Gen Med - Interpreting Exercise & Intro to Cardiopulmonary Patients

When are times to measure vitals in acute care

- Baseline vitals

- After position or activity level changes

- Prior to ending treatment

- With red flags or sudden changes

Normal respiratory rate is

12-18 breaths per minute

Normal heart rate is

60-100 BPM

What is normal blood pressure

120/80

What is a normal SpO2 level

>95%

Hypotension is defined as

SBP less than 80

AND

DBP less than 60

Pre-HTN levels are

SBP 120-129

AND

DBP less than 80

Stage 1 HTN levels are

SBP 130-139

OR

DBP 80-89

Stage 2 HTN levels are

SBP over 140

OR

DBP over 90

Hypertensive crisis levels are

SBP over 180

AND/OR

DBP over 120

Orthostatic hypotension is defined as

Decrease of SBP by at least 20 or DBP by 10 within 3 minutes of standing from a seated position

What are the key signs of orthostatic hypotension

- Dizziness

- Visual changes

- Syncope

- Marked weakness

- Light headedness

- Confusion

What are key signs of a hypertensive crisis

- Anxiety

- Nausea/vomiting

- Confusion

- Unresponsiveness

- Seizures

- Severe headaches

- Shortness of breath

- Angina

- Visual changes

What is one metabolic equivalent equal to

The energy you use when you are resting or sitting still

<3 METs is what level of activity

Light

3-6 METs is what level of activity

Moderate

>METs is considered what level of activity

Vigorous

Borg's scale runs from a perceived scale of

6 to 20

The modified Borg scale runs from

0 to 10

Activities that are 2 METs include

- Standing

- Transfer to chair

- Chair exercise

Activities that are 3 METs include

- Self care

- Walking in room

Activities that are 4 METs include

- Walking 2 mph

Activities that are 5 METs include

Climbing a flight of stairs

Systolic blood pressure should increase by around how many mmHg per MET increase

10

During steady sub-maximal aerobic exercise, SBP rises

For the first 2-3 minutes then remains constant or slightly decreses

During exercises DBP should remain

+/- 10 mmHg from baseline

SBP normally rises slightly from

Stand to sit to supine

DBP normally drops slightly from

Supine to sit to stand

Excessive blood pressure change in response to exercise is

SBP > 12

DBP > 10

For untrained people, every 2 MET increases should result in a BPM increase of

10 BPM

HR should return to baseline levels after exercise within

3-5 minutes

A tachycardic response to exercises sees

HR rising more than 10 BPM per 2 METs

A brachycardic response to exercise sees

Less than 8 BPM per MET increase

Generally, you want to maintain what oxygen level when exercising

>90%

Exercise should stop if oxygen drops

3-5% below baseline

Tachypnea is characterized by a RR of

>24

During exercise, use caution if RR exceeds _ and stop exercise if RR exceeds _

45; 50

Bradypnea is characterized by a RR of

10 BPM

If your patient has a pulmonary diagnosis, you want to maintain an oxygen above

88%

If your patient has a cardiac diagnosis, you want to maintain oxygen above

95%

Blunted HR response to exercise is normal for

Normal exercisers or people using beta blocker medications

How do restrictive diseases differ from obstructive diseases

Restrictive diseases cause difficulty getting air IN and obstructive diseases cause difficulty getting air OUT

Patients with restrictive diseases will have decreased

Total lung volume

Patients with obstructive diseases will have excessive

Mucus production

COPD is a broad umbrella term and the two most common ones are

Chronic bronchitis and emphysema

COPD is more common in the US in

Women

Despite being more common in women, COPD for men has a higher

Mortality rate

In chronic bronchitis, the bronchi

Are irritated and swell with mucus

Chronic bronchitis causes damage to the _, leading to _

Cilia; an inability to clear mucus

Both bronchitis and emphysema cause

Chronic cough

In emphysema, the alveoli may be

Destroyed, narrowed, collapsed, stretched, and/or overinflated

Alveolar damage is

Irreversible

Emphysema causes a decrease in

Respiratory function and SOB

Signs and symptoms of COPD include

- Excessive sputum production

- Frequent respiratory infections

- Frequent coughing or wheezing

- Progressive SOB

- Difficulty taking a deep breath

- Barrel chest

- Increased respiratory rate and accessory muscle usage during respiration

Breathing issues can cause systemic issues including

- General muscular weakness

- Balance problems

- Increased fall risk

- Poor nutrition resulting in weight gain/loss

Common treatments for COPD includes

- Progressive aerobic and resistive exercise

- Fall prevention and recovery training

- Pulmonary rehab

- Steroids and/or bronchodilators

- Supplemental oxygen

What is a coronary artery bypass graft

A cardiac procedure which diverts blood around a blocked vessel to improve blood flow and heart function

A CABG is often used to treat

CAD

What are the Post-OP CABG precautions

- No resistance training for 8 weeks

- No UE ROM above 90 degrees

- No lifting >5-10#

- Avoid UE weight bearing

- Avoid B horizontal shoulder Abd

- Avoid unilateral reaching posteriorly

What are "move in the tube" precautions

- No asymmetrical UE movements

- Pain-free pushing with UE is allowed

- Permission of lifting, pushing, and raising your arms as long as you remain within an imaginary tube around your body (soda can)