Exercise can be used as an airway clearance technique. 

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program   Looking at Mrs. H’s PFT results, is the FEV1/FVC ratio normal or abnormal?   Pre-bronchodilator: FVC: 70% predicted FEV1:  24% predicted FEV1/FVC: 35% predicted TLC: 120% predicted   Post Bronchodilator: FVC: 79% predicted; 12% change FEV1:  27% predicted; 14% change FEV1/FVC: 43% predicted; 23% change DLCO: 43% predicted

Wayne is a 49yoa male who has been aware he has a heart murmur for years. A family doctor told him they would “follow-it”. Over the past year Wayne has become increasingly breathless during daily activities. As a recreational runner, he has become frustrated with being unable to run more than 10-15 minutes at a time for the past several months. He reports occasional chest pain during exercise but has not experiences any syncope or presyncope. Before his symptoms progressed, he ran at least 4 miles every morning and competed in road races up to the half-marathon distance. He reports no family history of cardiovascular disease, does not smoke, and does not take any prescribed medications. He takes a daily multivitamin and a fish oil supplement. Additional medical information is available below.   Height: 6’1’’ Weight: 194lbs Resting BP: 118/59   Fasting Labs: Total cholesterol: 192 mg/dL LDL: 139mg/dL HDL: 52 mg/dL HbA1c: 4.8%   Resting EKG: see below     What is Wayne’s BMI classification?    

One day, Caleb comes to PR complaining of a worsening productive cough (thick dark green sputum), dyspnea, occasional hemoptysis, fatigue, and weight loss. You encourage Caleb to see his physician or go to urgent care. He follows your instructions and is ultimately admitted to the hospital due to respiratory compromise and an antibiotic resistant Staphylococcus aureus inflection. Additional information from his hospitalization is found below.   Arterial Blood Gases: ·      pH: 7.3 ·      PaCO2: 110 ·      HCO3-: 52 ·      PaO2: 45   1.     What lung sounds would you expect to hear upon auscultation during an acute pulmonary infection?

Identify the following rhythm strip:  

List 5 RELATIVE contraindications to symtpom-limted maximal exercise testing.

Which of the following could be an opportunity?

Mr. J is a 74yoa male with known CAD and a recent diagnosis of heart failure. 3 years ago the patient had a large MI and refused to attend cardiac rehab afterwards. He has had 3 hospital admissions in the past year related to pulmonary edema. Left ventricular ejection fraction was measured 3 months ago at 23%.  He also has osteoarthritis in both knees and type II diabetes. He lives alone on a ground floor of an assisted living facility. He prefers to stay at home, but when he does leave the house and can only walk 2 city blocks without resting. An EKG from his emergency room visit related to the MI is shown below.       Mr. J meet criteria for a cardiac rehab referral.

Mrs. H is a pleasant 70yoa female who has had progressive SOB over the past few years. She currently struggles to walk more than 2 city blocks at a time and does not get out of the house often.  The patient has a modest cough and brings up about 1 tsp of creamy sputum each morning. She is a current smoker and has smoked 2 packs of cigarettes per day since she was 20.  Today is her first day in your pulmonary rehab program.   While reviewing Mrs. H’s medical chart prior to meeting her, you come across recent ABG results as shown below. Is PaO2 normal or abnormal?   pH: 7.39 PaCO2: 48 PaO2: 61 HCO3-:28 SpO2: 91%

List 5 ABSOLUTE contraindications to symptom-limited maximal exercise testing