPD exacerbations are common? | III. Severe COPD
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| Which GOLD Spirometric Classification for COPD has FEV1/FVC < 0.7 FEV1 < 30% predicted or FEV1 < 50% predicted with chronic respiratory failure and Quality of life impaired, COPD exacerbations may be life threatening? | IV. Very Severe COPD
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| When differentiating between CV and CP causes of exertional dyspnea, what are the differences in peak VO2? | None, both are reduced
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| When differentiating between CV and CP causes of exertional dyspnea, what are the differences in VE max? | Cardiac = 80% MVV, Pulmonary > 80% of MVV
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| When differentiating between CV and CP causes of exertional dyspnea, what are the differences in SPO2? | Cardia > 90%, Pulmonary may drop <90%
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| When differentiating between CV and CP causes of exertional dyspnea, what are the differences in CO? | Cardiac may decrease, and pulmonary will stay normal
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| When differentiating between CV and CP causes of exertional dyspnea, what are the differences in FEV1? | Cardiac has no change, pulmonary > 15% decrease
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| When differentiating between CV and CP causes of exertional dyspnea, what are the differences in PEF? | Cardiac has no change, pulmonary = 15% decrease
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| What are the normal cardiovascular responses to exercise? | • SBP ↑ 10 mmHg
• DBP no significant change with aerobic exercise – ±10mmHg
• HR should ↑ ~ 10 bpm
• HR should be < 100 bpm within 6 minutes post
exercise
• RR ↑ proportional to workload
– Maximum RR achievable during exercise = 50 b/min
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| What are the ABNORMAL CV responses to exercise? | Drop in HR > 10 bpm with ↑ workload – Excessive rise in HR based on workload – Little to no ↑ in HR with ↑ workload
• Failure to level off at steady state at 3-4 min
• Drop in SBP or DBP 10-20 mmHg with ↑
workload
• ↑ SBP > 180 mmHg • ↑ DBP > 120 mmHg
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| What are CV exercise considerations where you could not exercise or have to stop exercise? | No Exercise or Stop exercise:
– RHR < 50 bpm > 120 bpm
– RSBP < 90 mmHg or > 200 mmHg – RDBP > 110 mmHg
– Dizziness / Angina
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| What are CV contraindications to exercise? | Contraindications: uncontrolled HTN, uncontrolled dysrhythmias, hypertrophic cardiomyopathy, severe stenotic or regurgitant valvular disease, unstable angina
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| Why would HR not be the best indicator of O2 consumption? | Because lung function and an inefficient cardiac pump ↑ HR
– Deconditioned person: exercise intensity is 55-64% of HRmax or 12-13 on RPE scale
– Physically active: exercise intensity is 70-85% of HRmax or 14-16 on RPE scale.
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| How do you progress exercise for CV? | • Initialsession9-10or“verylight”thenprogressto 11-13 or “Somewhat hard”
• Slow progression allows for adaptation to the increased stress to system• Interval training has been shown to be effective and safe
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| How should pts with cardiac disease proceed with exercise? | Pts w/ cardiac disease should be educated to include 5 min each of warm-up/cool-down to ↓ inducing cardiac ischemia with sudden, intense physical effort
• Older adults with CAD, recommended to ↑ walking duration first and then adjust speed i.e. intensity
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| What are types of valvular disease? | Aortic regurgitation, mitral valve stenosis, aortic stenosis - Intervention: Light to moderate exercise is recommended
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| What are implications for PT for valvular disease? | – Mild valve disease may be able to exercise vigorously
– STOP exercise is significant coughing occurs
– Angina is common in severe aortic stenosis
– Monitor for signs of ventricular failure and ↓ exercise tolerance
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| What are the exercise recommendations for HTN? | Moderate: 50-70% HRmax for 30-40 min, 3-5 days/week; Precautions: High Intensity Isometric resistance exercise (Watch for Valsalva maneuver); Abnormal BP Response: SBP > 250 mmHg, DBP > 90 mmHg, Stop exercise (Refer back to Physician)
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| What are the aerobic exercise prescriptions for HF? | Aerobic / endurance exercise - CHF = Swimming not usually recommended; 40-60 min / session (Target: 20-30 min moderate intensity range), 3-5days/wk, Moderate intensity: 60-80% Hrmax and / or RPE scale 12-14,
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| What are the modes for resistance training exercise for HF pts? | Dynamic resistance, circuit weight training, 8-10 muscle groups (avoid isometric exercises) Segmental→Unilateral→Bilateral - 1 RM is Used to determine intensity, safe to do but can also use estimating equations to determine
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| What are the resistance exercise recommendations for HF pts? | Start at 40-50% of 1RM, up to 80% based on pt response/tolerance, RPE = 11-14 Borg scale, Start with 1 set progress based on response and as tolerated, 10-15 (initially low reps 6-10 light weight), 3 sec conc ; 3 sec ecc, 2-3x/wk, work:rest ratio: 1:2
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| What are the functional capacity MET levels recommended for HF pts? | • Functional Capacity MET Levels < 3:
– Multiple, short duration, daily exercise sessions ~ 5- 10 minutes/session
• Functional Capacity MET Levels 3-5: – 1-2 sessions of 15 minutes
• Functional Capacity MET Levels > 5: – 3 to 5 x week of 20-30 minutes
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| What are interventions for orthostatic hypotension? | • Elastic Stockings
• Sleep elevated position 15-20o
• Avoid sudden standing
• Hydrate
• Medication consult with physician
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| What aerobic exercises are good for Peripheral artery disease (PAD) pts? | Walking; Treadmill or track walking at an intensity that elicits claudication symptoms within 3 to 5 minutes (1 CPR Scale); Walking until the claudication pain is rated as moderate (2 on CPR Scale) Followed by rest for symptoms to resolve
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| What are the parameters for aerobic exercise for PAD pts? | 40-60% HR reserve/resting HR or 40-60% VO2 Reserve, 30–60 min/d; Increasing exercise program by 5 minutes per session to 60 minutes, 3-5x/wk (min of 12 wks), and resistance training freq 2–3 d/wk Intensity 1–3 sets of 8–15 RM for all major muscle groups
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| What are some ways to prevent and treat PAD? | • Avoid prolonged bed rest
– Early ambulation and exercise
• Avoid dehydration
• Anti-coagulation medication
• LE Compression stockings 16 – 18 mmHg to prevent DVT
– 30-40 mmHg to be effective for edema, skin changes, and venous ulcers
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| What exercises are DesignedforLEarterialinsufficienciesandtoimprove circulation in LE and has 3 Positions: Supine, Supine Legs elevated 45o-90°, Seated? | Buerger-Allen - start 2-3min elevated, up to 5-10 min, then supine for 10min, Include ankle exercises with isometric contractions to stimulate muscle pump for venous BF and Modify technique for CHF (no Elevated position) – Contraindicated for cellulitis
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| What are some signs and symptoms to consider chronic venous conditions? | – Aching, tiredness in LE
– ↑ pigmentation, Skin ulcerations and secondary infections – ↓ tissue nutrition and cellular waste removal; Dependent edema with prolonged sitting / standing – worse at end of day
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| How do you treat chronic venous conditions? | – Moist heat to entire extremity
– Ambulation with legs wrapped in pressure stockings – Avoid prolonged dependent positions
– Rest with legs elevated
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| Which part of the pulmonary rehab team is responsible for On site patient management, required in hospital or outpatient settings? | Medical director
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| Which part of the pulmonary rehab team is responsible for Assessing strength, balance, endurance, and gait? | PT
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| Which part of the pulmonary rehab team is responsible for focusing on breathing mechanics, energy conservation? | respiratory therapist
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| Which part of the pulmonary rehab team is responsible for Endurance and activity tolerance for functional activities and Coordinates caregiver training to encompass assistance if needed? | OT
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| Which part of the pulmonary rehab team is responsible for providing support for grief adjustment, depression, and socialization disorders for Eldercare and senior living information and referral? | Social Worker
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| Which part of the pulmonary rehab team is responsible for developing meal plans for inpatient and home environment to insure proper nutrition? | dietician
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| What are the 6 parts of pulmonary rehab? | 1. diaphragmatic/pursed lip breathing 2. mobility/HEP 3. HEP compliance 4. STG/ LTG for O2 needs w/ ex and rest, SPO2 > 90% 5. Instuct about meds/nebulizer dose/rescue inhaler for gait/mobility 6. Teach self mngmt of sx's, wt, SPO2, O2 consumption, BP
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| What are the aerobic and strength training prescriptions for COPD? | Aerobic: Walking or cycle ergometer; Warm-up before and cool-down after exercise - Strength training: Train each muscle group (may be multiple groups) 2-4 sets
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| What is a recommended consideration for aerobic exercise for COPD pts? | Oxygen administered if SpO2 < 88%, Goal is have SpO2 >90% during exercise, Modifications to duration & frequency p.r.n.5-10 min sessions vs. 20-30 min
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| What is the appropriate aerobic intensity for COPD pts? | For mild COPD: RPE 12-14 (moderate) RPE 14-16 (vigorous)
For moderate to severe COPD: 60%-80% of peak work rate or RPE 10-13 for dyspnea from graded exercise test
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| What are the freq and duration for aerobic exercise for COPD pts? | > 3-5 d/wk of continuous or intermittent exercise; 6 wk ex program w/ group ex beneficial; 20-60 min/d, 20-90 min/session
If debilitated, starts sessions shorter, w/ more freq rests, > 30 min Interval training if pt can't achieve time and/or intensity
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| What type of equipment is best for strength training in COPD pts? | Free weights, and machine weights, band resistance, body weight, e.g, stairs or squats
Balance training, stretching e.g, modified yoga for stretching with coordinated Breathing
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| What is the proper frequency for strength training in COPD pts? | 2-3 times per week, at least 48-h apart; rest intervals of 2-3 min between sets;
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| What is the proper duration for strength training in COPD pts? | Intensity: 60%-80% of 1 RM
Deconditioned patients: 10-15 reps at RPE 12-14
2-4 sets of 6-12 reps at 50%-85% of 1-RM intensity Begin with lower resistance and higher reps to work on muscle endurance, progress to higher weight, less reps
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| What are the effects of walking on COPD pts? | • Study: Effects of walking COPD patients vs. healthy
• Evaluated cardiac and respiratory responses – EMG lower limb muscles during walking
• Results: Walking impact on COPD increased muscle fatigue
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| What are the effects of exercise training on COPD pts? | ↑ physical activity can improve VO2, work capacity and anxiety
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| What are the benefits of exercise for COPD pts? | – CV reconditioning
– Reduced ventilatory requirement at a given work rate – Improved ventilatory efficiency
– Reduced hyperinflation
– Desensitization to dyspnea
– ↑ strength, flexibility, standing balance
– Improved body composition
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| What are the effects of intermittent exercise for COPD pts? | hemodynamic adaption w/ intermittent HIT in COPD pts, ↑ VO2, CO & ventilation during 1st min of ex – Remained stable - Results: High intensity 1 min bouts of intermittent work exercise are well tolerated w/o pushing pulmonary arterial pressure too high
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