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GXT 2008-CH 3

GXT 2008-CH 3. Pretest clinical evaluations based on risk assessment absolutely necessary for CAD and other CV disorders a comprehensive pretest evaluation includes : medical history physical exam laboratory work. MEDICAL HISTORY. Must include past and present information about:

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GXT 2008-CH 3

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  1. GXT 2008-CH 3 • Pretest clinical evaluations • based on risk assessment • absolutely necessary for CAD and other CV disorders • a comprehensive pretest evaluation includes : • medical history • physical exam • laboratory work

  2. MEDICAL HISTORY • Must include past and present information about: • any medical diagnosis • previous physical findings • present or past history of symptoms • recent illness, surgery, or hospitalization • orthopedic problems • medications, lifestyle habits, work demands • family history****

  3. PHYSICAL EXAM • Body weight plus anthropometrics (BMI, W/H ratio, waist girth and body composition) • BMI- factors (divide by 2.2 and multiple by 0.0254) • Resting HR and rhythm and lung auscultation • Resting BP-lying, sitting and standing • Auscultation of heart, carotid, femoral and abdominal arteries • Palpation and auscultation of abdomen and bowel

  4. MORE • Evaluation of extremities for edema and pulses • Presence of xanthomas • Orthopedic testing • Neurological testing • Skin inspection, especially of extremities

  5. LABORATORY TESTS • Total serum cholesterol and lipid panel • Fasting blood glucose • Fasting triglycerides • Thyroid function • Hemoglobin (good idea but not necessary). • Additional tests based on symptoms and/or disease

  6. BASIC MEASURES • Blood Pressure • diagnostic decisions made based on two or more readings • tables 3-1 and 3-2 give parameters • lifestyle modification cornerstone of therapy • drug therapy follows in given circumstances

  7. BP ASSESSMENT • Minimum of 5 minutes rest--no stimulants • Supine, sitting and standing measures • Cuff size and positioning imperative • Stethoscope placement and holding position • Inflation ( 20 mm/hg above known ) and deflation ( 2-5 mm/hg per s) most important • Become refined enough to differentiate between phase 4 and 5 of diastolic

  8. CHOLESTEROL AND TRIGLYCERIDES • Apparently healthy asymptomatic • HDL > 35 mg/dl • LDL < 160 mg/dl--<130 mg/dl with 2 or more RF and <100 mg/dl with disease • Triglycerides < 200 mg/dl • See figure 3-1, table 3-3 and table 3-4

  9. PULMONARY FUNCTION TESTS • Interpreted with caution due to patient effort required • Forced vital capacity • Forced expiratory volume in one second-FEV1 • Tidal volume • Impacted by age, gender and height

  10. CONTRAINDICATIONS TO EXERCISE TESTING • Absolute Issues • Relative Issues • uncontrolled hypertension • arrhythmias • neuromuscular, musculoskeletal, or arthritic disorders • uncontrolled metabolic disease • chronic infectious disease • other

  11. INFORMED CONSENT • Ethical and Legal purposes • States risks and ensures client understanding • Provides opportunity for questions • Protocol for testing a minor • Legal counsel of institution must OK consent form used • Consent for use of information in research

  12. OTHER ISSUES • Emergency equipment availability and trained personnel to use • Client information and confidentiality • Benefits expected from testing • Signatures and date--client, technician (doc), and witness

  13. PATIENT INSTRUCTIONS PRIOR TO TESTING • Purpose is to increase test validity and accuracy • Instructions will be dictated by test type and purpose • Generally speaking: well-rested • no food, alcohol, caffeine and tobacco 3 hours before • clothes, hydration and pretest exercise • medications--functional or diagnostic

  14. In class assignment • Develop patient instruction check list • Be creative, motivating, helpful and empathetic

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