Cardiopulmonary Assessment and Management Flashcards

A physical therapist is auscultating the heart sounds of a patient and hears a distinct 'lub-dub' followed by a low-pitched sound early in diastole. This extra sound is MOST likely which of the following?

Answer: S3

An S3 heart sound, also known as a ventricular gallop, is a low-pitched sound that occurs in early diastole, following the S2 ('dub') sound. It is caused by the vibration of the ventricular walls as blood rushes in from the atria. While it can be normal in children and young adults, in older adults it often indicates heart failure. S1 is the 'lub' sound, and S4 is a late diastolic sound occurring just before S1.

A patient is participating in Phase II cardiac rehabilitation following a coronary artery bypass graft (CABG) 6 weeks ago. The physical therapist is monitoring the patient's response to treadmill walking. Which of the following RPE values on the Borg 6-20 scale is the MOST appropriate target for the main workout portion of the session?

Answer: 12-14

For the main workout in a cardiac rehabilitation setting, a Rating of Perceived Exertion (RPE) of 12-14 ('somewhat hard') on the Borg 6-20 scale is generally recommended. This intensity corresponds to a moderate level of exercise that is safe and effective for improving cardiovascular fitness post-surgery. An RPE of 6-8 is too low (no exertion), 9-10 is very light, and 17-18 is very hard and would be too strenuous for this phase of recovery.

A physical therapist is working with a patient diagnosed with moderate Chronic Obstructive Pulmonary Disease (COPD). The plan of care includes teaching the patient energy conservation and breathing techniques. Which of the following breathing techniques is MOST effective for reducing dyspnea during activities of daily living for this patient?

Answer: Pursed-lip breathing

Pursed-lip breathing is a primary technique taught to patients with COPD to manage dyspnea. It helps to slow the respiratory rate, keep airways open longer, and improve the exchange of air by creating back-pressure in the airways, thus reducing the work of breathing during activity. Stacked and segmental breathing focus more on lung expansion, while glossopharyngeal breathing is typically for patients with high spinal cord injuries.

A physical therapist is about to initiate an exercise session with a new patient in an outpatient setting. A review of the patient's chart reveals a recent diagnosis of symptomatic, severe aortic stenosis. Which of the following is the MOST appropriate action for the therapist to take?

Answer: Hold the exercise session and contact the referring physician.

Symptomatic severe aortic stenosis is an absolute contraindication to exercise testing and training. Patients with this condition have a fixed cardiac output and cannot increase blood flow to meet the demands of exercise, which can lead to syncope or sudden death. Therefore, initiating an exercise session would be unsafe. The therapist must hold the session and communicate with the physician for clarification and guidance.

During a graded exercise test on a treadmill, a physical therapist observes the following changes on a patient's ECG: the R-R interval shortens, the P-R interval shortens, and the QRS complex duration remains unchanged. Which of the following is the BEST interpretation of these findings?

Answer: A normal physiological response to exercise.

These ECG changes are all expected, normal physiological responses to exercise. The R-R interval shortens as heart rate increases. The P-R interval shortens due to faster atrioventricular conduction. The QRS complex, representing ventricular depolarization, typically remains stable in duration during exercise. Pathological changes would include significant ST-segment depression (ischemia) or premature ventricular contractions (arrhythmia).

A physical therapist is performing a 6-Minute Walk Test (6MWT) on a 72-year-old male with chronic heart failure. The patient completes 250 meters before stopping due to fatigue. Which of the following is the MOST accurate interpretation of this result?

Answer: The distance walked is associated with a poor prognosis.

A distance of less than 300-350 meters on the 6-Minute Walk Test is consistently associated with a poorer prognosis, including increased risk of hospitalization and mortality, in patients with conditions like heart failure and COPD. Therefore, walking 250 meters indicates significant functional limitation and is a poor prognostic indicator. This result would warrant a cautious approach to exercise prescription, not an immediate progression to high-intensity training.