Stroke volume
amt of blood ejected with each myocardial contraction
SV norm
55-100 mL/beat
LVEDV
left ventricular end diastolic volume=
amt of blood in LV at end of diastole (aka preload)
Frank Starling Law
the greater the diastolic filling (preload) the greater the amt of blood pumped
cardiac output
amt of blood discharged from LV or RV per minute
CO norm
4-5 L/min
LVEDP
left ventricular end diastolic pressure=
pressure in LV during diastole
5-12 mmHg
Ejection Fraction
percentage of blood emptied from ventricle during diastole, clinical measurement of LV fxn
EF norm
EF= SV/LVEDV
60-70%
lower EF -> impaired LV
Rate Pressure Product (myocardial oxygen demand)
energy cost to myocardium
RPP= HR x SBP
common adverse s/e of antiviral therapy
rash, nausea, HA, dizziness, mm pain, weakness, fatigue, difficulty sleeping (with hepatotoxicity signs of CTS can be seen)
composition of blood
55% plasma
45% RBC
1% WBC
complete blood count
(CBC), determines number of RBC, WBC, and platelets per unit blood
Erythrocyte sedimentation rate
(ESR), rate of RBCs that settle out in a tube of unclotted blood (mL/hour)
elevated ESR= presence of inflammation
c/i with sickle cell disease
COLD
it increased vasoconstriction and sickling
hemophilia precautions
PROM/stretching rarely used 2/2 risk of myositis ossifcans
red flags for hematological disorders
EXTREME caution with manual therapy and use of some modalities (ex: mechanical compression)
strenuous exercise is c/i 2/2 to risk of increased hemorrhage
red flags for anemia
pts have decreased EX tolerance, initiate EX gradually with MD approval, use RPE ratings
c/i for chronic fatigue syndrome (CFS)
bed rest is c/i other than for sleep
s/e of radiation for CA Tx
radiation sickness, immunosuppression, fibrosis, burns, delayed wound healing, edema, hair loss, CNS effects
s/e of chemotherapy for CA Tx
GI symptoms (n/v, anorexia, diarrhea, ulcers, hemorrhage), bone marrow suppression, skin rashes, neuropathies, phlebitis, hair loss
s/e of biotherapy (immunotherapy) for CA Tx
fever, chills, n/v, anorexia, fatigue, fluid retention
s/e of hormonal therapy for CA Tx
GI sxs, HTN, steroid-induced diabetes and myopathy, weight gain, hot flashes and sweating, altered mental status, impotence
CA red flags for PT exam: paraneoplastic syndrome
s/s at a site distance from the tumor or met, from etopic H production by tumor cells or metabolic abnormalities from secretion of tumor-vasoactive products
CA red flags for PT exam: Cushing's syndrome
can result from small cell cancers of the lung
CA red flags for PT exam: neuro sxs
cerebellar degeneration, peripheral neuropathy, myasthenia gravis
CA red flags for PT exam: sxs from CA stimulation of antibody production
anorexia, malaise, diarrhea, weight loss, fever, progressive mm weakness (type II atrophy), diminished DTRs, myositis, joint pain
red flags for pts with signficant bony mets, osteoporosis, or low platelet counts (< 20,000)
*
AROM, ADL EX ONLY
*
WB may be restricted (provide AD)
high risk of vertebral compression and other fx- light EX only
c/i for EX with low platelet count
<20,000 c/i
20,000-50, 000 pxn
referred pain for constipation
abdominal pain and tenderness in the anterior hip, groin or thigh regions
referred pain: esophagus->
mid back
referred pain: mid thoracic spine pain (nerve root) ->
esophagus
referred pain: gallbladder, stomach, pancreas, small intestine ->
mid back and scapular regions
referred pain: colon, appendix, or pelvic viscera ->
pelis, low back or sacrum
red flags for GERD
head and neck pain, chest pain (mistaken for MI, unrelated to activity), respitory sxs
c/i for the GERD
valsalva's maneuver
red flag for hiatal hernia
pts taking long term NSAIDS should be monitored closely for stomach pain, bleeding, n/v
referred pain: peptic ulcers on posterior wall of the stomach ->
radiating back pain, can also radiate to the right shoulder
red flags for IBD, referred pain: joints ->
low back
red flags for IBD
intestinal obstruction and corticosteroid toxicity (low bone density, increased fx risk), intestinal absorption disrupted (nutritional deficiencies), anxiety/depression
red flags for diverticular disease
pt may c/o back pain
red flags for appendicitis
need immediate medical attention when sxs present
sxs of appendicitis: Blumberg's sign
rebound tenderness present in response to depression of abdominal wall at site distant from pain area
sxs of appendicitis: McBurney's point
point tenderness over appendix, 1.5-2 inches above ASIS in RLQ
red flags for menopause
osteoporosis and risk fo bone fx dramatically increased, heart disease and stroke risk factors increase
postural changes with PG
kyphosis with scap retraction, cervical lordosis with forward head, lumbar lordosis (continues postpardum 2/2 carrying baby)
diastasis recti abdominis
lateral separation or split of the rectus abdominis
separation from lina alba >2cm is significant
diastasis recti abdominis pxns
avoid abdominal EX when >2cm
resume wth separation < 2cm (partial sit-ups, pelvic tilts); use hands to support abdominal wall
cystocele
herniation of bladder into vagina
rectocele
herniation of rectum into vagina
uterine prolapse
bulging of the uterus into the vagina
red flag for pelvic floor disorders
pain can radiate down the posterior thigh
preeclampsia
PG induced, acute HTN after 24 weeks
*
prompt MD referral
*
C-section Tx
TENS for incision pain (electrodes //to incision), assist breathing/coughing, gentle ab EX (pillow for bracing), pelvic floor EX, ambulation, friction massage for scar
precautions post C-section
no heavy lifting for 4-6 weeks
red flags for endometriosis
pt may c/o back pain, endometrial implants on mm (psoas major, pelvic floor) may produce pain with palpation
red flags for prsotatitis
dull, aching pain in lower abdominal, rectal, lower back, sacral or groin regions
glomerular filtration rate
(GFR), amt of filtrate that is formed each minute as blood moves thru the glomeruli
serves as important gauge of renal fxn
blood urea nitrogen
(BUN), urea produced in the liver as a by-product of protein metabolism that is eliminated by the kidneys
norm K level
3.5-5.5 mEq/L
sxs of hypokalemia
mm weakness, aches, fatigue, cardiac arrhythmias, abdominal distention, n/v
sxs of hyperkalemia
(often no sxs until very high levels)
mm weakness, arrhythmias, ECG changes (tall T wave, prolonged P-R interval and QRS duration)
norm Na levels
135-146 mEq/L
sxs of hyponatremia
confusion, decreased mental alertness can progress to convulsions, signs of increased intracerebral pressure, poor motor coordination, sleepiness, anorexia
sxs of hypernatremia
circulatory congestion (pitting edema, excessive wt gain), pulm. edema with dyspnea, HTN, tachycardia, agitation, restlessness, convulsions
norm Ca levels
8.4-10.4 mg/dL
sxs of hypocalcemia
mm cramps, tetany, spasms, parasthesias, anxiety, irritability, twitching convulsion, arrhythmias, hypotension
sxs of hypercalcemia
fatigues, depression, mental confusion, n/v, increased urination, occasional cardiac arrhythmia
norm level of Mg
1.8-2.4 mg/dL
sxs of hypomagnesemia
hyperirritability, confusion, leg and foot cramps
sxs of hypermagnesemia
hyporeflexia, mm weakness, drowsiness, lethargy, confusion, bradycardia, hypotension
sxs of metabolic acidosis
hyperventilation, deep respirations, weakness, muscular twiching, malaise, n/v, diarrhea, HA, dry skin & mucous membranes, poor skin turgor
metabolic acidosis
depletion of bases or an accumulation of acids
metabolic alkalosis
increase in bases or a reduction of acids
sxs of metabolic alkalosis
hypoventilation, depressed respirations, prolonged vomiting, diarrhea, weakness, mm twitching, irritability, agitation, convulsions, and coma (death)
causes of metabolic acidosis
DM, renal insufficiency or failure, diarrhea
causes of metabolic alkalosis
excess vomiting, excess diarrhea, hypokalemia, peptic ulcer, excessive intake of antacids
respiratory acidosis
CO2 retention
impaired alveolar ventilation
causes of respiratory acidosis
hypoventilation, drugs/oversedation, chronic pulm, disease, hypermetablism
sxs of respiratory acidosis
dyspnea, hyperventilation cyanosis, restlessness, HA
respiratory alkalosis
diminished CO2
alveolar hyperventilation
causes of respiratory alkalosis
anxiety attack with hyperventilation, hypoxia, impaired lung expansion, CHF, PE, diffuse liver or CNS disease, salicylate poisoning, extreme stress
sxs of respiratory alkalosis
tachypnea, dizziness, anxiety, difficulty concetrating, numbness/tingling, blurred vision, diaphoresis, mm cramps, twitching or tetany, weakness, arrhythmias, convulsions
dialysis shunt c/i
cannot take BP at shunt site
stress incontinence
sudden release of urine 2/2:
increases in intra-abdominal pressure
weakness/laxity of pelvic floor mm, sphincter weakness
urge incontinence
bladder begins contracting and urine is leaked after sensation of bladder fullness is perceived
inability to delay voiding (detrusor mm instability, sensory instability)
overflow incontinence
bladder continuously leaks 2/2 to urinary retention (atatomical obstrcution, acontractile bladder, neuroenic bladder)
functional incontinence
inability or unwillingness to toilet (impaired cognition, impaired physical fxning, environmental barriers)
historical research
investigation of a variety of data sources
investigates authenticity of data (external criticism)
investigates worth of the data (internal criticism)
descriptive research
involves collecting data about conditions, attitudes or characteristics of subjects, groups, or groups of subjects
case study
type of descriptive research; in-depth investigation of an individual, group or institution
developmental research
type of descriptive research; studies of behaviors that differentiate individuals at different levels of age, growth, maturation
longitudinal studies
type of descriptive research; differentiate changes in an individual or group over time
normative research
type of descriptive research; investigates standards of behavior, standard values for given characteristics of a sample (ex: gait characteristics)
qualitative research
type of descriptive research; seeks facts or causes of social phenomena, complex human behavior
correlational research
attempts to determine whether a relationship exists b/t two or more quantifiable variable and to what degree
retrospective
example of correlational research; investigation of data collection in the past
prospective
example of correlational research; recording and investigation of present data
descriptive
example of correlational research; investigation of several variables at once, determines existing relationships among variables
predictive
example of correlational research; use to develop predictive models
experimental research
attempts to define a cause and effect relationship thru group comparison
true experimental design
example of experimental research; includes random assignment into experimental group or control group
cohort design
example of experimental research; quasi-experimental design, subjects ID'd and followed over time for changes, lacks randomization
with-in subject design (repeated measures)
example of experimental research; subjects serve are their own controls, randomly assigned to Tx or no Tx blocks
between subject design
example of experimental research; comparison made b/t groups of subjects
single subject experimental design
involves a sample of one with repeated measurements and design phases
A-B design
example of single subject experimental design; involves 2 phases: baseline f/b Tx
A-B-A
single subject experimental design; aka multiple baseline design, involves 3 phases: baseline phase, Tx phase, 2nd baseline phase
A-B-A-B
single subject experimental design; aka multiple baseline multiple Tx, includes baseline, Tx and additional baseline and Tx phases
factorial design
refers to the number of independent variables utilized (ex: single factor)
causal- comparative research
attempts to define a cause-and-effect relationship thru group comparisons
epidemiology
the study of disease frequency and distribution in a community
the science concerned with examining and determining the specific causes of health problems and interrelationship of factors
independent variable
the cause or Tx, the factor believed to bring about a change in the dependent variable
dependent variable
the outcome being evaluated, the change or difference in the behavior that results from the intervention (Independent variable)
directional (research) hypothesis
generalization that predicts an expected relationship b/t variables
null hypothesis
states that no relationship exists b/t variables
reject null hypothesis
significant difference observed b/t groups or Tx
accept null hypothesis
no significant difference b/t groups or Tx
nominal data
classifies variables or scores into 2 or more mutually exclusive categories based on common characteristics; lowest level of measurement (ex: male/female, tall/short)
ordinal data
classifies variables by the degree to which they possess a common characteristic; intervals not equal (ex: MMT)
interval data
classifies variables based on predetermined equal intervals, does not have a true zero (ex: temperature)
ratio data
classifies variables basked on equal intervals and a true zero point, highest and most precise measurement (ex: goniometry, weight, height)
random selection
all individuals in a population have an equal chance of being chosen
systematic selection
individuals are selected from a population list at a specific interval (ex: every 10th)
stratified selection
individuals selected from a population from identified subgroups based on a predetermined characteristic (ex: height, weight, gender)
double-blind study
experiment in which subject and researcher are not aware of group assignment
effect size
the size of the difference b/t sample means
allows a statistical test to find difference when one does exist
generalizibility
degree to which a study's findings based on a sample apply to the entire population
gold standard
an instrument with established validity can be used as a standard for assessing another instrument
components of informed consent
information about the general nature of what is to take place, any risks to the individual and what will be done to minimize the risks, possible benefits, an ethical disclosure
control
researcher attempts to remove the influence of any variable other than the one being tested
control group
group that resembles the experimental group but who do not receive the different Tx
experimental group
group that receives a new or novel Tx that is under investigation
intervening variable
variable that alters the relationship b/t independent and dependent variable (ex: anxiety)
validity
the degree to which a test, instrument or procedure accurately measures with is supposed to or intended to measure
internal validity
degree to which the observed differences on the dependent variable are the direct result of manipulation of the independent variable
external validity
degree to which the results are generalizable to individuals or environmental settings outside of the experimental study
content validity
degree to which an instrument measures an intended content area
concurrent validity
degree to which the scores on one test are related to score on another criterion with both tests being given at relatively similar times (usually involves comparison to the gold standard)
predictive validity
degree to which a test is able to predict future performance
construct validity
degree to which a test measures an intended hypothetical abstract concept (non-observable behaviors or ideas)
sampling bias
threat to validity; selection bias, researcher introduces sampling error (ex:sample of convenience)
failure to exert rigid control over subjects and conditions
threat to validity; intervening variables interact with dependent variable
pretest treatment interaction
threat to validity; subjects respond differently to Tx b/c of the pretest
multiple Tx interference
threat to validity; more than once Tx is being given to the subjects at the same time or carryover effects from an earlier Tx influences results of a later Tx
experimenter bias
threat to validity; expectations of the researcher about the expected outcomes influence the results
Hawthorne effect
threat to validity; subject's knowledge of participation in an experiment influences the results of the study
placebo effect
threat to validity; subjects respond to a sham Tx with positive effects
reliability
degree to which a test consistently measures what it is intended to measure
test-retest reliability
degree to which the scores on a test are stable or consistent over time, measure of instrument stability
split-half reliability
degree of agreement when a test is split in half and the reliability of the first half compared to the second; internal consistency of an instrument
threats to reliability
errors of measurement, random/systematic errors
sensitivity
ability to correctly identify proportion of individuals who truly have a disease (true positive)
specificity
ability to correctly identify the proportion of individuals who do not have a disease (true negative)
predictive value
test's ability to estimate the likelihood that a person will test positive (or negative) for a target condition
true negative
individuals correctly identified as not having the target condition
true positive
individuals correctly identified as having the condition
false positive
individuals are identified as having the condition when they do not
false negative
individuals are identified as not having the condition when they do
systematic review (meta-analysis)
review in which the primary studies are summarized, critically appraised, and statistically combines, usually quantitative in nature with specific inclusion/exclusion criteria
randomized control trial
experimental study in which participants are randomly assigned to either experimental or control group to receive different interventions or a pacebo
cohort study
prospective, group of participants with similar condition followed for a defined period of time, comparison made to a group w/o condition
homogeneity
SR free of variation
case-control study
retrospective, group with similar conditions compared to a group w/o, to determine factors that played a role in the condition
case report
descriptive research, only one individual is studied in depth, often retrospective
evidence level 1a
SR (w/ homogeneity), multiple RCTs, randomization of large numbers of pts, multicenter, substantial agreement of size and direction of Tx effects
evidence level 1b
individual RCT with narrow confidence level, Tx effects precisely defined
evidence level 1c
all or none case series, in absence of RCT overwhelming evidence of substantial Tx effect following introduction of a new Tx (ex: vaccine)
evidence level 2a
SR (with homogeneity) or cohort studies (comparison groups); prospective: pts are ID'd for study b/4 outcomes achieved
evidence level 2b
individual cohort study or low quality RCT (small N), quality study includes more than 80% f/u of pts enrolled in study
evidence level 3a
SR (with homogeneity) of case-controlled studies (case comparison)
evidence level 3b
individual case control study, retrospective: pts ID'd for study after outcomes achieved
evidence level 4
case-series and poor-quality cohort and case-control studies, largely descriptive studies
evidence level 5
expert opinion w/o explicit critical appraisal, or based on physiology, bench research or first principles
observations not made on pts
mean
average of all the scores, used with interval or ratio data
median
midpoint, used with ordinal data
mode
most frequently occurring score, used with nominal data
standard deviation
determination of variability of scores from the mean, most frequently used measure of variability; used with interval or ratio data
tests of significance
estimation of true differences, not due to chance; rejection of the null hypothesis
alpha level
preselected level of statistical significance, allows rejection of the null, often expressed as a value of P
standard error
expected chance variation among the means, the result of sampling error
type I error
null hypothesis is rejected with it is true (i.e. scores concluded to be significantly different when the difference is really due to chance)
type II error
null hypothesis not rejected when it is false (i.e. scores concluded to be due to chance when they are actually statistically significant)
t-test
parametric test of significance used to compare two independent groups created by random assignment and identify a difference at a selected probability level
t-test for independent samples
compares difference b/t 2 independent groups (ex: if a splint improves fxn in pts with RA)
t-test with paired samples
compares the difference b/t 2 matched samples (ex: does therapy improve fxn in siblings with autism)
one tailed t-test
based on directional hypothesis, evaluates data on one end of the distribution, positive or negative (ex: pts who receive an Rx will have a better rehab outcome than those that do not)
two tailed t-test
based on non-directional hypothesis, evals data on both positive and negative ends of distribution, *
tests of significance are almost always 2 tailed
* (ex: either group, Tx or control, may exhibit better rehab outcomes)
analysis of variance
ANOVA
parametric test used to compare 3 or more independent Tx groups or conditons
one-way (simple) ANOVA
compares multiple groups on a single indep. variable
multifactorial ANOVA
compares multiple groups on two or more indep. variables
analysis of covariance
ANCOVA
parametric test used to compare two or more treatment conditions while also controlling for the effects of the intervening variables
chi square test
non-parametric test of significance used to compare data in the form of frequency counts occurring in two or more mutually exclusive categories
correlational statistics
used to determine the relative strength of a relationship b/t 2 variables
pearson product-moment coefficient (r)
used to correlate continuous data with underlying normal distribution on interval or ratio scales
spearman's rank correlation coefficient
non-parametric test used to correlate ordinal data
point biserial correlation
one variable is dichotomous (nominal) and the other is a ratio or interval (ex: relationship between elbow flexor spasticity and side of stroke)
rank biserial correlation
one variable is dichotomous (nominal) and the other is ordinal (ex: relationship b/t gender and fxnal ability)
intraclass correlation coefficient
ICC
reliability coefficient based on analysis of variance
high correlation
>0.76 to 1.0
moderate correlations
0.51 to 0.75
fair correlation
0.26 to 0.50
low correlation
0.0 to 0.25
common variance
representation of the degree that variation in one variable is attributable to another variable, determine by squaring the correlation coefficient
linear regression
used to establish the relationship b/t two variables as a basis for prediction; purpose is to generate an equation which relates X to Y
tidal volume
TV
volume of gas inhaled (or exhaled) during nL resting breath
inspiratory reserve volume
IRV
volume of gas that can be inhaled beyond a nL resting tidal inhalation
expiratory reserve volume
ERV
volume of gas that can be exhaled beyond a nL resting tidal exhalation
residual volume
RV
volume of gas that remains in the lungs after ERV has been exhaled
capacities
two or more lung volumes added together
inpiratory capacity
IRV + TV
amt of air that can be inhaled from REEP
resting end expiratory pressure
REEP
point of equilibrium where forces acting on the rib cage are balanced, occurs at end tidal expiration
vial capacity
IRV + TV +ERV
amt of air that is under volitional controls, measured as forced expiratory vital capacity (FVC)
functional residual capacity
ERV + RV
amt of air that resides in the lungs after a nL resting tidal exhalation
total lung capacity
IRV + TV +ERV + RV
total amt of air contained within the thorax during maximum inspiratory effort
forced expiratory volume in 1 second
FEV1
amt of air exhaled during 1st second of FVC
FEV1 norms
at least 70% of FVC
FEV1/FVC * 100> 70%
forced expiratory flow rate
FEF 25%-75%
slope of the line drawn b/t 25% and 75% of exhaled volume on a FVC exhalation curve; more specific to smaller a/w
partial pressure of O2 in atmosphere
PaO2= 159.6 mmHg
partial pressure of O2 in arterial blood
PaO2= 95-100 mmHg
fraction of O2 in inspired air
FiO2= 21%
pH norms
7.35 - 7.45
PaCO2 norms
35 mmHg - 45 mmHg
inversely proportional to pH
hypercapnea
PaCO2 > 45 mmHg
hypocapnea
PaCO2 < 35 mmHg
bicarbonate norms
22 - 28 mEq/mL
proportional to pH
dead space
space that is well-ventilated but no respiration (gas exhange) occurs
pathological ex: PE
shunt
no respiration occurs b/c of a ventilation abnormality
heart rate adult
60-100 bpm
heart rate infant
120 bpm
blood pressure adult
<120/80 mmHg
blood pressure infant
75/50 mmHg
resp rate adult
12-20 breaths/min
resp rate infant
40 breaths/min
PaO2 infant
75-80 mmHg
tidal volume adult
500 mL
tidal volume infant
20mL
crackles
(rales, crepitations)
crackling sound heard usually during inspiration that indicated pathology (atelectasis, fibrosis, pulm. edema)
wheezes
musically pitched sound, usually heard during expiration, cause by a/w obstruction (asthma, COPD, foreign body aspiration)
signs of respiratory acidosis
early: anxiety, restlessness, dyspnea, HA
late: confusion, somnolence, coma
signs of respiratory alkalosis
dizziness, syncope, tingling, numbness, early tetany
signs of metabolic acidosis
secondary hyperventilation (Kussmaul breathing), nausea, lethargy, coma
signs of metabolic alkalosis
vague sxs: weakness, mental dullness, possibly early tetany
WBC norm
4,300 to 10,800
*
<5,000 with fever EX is C/i
*
<1, 000 use mask
hematocrit norm
35% to 48%
hemoglobin norms
12 to 16 g/dL
COPD stage 1 (mild)
FEV1/FVC <70%
FEV1 >= 80% predicted
with or without chronic sxs
COPD stage 2 (moderate)
FEV1/FVC <70%
50 % < FEV1 < 80% predicted
often with SOB on exertion
COPD stage 3 (severe)
FEV1/FVC <70%
FEV1 < 30% predicted
increasing SOB, decreased EX capacity, exacerbations of disease
COPD stage 4 (very severe)
FEV1/FVC <70%
FEV1 < 30% predicted
FEV1 < 50% with chronic resp. failure sxs
impaired QOL
exacerbations of disease may be life threatening
ABI 1.0 or higher
nL
ankle systolic P is at least as high as brachial P
ABI 0.8 to 1.0
mild PAD
compression Tx with caution
ABI 0.5 to 0.8
moderate PAD
compression Tx C/i
ABI <0.5
severe arterial disease, critical limb ischemia, + for resting pain
compression Tx C/i
dyspnea +1
mild
noticable to pt but not to observer
dyspnea +2
mild
some difficulty, noticeable to observer
dyspnea +3
moderate difficulty but can continue
dyspnea +4
severe difficulty, pt cannot conitnue
anginal scale 1+
light, barely noticable
anginal scale 2+
moderate, bothersome
anginal scale 3+
severe, very uncomfortable
anginal scale 4+
most severe pain ever experienced
edema 1+
mild, barely perceptible to indentation
0 to 1/4" pitting
edema 2+
moderate, easily identified depression, returns to nL within 15 sec
1/4 to 1/2" pitting
edema 3+
severe, depression takes 15-30 seconds to rebound
1/2 to 1" pitting
edema 4+
very severe, depression lasts for 30 seconds or more
>1" pitting
SpO2 norm
95% - 100%
prothrombin time (PT)
11 - 15 sec
*
if <2.5x norm PT C/i
*
partial prothrombin time (PTT)
25 - 40 sec
international normalized ratio (INR)
0.9 - 1.1
bleeding time
2 - 10 min
red blood cells (RBC)
male 4.6 - 6.2 10^6/uL
female 4.2 - 5.9 10^6/uL
erythrocyte sedimentation rate (ESR)
male: up to 15 mm/hr
female: up to 20 mm/hr
hematocrit (Hct)
male: 45 - 52%
female: 37 - 48%
*
<25% EX is C/i
*
hemoglobin
male: 13-18
female: 12-16
*
<8 EX is C/i
*
platelet count
150,000 - 450,000 cells/mm^3
fibrinogen, plasma
175 - 433 mg/dL
S1 sound
lub"
nL closure of the mitral and tricuspic valves, beginning of systole
S2 sound
dub"
nL closure of aortic and pulmonary valves, end of systole
S3 sound
abnL
associated with CHF
S4 sound
abnL
associated with MI or chronic HTN
P wave
atrial depolarization
QRS wave
ventricular depolarization
ST segment
beginning of ventricular repolarization
T wave
ventricular repolarization
PVC
premature ventricular contractions
during EX: serious when more than 3-5 in a row per minute, multifocal
ventricular tachycardia
run of 3 or more PVCs in a row
wide QRS
no P wave
ventricular fibrillation
chaotic activity of ventricle from multiple foci
unable to determine HR
erratic, without QRS
ST depression
may indicate ischemia if downsloping 2-3mm
ST elevation
new infarct or pericarditis
inverted T wave
ischemia
wide QRS
occurs with bundle branch heart blocks
slowed ventricular rate, dec CO
*
3rd degree block= life threatening, need atropine
*
SaO2 cutoff for supplemental O2
88%
EX guidelines for phase 1 cardiac rehab
acute stage (<1 wk for uncomplicated MI)
initially 2-3 METS, progress to 3-5 METS
short bouts, 2-3x/day
EX guidelines for phase 2 cardiac rehab
subacute (home or OP; 1-2 wks post MI)
3-4x/week
30-60 min with 5-10 min warm up/cool down
d/c at 9 METS
EX guidelines for phase 3 cardiac rehab
post-acute, community EX (3-6 months post MI)
must fxn at 5 METS to start
progress from supervised -> indep. EX
progress to 50-80% fxnal capacity
3-4x/week
45+ min/session
signs that pt needs further diagnostic eval for cardiac rehab
sxs: fatigue, lightheaded, confusion, ataxia, pallor, cyanosis, dysnpea, nausea, onset of angina
st displacement (2mm) horizontal or downsloping from rest
v-tach
3+ consecutive PVCs
dec SBP more 20 mmHg
inc SBP >220 DBP> 110