Pulmonary and Cardiac Rehabilitation

Flashcards for Pulmonary and Cardiac Rehabilitation

Pulmonary Evaluation

Assess respiratory/ventilatory impairments and impact on function.

Ventilatory Pump Assessment

Checks oxygen uptake and CO₂ elimination during rest and activity.

Rehabilitation Suitability

Determines if the patient is fit for pulmonary rehab.

Intervention Planning

Guides treatment plan development.

Progress Monitoring

Establishes baseline and tracks treatment effectiveness.

Discontinuation Criteria

Helps decide when to stop interventions and shift to home programs.

Pulmonary Evaluation Components

Patient history, physical exam, and interpretation of diagnostics.

Patient History (Pulmonary Evaluation)

Smoking history, supplemental oxygen therapy, exposure to toxins, history of lung diseases, sputum characteristics, airway clearance techniques, and sleeping position.

Procedures for Physical Examination of Chest & Lungs

Inspection, Palpation, Percussion, Auscultation.

Inspection (Chest & Lungs)

Observes symmetry, chest contour, breathing pattern, posture, etc.

Barrel Chest

AP:lateral ratio ≈ 1:1

Pigeon Chest (Pectus Carinatum)

Anteriorly displaced sternum

Funnel Chest (Pectus Excavatum)

Depressed lower sternum

Assessment of Breathing Patterns

rate (12–20 cpm), depth, rhythm, use of accessory muscles, etc.

Muscles during Quiet Inspiration

Diaphragm, Scaleni, Intercostals, Levatores costarum, Serratus posterior superior

Muscles during Forced Inspiration

SCM, Scaleni (anterior & medius)

Muscles during Respiratory Distress

Serratus anterior, Pectoralis minor & major

Muscles during Quiet Expiration

Anterior abdominal wall, Serratus posterior inferior

Muscles During Forced Expiration

Abdominals, QL, intercostals, serratus post. inf., lat. dorsi

Kussmaul Breathing

Metabolic acidosis

Ataxic Breathing

Medulla damage

Cheyne-Stokes Breathing

Heart failure/brain damage

Tachypnea

Rapid breathing

Stridor

Airway obstruction

Stertorous

Snoring-like

Bradypnea

Slow breathing

Hyperpnea

Deep breathing

Hyperventilation

↑rate and depth

Hypoventilation

↓rate and depth

Orthopnea

Difficulty when lying down

Paradoxical breathing

Abnormal chest movement

Fremitus

Vibrations during speaking

Pleural friction rub

Felt when pleura is inflamed

Respiratory excursion

Chest movement during breathing

Resonant Percussion

Normal lung

Hyperresonant Percussion

Emphysema

Dull Percussion

Consolidated tissue (e.g., pneumonia)

Flat Percussion

Pleural effusion

Tympanic Percussion

Gas in abdomen

Adventitious Sounds

Crackles/Rales (wet/dry), Wheezes, Rhonchi, Stridor, Pleural rub

Wheezes

Bronchoconstriction

Rhonchi

Large airway obstruction

Stridor (Auscultation)

Emergency

Pleural rub (Auscultation)

Inflammation

Whispered Pectoriloquy

“1,2,3” test

Bronchophony

“99” test

Egophony

“E to A” change indicates fluid

Cough Phases

Inspiration → Glottis closure → Abdominal contraction → Expulsion

Fetid Sputum

Foul-smelling

Frothy Sputum

Pulmonary edema

Hemoptysis

Blood

Mucoid Sputum

Clear, chronic cough

Rusty Sputum

Pneumococcal pneumonia

Tenacious Sputum

Thick/sticky

Breathing Techniques

Pursed-Lip, Glossopharyngeal, Segmental Breathing

Glossopharyngeal Breathing

For ventilator-dependent patients

Segmental Breathing

Local expansion

Chest Mobilization Exercises

Combine stretching and deep breathing; Used to improve chest wall mobility and posture

Manual-Assisted Coughing

Therapist helps abdominal compression

Self-Assisted Coughing

Patient uses arms/forearms

Splinting

Pressing on incision site

Tracheal Stimulation

Reflexive cough in infants

Postural Drainage

Uses gravity to drain lung segments

Techniques used in Postural Drainage

Percussion, vibration, shaking

Contraindications for Postural Drainage

Hemoptysis, edema, embolism, MI, etc.

Phase 1 (Inpatient) of Cardiac Rehabilitation

ADLs, 2-5 METs, education

Phase 2 (Outpatient) of Cardiac Rehabilitation

3-5x/week, 9 METs goal

Phase 3 (Community) of Cardiac Rehabilitation

≥5 METs, independent

Resistance Training Considerations

Start post-acute (3–8 weeks post-event); Use light weights, bands, 12–15 reps; Avoid Valsalva

Special Considerations for Heart Failure

Interval, low-intensity, avoid supine

Special Considerations for Cardiac Transplant

Use RPE, METs (HR unreliable)

Special Considerations for Pacemakers/AICDs

Avoid UE work early

Special Considerations for Diabetes

Avoid hypoglycemia, monitor HR and BP

Contraindications to Cardiac Rehab

Unstable angina, Uncontrolled hypertension/dysrhythmias, Acute illness, Recent MI without clearance, Critical aortic stenosis, etc.