cardiopulmonary physical therapy - kocw

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.


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.


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


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.

1. National Physical Therapy Examination, O’sullivan&Siegelman, TherapyEd2. Essentials of Cardiopulmonary Physical Therapy, 3rd edition, Ellen Hillegass,

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