Miscellaneous 1
Structured PR exercise classes should include these 3 components:
1. warm up (15 mins)
2. conditioning phase (achieving recommended weekly dose of CV exercise)
3. cool down (reverse of the warm up, returning cardiorespiratory system to resting levels)
The history of presenting condition allows the physio to gain important info in relation to the present condition, and helps to establish the patients baseline. What things do we need to inquire about for a cardio patient? (6)
-breathing
-cough
-sputum (so gross)
-wheeze
-chest pain
-functional ability
what factors contribute to the negative intrapleural pressure in relation to the atmospheric pressure?
-inward pull of the lungs by elastic recoil
-gravity and its impact on pulmonary circulation
-the outward pull on the rib cage due to elasticity pulling the rib cage up and out
-lymphatic activity in the lungs
HPC: wheeze
what information are we looking for when inquiring about a patients wheeze?
*bronchospasm- air flowing through a narrow airway*
-ask patient about the characteristics of the wheeze
-what brings on the wheeze?
-what are some aggravating & easing factors?
what is intrapleural pressure?
force exerted by gasses in the pleural cavity and should always be negative in relation to atmospheric pressure. at rest it is -4mmHg
Pre-screening should always occur prior to participation in a PR exercise class. What should we, as physios, look for in the pre-screening? Name 2 things.
-presence of illness
-changes in signs and symptoms
-change in medication
-wound healing
-glucose checks (especially for Pt's w/ diabetes)
these two centres are located in the pons, and are believed to fine tune the frequency, timing and duration of respiration
-apneustic centre (prolongs inspiration if damage is present)
-penumotaxic (fine tunes rhythm, inhibits or switches off inspiration to prevent over inflation of the lungs)
when inquiring about the patients drug history in the subjective examination, what information are we looking for?
-are you taking any medications?
-how often do you take them?
-include any new medication since admission to hospital/ health care facility
-important medication including anticoagulants, sedatives, cardiac, neuro medications
inspiration & expiration is cycled by impulses from the respiratory centres in the ______ & fine tuned by input from centres in the ______
medulla, pons
HPC: Sputum
what information are we looking for when inquiring about a patients sputum (so gross)?
-ask Pt to describe the characteristics of the sputum & what their normal is
-how much sputum do they clear when well?
-what changes with exacerbation?
-changes in color, volume and/or consistency
Where can we find notes on our patients prior to performing our own assessment?
-medical/nursing notes
-patient referrals
-conversations with the patient
*remember- we document our interaction w/ the Pt using SOAP notes :)
What is stress incontinence?
involuntary leaking of small amounts of urine in response to increases in intra-abdominal pressure. SI may make the patient not want to cough
prior to assessment, what is legally required to obtain from all patients?
CONSENT BB
what is transpulmonary pressure?
difference between intrapleural and intra-alveolar pressure
what information are we looking for when inquiring about smoking history in a subjective examination?
-calculating pack years
-do you smoke?
-for how long have you been a smoker?
-what motivates you to smoke? would you consider eventually quitting?
-how many cigarettes do you smoke per day?
Name 4 health behaviour change techniques
1. action planning/ SMART goals
2. self-monitoring
3. if-then plans
4. weighing up pros and cons
HPC: Functional Ability
what information are we looking for when inquiring about a patients functional ability?
-is there any change in baseline?
-how is their breathlessness? is it impacting daily activities?
-what is the level of difficulty of performing ADL's?
name the muscles involved in quiet inspiration (4)
1. diaphragm
2. external intercostals
3. scalenes
4. sternocleidomastoid
HPC: Breathing
what do we look for when inquiring about patients breathing?
-is the patient more or less breathless?
-what have they done recently that may have exacerbated symptoms?
-are they fatigued?
-side note: breathing generally changes first when a patient is deteriorating
what patient information is necessary for us to acquire? (5)
-patients name
-CHI number/ DOB
-date
-time
-location
What is Boyle's Law?
states that there is an inverse relationship between pressure and volume
HPC: cough
what do we look for when inquiring about a patients cough?
-baseline: do they usually have a cough?
-is it wet/ dry?
-when do they usually cough?
-how often are they coughing? more or less?
Health Behaviour Change Model- what are the 5 stages of change?
1. precontemplation
2. contemplation
3. preparation
4. action
5. maintenance
HPC: chest pain
what are the 5 bodily systems that may affect chest pain?
1. respiratory (pleuritic- sharp/sudden pain)
2. cardiac (pressure pain/ crushing & radiating)
3. vascular (sudden onset of central/ excruciating pain in chest)
4. MSK (pain specific or locally radiating that is reproducible with mvmt & palpation)
5. gastro-oesophageal (burning/ central pain)
I know I have urinary incontinence.....but what is it?
loss of bladder control. Characterized by the complaint of involuntary leakage of urine. It is an important social and individual problem