Cardiovascular Procedures and Management Quiz
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Questions and Answers

What is the primary purpose of PTCA in managing CAD?

  • To compress plaque and restore blood flow (correct)
  • To introduce medications that lower cholesterol
  • To insert a stent to maximize blood flow
  • To increase the heart's contractility

Which of the following factors is not typically optimized for medical management of CAD?

  • Increased carbon dioxide production (correct)
  • Blood pressure through medication
  • Heart's contractility
  • Myocardial oxygen demand

What type of vessel is typically harvested for a CABG procedure?

  • Saphenous vein (correct)
  • Femoral vein
  • Brachial artery
  • Jugular vein

When managing ischemic conditions, which medication strategy is important for reducing myocardial oxygen demand?

<p>Lowering heart rate or contractility (B)</p> Signup and view all the answers

What is a common complication that stents aim to address after PTCA?

<p>Re-stenosis (D)</p> Signup and view all the answers

What is one of the primary indications for performing a MID-CAB procedure?

<p>Patient has a high risk for bypass surgery (A)</p> Signup and view all the answers

Which of the following is NOT a benefit of MID-CAB surgery?

<p>Longer recovery time (B)</p> Signup and view all the answers

During a physical therapy examination post-surgery, which aspect is specifically required?

<p>Cardiovascular screen (B)</p> Signup and view all the answers

Which special test is NOT included in the cardiovascular examination?

<p>Neurological reflexes (B)</p> Signup and view all the answers

What is a risk factor that could increase the likelihood of sternal dehiscence after surgery?

<p>Smoking (B)</p> Signup and view all the answers

What is the recommended duration for patients to keep their upper arms close to their body after surgery?

<p>6-8 weeks (D)</p> Signup and view all the answers

Which group of patients is advised to wear a supportive vest for sternum protection?

<p>Patients with a BMI of 35 or higher (A)</p> Signup and view all the answers

What should patients do when coughing or sneezing to protect the surgical incision?

<p>Hug a pillow over the incision (A)</p> Signup and view all the answers

Which type of bra should patients with large breasts utilize after surgery?

<p>A supportive bra that fastens at the front (C)</p> Signup and view all the answers

What is a key consideration for patients regarding sternal precautions?

<p>Patients should adhere to either traditional precautions or move in the tube, but not both. (C)</p> Signup and view all the answers

What is the maximum weight that patients should avoid lifting during the first 8 weeks post-surgery?

<p>5-10 pounds (D)</p> Signup and view all the answers

Which movement is NOT allowed during the standard sternal precautions?

<p>Bilateral shoulder elevation past 90 degrees (B)</p> Signup and view all the answers

During which activity should the sternum NOT be palpated?

<p>Driving (A)</p> Signup and view all the answers

How is a 'Moderately separated sternum' classified on the sternal instability scale?

<p>Moderate increase in motion upon testing (C)</p> Signup and view all the answers

What is the primary focus of the modified sternal precautions program titled 'Move in the Tube'?

<p>Allowing movements within a designated area (A)</p> Signup and view all the answers

What precaution should be taken when a patient is coughing post-surgery?

<p>Coughing while splinted (D)</p> Signup and view all the answers

Which of the following is allowed during the initial 10 days following sternotomy?

<p>Horizontal arm movements within pain-free limits (D)</p> Signup and view all the answers

Which special testing result indicates a clinically stable sternum?

<p>Normal detectable motion (B)</p> Signup and view all the answers

What does the term 'Independent (I)' in the level of assist indicate?

<p>Patient can transfer independently and safely. (B)</p> Signup and view all the answers

Which level of assist indicates the patient performs 50% of the movement with the clinician providing the remaining 50%?

<p>Moderate Assist (Mod A) (A)</p> Signup and view all the answers

What is not a function of Functional Measures?

<p>Assessing the psychological well-being of patients (C)</p> Signup and view all the answers

What does CGA stand for in the context of levels of assist?

<p>Contact Guard Assist (D)</p> Signup and view all the answers

How much effort does a patient performing at the Maximum Assist (Max A) level provide?

<p>25% of the movement (C)</p> Signup and view all the answers

What is the primary purpose of the Six Minute Walk Test?

<p>To determine aerobic capacity in patients (C)</p> Signup and view all the answers

How long should the 30 seconds sit to stand test be performed?

<p>For a minimum of 30 seconds (C)</p> Signup and view all the answers

What is a use of determining baseline data from Functional Measures?

<p>To tailor a home exercise program (D)</p> Signup and view all the answers

What is a major advantage of the 2-minute step test compared to the 6-minute walk test (6MWT)?

<p>It requires only basic items like tape and a timer. (C)</p> Signup and view all the answers

Which age group of women has the highest threshold for being classified as above average in the 2-minute step test?

<p>80-84 (D)</p> Signup and view all the answers

What is a noted limitation of the 2-minute step test?

<p>There is insufficient data on its reliability. (A)</p> Signup and view all the answers

Which of the following best describes the response options in the senior fitness test protocol for men aged 90-94?

<p>&lt; 52 (D)</p> Signup and view all the answers

What aspect of quality of life does the SF-36 questionnaire NOT directly assess?

<p>Chest pain frequency (B)</p> Signup and view all the answers

In the context of the 2-minute step test, what is the average threshold for women aged 70-74?

<p>68 to 101 (A)</p> Signup and view all the answers

What is the primary role of the function assessment tool mentioned in the text?

<p>Determining therapy effectiveness (D)</p> Signup and view all the answers

Flashcards

Percutaneous Translumenary Coronary Angioplasty (PTCA)

A procedure where a balloon-tipped catheter is inserted into a blocked coronary artery to compress plaque and restore blood flow.

Stent

A small, expandable tube inserted into a coronary artery after PTCA to prevent re-stenosis (reblocking) of the artery.

Coronary Artery Bypass Graft (CABG)

A surgical procedure where a healthy blood vessel from another part of the body is used to bypass a blocked coronary artery, restoring blood flow.

Saphenous Vein

A type of vessel commonly used for CABG, harvested from the leg.

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Internal Mammary/Internal Thoracic Artery

A type of vessel commonly used for CABG, harvested from the chest wall.

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MID-CAB

Minimally invasive cardiac surgery procedure used for patients with 1-2 blocked arteries on the anterior surface of the heart, who are at high risk for bypass surgery.

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Post-Operative PT Examination

A cardiovascular screen, heart auscultation, observation of skin color and perfusion, sternal stability assessment, sternal precautions teaching, cardiorespiratory fitness tests, risk factor reduction education, referral to cardiac rehabilitation, vital sign monitoring during activity, and possible ECG/telemetry monitoring.

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Heart Auscultation

The auscultation of the heart to identify any abnormalities in heart sounds and rhythm.

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Sternal Stability

The assessment of sternal stability following open heart surgery to ensure sternal healing and prevent complications like dehiscence.

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Risk Factors for Sternal Dehiscence

Factors that increase the risk of sternal dehiscence (separation) after open heart surgery.

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Splinted Cough

A technique used for 6-8 weeks after a sternotomy (chest incision) where the patient hugs a pillow tightly against their surgical site while coughing or sneezing to minimize stress on the healing bone.

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Sternal Vest

A type of vest worn after a sternotomy (chest incision) to support the sternum and minimize movement while healing. It's usually worn for 6-8 weeks.

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Upper Arms Close to the Body

This principle emphasizes keeping the upper arms close to the body during movement and activities after a sternotomy (chest incision). It helps protect the healing bone and minimizes strain.

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BMI ≥ 35 and Sternal Vest

Patients with a Body Mass Index (BMI) of 35 or higher should wear a supportive vest to help protect the chest bone after a sternotomy. This is because a higher BMI increases stress on the sternum.

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Movement System Analysis

The speed, range of motion, smoothness, and amount of movement required to complete a task. This term is used to assess a patient's functional capacity and movement limitations.

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Sternal Stability Assessment

Assessing for stability of the sternum, looking for movement or gaps during specific maneuvers.

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Sternal Instability Scale

A structured system for grading the degree of sternal instability based on the amount of movement observed.

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Sternal Precautions

Restrictions placed on movements after a sternotomy to allow the sternum to heal properly.

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Standard Sternal Precautions

Standard precautions typically involve restrictions on activities like pushing, pulling, lifting, shoulder elevation, and reaching behind the back for 8 weeks.

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Modified Sternal Precautions ('Move in the Tube')

An alternative approach to standard sternal precautions, focusing on keeping movements within a defined 'tube' or green area for the first 10 days.

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Move in the Tube

A key component of Modified Sternal Precautions (Move in the Tube) where movements are restricted to within a defined safe zone.

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Bilateral Movements in the Tube

Activities that involve the arms moving in the horizontal or overhead plane, usually allowed within pain limits during the first 10 days after sternotomy.

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Open-Chain Activities

Activities that involve moving the arms in a way that doesn't put direct stress on the sternum, often allowed outside the tube.

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Level of Assist

A standardized system of describing the level of assistance a patient needs during a transfer, ranging from independent to dependent.

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Independent (I)

A patient can perform the entire transfer without any help or assistance.

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Supervision (S)

A patient requires some supervision and may need help adjusting the environment for safety, but no actual physical assistance.

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Contact Guard Assist (CGA)

A patient needs light contact from a therapist to help with stability and balance during a transfer.

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Minimal Assist (Min A)

A patient can perform 75% of the transfer themselves, requiring only 25% of support from a therapist.

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Moderate Assist (Mod A)

A patient performs 50% of the transfer, with the therapist providing the other 50% of the effort.

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Maximum Assist (Max A)

A patient performs only 25% of the transfer, requiring 75% of the effort from the therapist to complete the move.

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Dependent (D)

A patient cannot perform any part of the transfer and requires complete assistance from the therapist.

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2-Minute Step Test

A 2-minute exercise test that involves marching in place while lifting your knees to a 90-degree angle. It is used to assess cardiovascular fitness and is part of the Senior Fitness Test protocol.

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How does the 2-Minute Step Test measure fitness?

A 2-minute test used to estimate a person's aerobic capacity based on how many times they can lift their knee to a designated height within the timeframe. It is considered a valid indicator of cardiovascular fitness.

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What makes the 2-Minute Step Test practical?

A common alternative to the 6-Minute Walk Test (6MWT). It is performed without specialized equipment, making it easy to administer.

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What are the limitations of the 2-Minute Step Test?

The 2-Minute Step Test is not as strongly correlated with VO2 max as other tests, but it is still a useful indicator of cardiovascular fitness.

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SF-36

A standardized questionnaire designed to gather information about a patient's physical function, role limitations, bodily pain, general health, vitality, social functioning, role emotional, and mental health.

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What is the Function assessment tool?

A widely used tool that helps physical therapists measure a patient's functional abilities, assess their progress, and inform discharge recommendations.

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Seattle Angina Questionnaire

A questionnaire aiming to gather details about a patient's experience with angina, including frequency, severity, and associated symptoms.

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What is the Short-Form Seattle Angina Questionnaire?

A shorter version of the Seattle Angina Questionnaire designed for efficiency and practicality, while still providing valuable information about angina symptoms.

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Study Notes

Patient Positioning for Evaluation

  • Sit in a new part of the room next to someone you normally don't sit with.

Ischemic Conditions and Med/Surg Management

  • Patients with CAD and/or MI may be managed medically:
    • Optimize blood pressure through medications, weight loss, and exercise.
    • Optimize myocardial oxygen demand through medications that lower heart rate and/or lower contractility.
    • Optimize coronary blood flow through medications that thin blood.
    • Manage cholesterol.
    • Optimize physical activity.
  • Additional pharmacology lecture is planned.

Surgical Interventions for CAD & MI

  • Percutaneous transluminal coronary angioplasty (PTCA):
    • Balloon-tipped catheter fed into occluded coronary artery.
    • Balloon compresses plaque, restoring blood flow.
  • Stent:
    • Used in conjunction with PTCA.
    • Used to prevent re-stenosis (restenosis).
    • Blood thinners used with stents.

Surgical Interventions - CABG

  • Coronary artery bypass graft (CABG):
    • Uses saphenous vein, internal mammary/internal thoracic artery, or brachial vein.
    • Bypasses occlusion to restore blood flow.

Surgical Treatments: Coronary Artery Bypass Graft (CABG)

  • Harvest a blood vessel (saphenous vein, ulnar artery) from the body.
  • Connect the harvested vessel from the aorta to the distal area of occlusion.

Mid-CAB: Indications and Contraindications

  • Indications:
    • 1-2 blocked arteries on the anterior surface of the heart.
    • High risk for bypass surgery.
  • Benefits:
    • No sternotomy (less functional impairment).
    • Shorter length of stay.
    • Lower risk than with heart-lung machine.

Chart Review: Surgery

  • Look for:
    • Type of surgery.
    • Method of surgery.
    • Where the vein was harvested.
    • Anything unusual in the perioperative or operative period.

PT Examination

  • Cardiorespiratory screen/heart auscultation
  • Observation of color/perfusion.
  • Sternal stability and precautions.
  • Cardiac rehabilitation and education.
  • Vital signs/cardiorespiratory response to activity.
  • ECG/telemetry.

Examination Continued: Special Tests CV

  • Special tests:
    • Heart auscultation.
    • Capillary refill.
    • Peripheral pulse strength.
    • Lung auscultation.
    • Blood pressure (orthostatic hypotension)
    • Sternal stability.

Examination - Sternal Incision

  • Wound evaluation (color, odor, discharge; more detail in future).
  • Sternal stability.
  • Risk factors for dehiscence (older age, smoking, diabetes, overweight/obese, poor nutritional status).

Sternal Instability

  • Method for testing:
    • Palpate between sternal halves using the 2nd, 3rd, and 4th digits.
    • Consider shoulder flexion/rotation, coughing, and deep breathing.
    • An optional further challenge is contrary shoulder movement.
    • Record grade of motion, gap, and tenderness.
  • Sternal Instability Scale:
    • 0: Clinically stable sternum (no detectable motion).
    • 1: Minimally separated sternum (slight increase in motion).
    • 2: Moderately separated sternum (moderate increase in motion).
    • 3: Completely separated sternum (marked increase in motion).

Sternal Precautions

  • Limit pushing, pulling, lifting, or carrying > 5-10 lbs for 8 weeks.
  • Limit bilateral shoulder elevation past 90 degrees for 8 weeks (Unilateral unweighted shoulder elevation is allowed within pain limits).
  • Limit reaching behind back.
  • Splinted coughing.
  • No driving (for 8 weeks).

Modified Sternal Precautions ("Move in the Tube")

  • Alternative to standard sternal precautions.
  • Patients keep moves within a defined "tube" or green area.
  • Allowed to move out of the green area for open-chain activities (e.g., ADLs).
    • Detailed guidelines for arm movements, loading, positioning, and specific precautions concerning patients with BMI≥35, coughing, and large breast size are included.

Functional Measures

  • Determining functional status.
  • Determining impact of medications and/or surgery on function.
  • Risk stratification for mortality, readmissions, and falls.
  • Baseline data for a home exercise program.

Aerobic Capacity

  • Six-minute walk test.
  • Two-minute marching/step test.
  • Functional activities (e.g., 5 times sit-to-stand, 30-second sit-to-stand).

Ready, Set, Go!

  • Testing procedure for functional activities:
    • Stand upright next to a wall, marking a point midway between patella and iliac crest.
    • March for 2 minutes, lifting knees to 90 degrees.
    • Allow rest and use of support (wall/chair).
    • Count knee hits against the mark.

Men's and Women's Results (Fitness Protocol):

  • Provides average, above average, and below average data for various age ranges

2 Minute Step Test

  • An alternative to 6-minute walk test.
  • Lightweight (no equipment except tape and timer).
  • Low correlation to VO2.
  • Insufficient data determining reliability and responsiveness.

Documentation of Level of Assistance

  • Independent (I), Supervision (S), CGA, Minimal Assist (Min A), Moderate Assist (Mod A), Maximum Assist (Max A), Dependent (D).
  • Description of each level.

QOL - SF-36

  • Physical functioning, Role physical, Bodily pain, General health.
  • Vitality, Social functioning, Role emotional, Mental health.

Seattle Angina Questionnaire

  • Detailed questions about limiting factors due to chest pain over the past 4 weeks; frequency, symptoms, and impact on daily life and ability.

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Ischemia and Med-Surg Management 2024 PDF

Description

Test your knowledge on cardiovascular procedures like PTCA and CABG, as well as the associated management strategies in coronary artery disease. This quiz covers indications, complications, and rehabilitation aspects related to these procedures.

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