Emilio Aguinaldo College – Manila

School of Physical, Occupational, and Respiratory Therapy

OCE2 42: Clinical Education II (Continuation of Introduction to Clinics)

CARDIAC, PULMONARY, AND VASCULAR REHABILITATION

Outline for Skills Demonstration

● Vital Signs
o Heart Rate and Rhythm
o Respiratory Rate, Rhythm, and Shortness of Breath
▪ Note use of accessory muscles
o Blood pressure – aka. systemic arterial blood pressure – product of cardiac output and
peripheral vascular resistance; BP = CO x PVR
▪ Mean arterial pressure – when goal is to keep MAP > 60 mmHg (in ICU); arterial
pressure within the large arteries over time (cardiac cycle) and is dependent on
blood flow and arterial compliance; formula: (SBP + 2DBP / 3)
▪ Orthostatic Hypotension – aka. Orthostatic postural hypotension; sudden
prolonged drop in BP that accompanies a position change from lying to either
sitting or standing; symptoms: light-headedness, dizziness, and loss of balance
● Observation, Inspection, and Palpation
o Cyanosis – bluish color of skin, nail beds, lips and tongue
o Pallor – absence of pink, rosy color
o Diaphoresis – excess sweating, cool clammy skin; indicates excessive effort or
inadequate cardiovascular response
o Pulses – femoral, dorsalis pedis, posterior tibialis pulses
▪ Bounding – 4+
▪ Normal – 3+
▪ Weak – 2+
▪ Thready – 1+
▪ Absent - 0
o Edema – pitting vs. non pitting
o Texture
o Use of accessory muscles
o Mediastinal shift of trachea
o Jugular vein distention
o Nose flaring
o Posture
o Pain assessment
o Wound assessment
 Emilio Aguinaldo College – Manila
School of Physical, Occupational, and Respiratory Therapy
OCE2 42: Clinical Education II (Continuation of Introduction to Clinics)

CARDIAC

Auscultation

● Heart Sounds – associated with valvular closing

● Normal heart sounds: S1 (“lub”, mitral valve closure; tricuspid valve closure) and S 2 (“dub”, aortic
valve closure; pulmonic valve closure)
● Systole: between S1 and S2; Diastole: between S2 and S1
● Abnormal heart sounds – murmurs
o Systolic murmurs – audible turbulence between S1 and S2
o Diastolic murmurs – audible turbulence between S2 and S1
● S3 – “ventricular gallop”, early diastole, assoc. with CHF; S 4 – “atrial gallop”, late diastole, assoc.
with MI or Htn

Functional Tests

o Exercise Stress Test

Cardiac Rehabilitation

o Techniques based on stage and level (Sullivan)

PULMONARY

Auscultation:
o Look for
1. Normal breath sound
- Vesicular: soft, low-pitched
– Tracheal: High Pitched
– Bronchial: loud, hallow, high pitched
– Bronchovesicular: medium pitched
2. Adventitious breath sound
– Crackles/Rales: Fine, Discontinued sound
– Wheezes: continuous, high pitched on exhalation
– Rhonchi: snoring sound d/t (+) secretion
– Strider: musical breath sound d/t obstruction of pharynx, larynx or trachea
2. Abnormal breathing pattern
– Dyspnea: rapid, shallow, regular rhythm`
– Tachypnea: fast, shallow, regular rhythm
– Bradypnea: slow, (N) to shallow, regular rhythm
– Apnea: absence of ventilation in expiration
– Apneusis: absence of ventilation in inspiration
– Hyperventilation: rapid, increased depth, regular rhythm
 Emilio Aguinaldo College – Manila
School of Physical, Occupational, and Respiratory Therapy
OCE2 42: Clinical Education II (Continuation of Introduction to Clinics)

Chest Wall Symmetry

Chest Expansion Measurement
Tactile Fremitus
Percussion

Functional Tests

o Borg Scale / RPE

o 6MWT
o Other CV endurance tests

Pulmonary Rehabilitation

● Breathing exercises:
• Diaphragmatic breathing
• Pursed-lip breathing – in dyspnea-relieving position
• Segmental breathing
• Glosssopharyngreal breathing
• Active cycle of breathing techniques (ACBT) – if necessary
o Use of incentive spirometry
o Segmental breathing techniques
● Lateral costal expansion
● Posterior basal expansion
● Right middle lode or lingual expansion
o Coughing techniques
● Double cough
● Controlled cough
● Series of 3 coughs
● Huffing
● Pump coughing
o Chest mobility exercises
● Mobilizing one side of the chest
● Mobilizing the upper chest and stretching the pectoralis muscle
● Mobilizing the upper chest and shoulder
o Manually-assisted cough
● Costophrenic assist
● Heimlich-type assist
● Tracheal tickle
o Postural Drainage
● Percussion
● Vibration
● Shaking
● Rib springing
● Positions of auscultation
o Relaxation exercises
 Emilio Aguinaldo College – Manila
School of Physical, Occupational, and Respiratory Therapy
OCE2 42: Clinical Education II (Continuation of Introduction to Clinics)

VASCULAR

Sensory Assessment, including monofilament testing

Special Tests
o Tests for LE arterial disorders
o Tests for LE venous disorders
o Tests for lymphatic disorders
o Tests for TOS

Vascular Rehabilitation

o Sensory modification techniques

o Graded exercises for arterial problems
o Techniques to clear edema for venous and lymphatic problems
● Difference between techniques for the two types of problems
● Compression
● Manual (Lymphatic/Venous) Drainage
● Exercises