Correct Answer: Brisk walking
- Initially, the patient should begin with beneficial low-risk activities (e.g., lymphedema exercise, walking, easy biking, swimming, water aerobics or Tai Chi).
- Exercise should always be performed with a compression garment or compression bandages.
- The patient should avoid medium-risk activities (e.g., jogging, running or stair climbing machines) or sport activities that involve high risk of injury (e.g., soccer, tennis, golf volleyball or karate).
- Intermittent claudication, often the earliest indication of PAD, is manifested by cramping, pain or fatigue in the muscles during exercise that is typically relieved by rest.
- The calf muscle is most commonly affected, but discomfort may also occur in the thigh, hip or buttock.
- Cessation of pain immediately upon stopping the exercise is characteristic of intermittent claudication.
With severe disease, however, pain may be present even at rest.
- The pain associated with spinal root impingement (nerve pain) is often acute and becomes worse or aggravated by extension, side flexion, rotation, standing, walking and exercise in general.
it is relieved by lying down d/t decreased vertebral weight .
- Peripheral nerve injury presents with sensory and motor loss.
-Raynaud's phenomenon is an intermittent attack of pallor or cyanosis of the small arteries and arterioles of the fingers as a result of inadequate blood flow.
-Typical clinical manifestations of left ventricular failure (CHF) include an S3 heart gallop, paroxysmal nocturnal dyspnea, orthopnea and signs and symptoms of pulmonary edema (marked dyspnea, pallor, cyanosis, diaphoresis, tachypnea, anxiety and agitation).
- Typical clinical manifestations of right ventricular failure include dependent edema of the ankles (usually pitting edema), weight gain, fatigue, right upper quadrant pain, anorexia, nausea, bloating, right-sided S3 or S4, cyanosis of nail beds and decreased urine output.
- Impending MI may include anginal pain or discomfort in the chest, neck, jaw or arms; palpitations; tachycardia; or unusual fatigue or dyspnea.
- Pericarditis produces substernal pain that may radiate to neck and upper back; difficulty swallowing; pain aggravated by movement or coughing and relieved by leaning forward or sitting upright; and a history of fever, chills, weakness or heart disease
Correct Answer: ST segment depression from baseline of 3-mm horizontal or downsloping depression
- A positive exercise tolerance test (graded exercise test) indicates myocardial ischemia with increasing exercise intensities->ECG changes from baseline (> 2 mm horizontal or downsloping; ST segment depression, or > 2 mm ST segment elevation).
- Additional signs of exertional intolerance that indicate the test should be terminated include
=onset of moderate to severe angina (some angina is expected with increasing work),
=a drop in systolic BP with increasing workload,
=signs of exertional intolerance (pallor, cyanosis, cold or clammy skin),
=unusual or severe shortness of breath (some shortness of breath is expected),
=CNS signs (ataxia, vertigo, visual or gait problems, confusion)
=a hypertensive response equal to or greater than 260/115.
- Muscle wasting is a common manifestation of COPD of stage III.
-The cause of muscle wasting is not clear, but it is not simply a malnutrition problem.
The results of this muscle wasting are peripheral weakness, impaired functional abilities, poor quality of life and a poor prognostic sign.
- Supplemental oxygen is typically found in patients in stage IV of GOLD, not stage III.
- Weight loss is a common finding in patients with COPD, especially as the disease progresses.
The energy demands of a person with COPD are higher than those of a person without COPD for the same activity.
A usual finding is that persons with COPD are less active than their nondiseased counterparts.
As the disease progresses, the person with COPD cannot maintain his/her independence with any further decrease in his/her activity and weight loss ensues.
-As lung destruction increases with worsening COPD, there are less elastic recoil properties of the lung to pull the thorax back into what we recognize as a usual thoracic configuration.
A barreled chest, or an increased anteroposterior-to-lateral diameter of the chest, is a common finding in advanced, stage III COPD.