cardiopulmonary physical therapy - kocw
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Cardiopulmonary Physical Therapy
Haneul Lee, DSc, PT
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Chief complaint
Loss of function Decreased ability to perform activities of daily living (ADLs)
Discomfort Shortness of breath (dyspnea)
Present illness
Initial onset (sudden vs. insidious) and progression of primary problem
Anything that worsens or improves condition Positions, rest, medications
Review the patient's history
Occupational history
Past occupational exposures for diseases
Present occupational exposure to antigens within the workplace
Past medical history
Alter physical exam or treatment plans
(e.g., heart disease, long-term steroid use)
Current medications
mask (steroids) or alter (beta blockers, bronchodilators) vital signs
Review the patient's history
Social habits Smoking in pack years
Alcohol consumption
Street drugs
Functional and exertional activity level during periods of wellness, as well as with present illness.
Cough and sputum production Record any changes from baseline because of present illness.
Family history
Vital signs
Temperature: normal (afebrile) 98.60 F (37 0 C) Core temperature increase indicates infection
Heart rate (HR): normal 60-100 bpm Tachycardia HR> 100 bpm; bradycardia: HR < 60 bpm
Respirations Rate (RR): normal 12-20 bpm
Tachypnea is a rate> 20 bpm Apnea means no respirations Rhythm: regular or irregular. Amplitude: shallow or deep
Blood pressure : normal 120/80 mmHg
National Physical Therapy Examination, O’sullivan&Siegelman, TherapyEd
Peripheral edema seen in gravity-dependent areas and jugular venous distension indicates possible heart failure.
Right ventricular hypertrophy and dilation (cor pulmonale) are common sequelae to chronic lung disease.
Body positions
Stabilizing the shoulder girdle (e.g., sitting, hands placed on seat, arms extended, body leaning forward) places the thorax in the inspiratory position and allows the additional recruitment of muscles for inspiration (pectorals)
Color Cyanosis, an acute sign of
hypoxemia, is a bluish tinge to nail beds and the areas around eyes and mouth
Digital clubbing A sign of chronic hypoxemia
The configuration of the distal phalanx of fingers or toes becomes bulbous
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Standard precautions should be used when the therapist may come in contact with a patient's body fluids. Gloves are usually all that is needed during a routine physical exam.
Standard Precautions combine the major features of Universal Precautions (UP) and Body Substance Isolation (BSI) and are based on the principle that all blood, body fluids, secretions, excretions except sweat, non intact skin, and mucous membranes may contain transmissible infectious agents. Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered. These include hand hygiene; use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure; and safe injection practices. Also, equipment or items in the patient environment likely to have been contaminated with infectious body fluids must be handled in a manner to prevent transmission of infectious agents (e.g., wear gloves for direct contact, contain heavily soiled equipment, properly clean and disinfect or sterilize reusable equipment before use on another patient) . The application of Standard Precautions during patient care is determined by the nature of the health care worker (HCW)- patient interaction and the extent of anticipated blood, body fluid, or pathogen exposure. For some interactions only gloves may be needed; during other interactions (e.g. , intubation), use of gloves, gown, and face shield or mask and goggles is necessary. Education and training on the principles and rationale for recommended practices are critical elements of Stand and Precautions because they facilitate appropriate decision-making and promote adherence when HCWs are faced with new circumstances. An example of the importance of the use of Standard Precautions is intubation, especially under emergency circumstances when infectious agents may not be suspected, but later are identified (e .g. , severe acute respiratory syndrome [SARS]. Standard Precautions are also intended to protect patients by ensuring that health care personnel do not carry infectious agents to patients on their hands or via equipment used during patient care.
National Physical Therapy Examination, O’sullivan&Siegelman, TherapyEd
Intensity of inspiration and expiration is quieter at the bases than the apex
Vesicular (normal breath sound): a soft rustling sound heard throughout all of inspiration and the beginning of expiration.
Bronchial: a more hollow, echoing sound normally found only over the right superior anterior thorax. This corresponds to an area over the right main stem bronchus. All of inspiration and most of expiration are heard with bronchial breath sounds.
Decreased: a very distant sound not normally heard over a healthy thorax; allows only some of the inspiration to be heard. Often associated with obstructive lung diseases.
Adventitious (extra) sounds. According to the American Thoracic Society, there are only two adventitious breath sounds
Crackles (also termed rales)▪ a cracking sound heard usually during inspiration that
indicates pathology
Wheezes▪ a musical pitched sound, usually heard during expiration
caused by airway obstruction (asthma, chromic obstructive pulmonary disease). With severe airway constriction,wheezesmay be heard on inspiration as well.
Vocal sounds
Normal transmission of vocal sounds
▪ As with breath sounds, vocal transmission is loudest near trachea and main-stem bronchi.
▪ Words should be intelligible, though softer and less clear at the more distal areas of the lungs.
Arterial blood gas (ABG) analysis indicates the adequacy of : Alveolar ventilation by determining pH, bicarbonate ion, and partial
pressure of carbon dioxide
Arterial oxygenation by determining the partial pressure of oxygen in relation to the fraction of inspired oxygen.
National Physical Therapy Examination, O’sullivan&Siegelman, TherapyEd
Sputum studies
Gram stain: immediate identification of the category of bacteria (gram negative or gram positive) and its appearance
Culture and sensitivity: identifies the specific bacteria as well as the organism's susceptibility to various antibiotics. Results available within a few days.
Cytology: reports the presence of cancer cells in sputum
Pulmonary function tests (PFTs)
Evaluate lung volumes, capacities, and flow rates.
Used to diagnose disease, monitor progression, and determine the benefits of medical management
Blood values
White blood cell count (WBC) normal values : 4,000-11,000
Hematocrit (Hct) normal values :35%-48%
Hemoglobin (Hgb) normal values : 12-16 g/dL
Lung volumes of a healthy pulmonary system compared with lung volumes and capacities found in restrictive and obstructive pulmonary disease
National Physical Therapy Examination, O’sullivan&Siegelman, TherapyEd
Exercise tolerance tests (ETT)
Evaluates an individual's cardiopulmonary response to gradually increasing exercise.
Determines the presence of exercise-induced bronchospasm by testing pulmonary function, particularity FEV1 before and after ETT.
Documents the need for supplemental oxygen during an exercise program by analyzing arterial blood gas values throughout the ETT. ABGs also provide a criterion for test termination. If arterial blood sampling is unavailable, pulse oximetry can be used to monitor the percent saturation of oxygen within the arterial blood.
National Physical Therapy Examination, O’sullivan&Siegelman, TherapyEd
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Elsevier3. Cardiovascular and pulmonary Physical Therapy Evidence to Practice, 5th
edition, Donna Frownfelter, Elizabeth Dean, Elsevier4. Cardiopulmonary Physical Therapy Management and Case Studies, 2nd edition,
W.Darlence Reid, Frank Chung, Kylie Hill, SLACK Inc.5. Steele, Joel Dorman Hygienic Physiology (New York, NY: A. S. Barnes &
Company, 1888)6. PTEXAM the complete study guide, Scott M Giles, Scorebuilders