Cardiovascular and Pulmonary Systems

Why it matters on this exam

These items decide whether you would have mobilised a patient safely, which is why they appear across all three outline columns.

Key concepts

• Normal exercise response: systolic pressure rises with intensity while diastolic stays roughly flat; heart rate rises linearly. A falling systolic, a widening or narrowing beyond expectation, or a failure to rise is abnormal.
• Termination criteria: drop in systolic of 10 mmHg or more with increasing workload, new angina, significant dysrhythmia, severe dyspnoea, dizziness, pallor or a request to stop.
• Exercise prescription: METs for common activities, Karvonen and age-predicted maximum methods, rating of perceived exertion when the patient is on rate-limiting medication.
• Cardiac rehabilitation: phase I precautions after myocardial infarction or sternotomy, sternal precautions, inpatient progression criteria.
• Airway clearance: postural drainage positions and contraindications, active cycle of breathing, huffing, and when devices are indicated.
• Acute care: what an arterial line, central line, chest tube, ventilator or IABP means for mobilisation, and the effect of beta blockers, diuretics and anticoagulants on the session.

Common mistakes

• Using age-predicted maximum heart rate for a patient on a beta blocker rather than RPE.
• Continuing exercise through a falling systolic pressure because the patient "feels fine".

Worked example

Resting BP 118/74, and at moderate intensity it reads 104/78 with the patient still walking. Systolic has fallen more than 10 mmHg with increasing work: stop the activity, monitor, and report — this is a termination criterion, not a measurement error.