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College of Rehabilitation Sciences - Department of Physical Therapy
LIST OF CARDIORESPIRATORY CLINICAL SKILLS LEARNED IN CLASS (2016)
Adapted from the National Association for Clinical Education in Physiotherapy (2013)
Students who are involved in cardiorespiratory clinical placements are in the second year of the
program and have completed 12 weeks of clinical experience in the Neuromusculoskeletal area of
practice. This experience may range from acute in-hospital practice to community based care. The
foundational physiotherapy skills related to communication, health education, and general assessment
and treatment principles have been introduced in the first year of the program.
Assessment Techniques
Cardiorespiratory History/Lab Results
The student will demonstrate knowledge of relevant history and lab results such as those listed below
and incorporate them into assessment and treatment planning, in keeping with the practices of the
clinical setting.
1. Chart review: accurate & complete for relevant data
2. Arterial Blood Gas interpretation
3. Pulmonary Function Tests/spirometry interpretation
4. Results of cardiac/pulmonary diagnostic tests (e.g. echocardiography, ECG arrhythmias)
5. Awareness of cardiorespiratory precautions/contraindications for treatment
6. Collection of radiographic information
7. Blood work findings (e.g. WBC, Hgb, platelets, INR, PTT, Troponin, BUN, Creatinine, Albumin,
electrolytes)
8. Pharmacological implications of medications taken (e.g. ACE inhibitors, B-blockers, inhaled
agents, analgesia, PCA, anesthesia)
Subjective
The student will demonstrate knowledge and/or use of a variety of subjective assessment tools such as
those listed below, in keeping with the practices of the clinical setting.
1. CR complaints (e.g. shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, cough,
angina, syncope, nausea)
2. Pain/discomfort (e.g. angina, musculoskeletal, surgical)
3. Use of patient self-report measures (e.g. McGill pain measure, VAS, CLASP, Quality of Life
Measures, Borg Rating of Perceived Exertion)
4. Patient history (with focus on respiratory AND cardiac issues such as smoking, etc.)
5. Recent activity history
Objective: Inspection/Observation
The student will demonstrate knowledge and/or use of a variety of objective assessment measures such
as those listed below, in keeping with the practices of the clinical setting.
1. Lines and Tubes (understand implications)
2. Vital signs (e.g. heart rate, oxygen saturation, blood pressure, respiration rate, temperature)
3. Fluid Balance (understand implications)
4. Elevated jugular venous pressure (distention), reduced peripheral pulses
5. Low flow and high flow oxygen delivery systems
6. Modes and parameters of non-invasive and invasive ventilation
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Patient Assessment
1. Chest Assessment (IPPA)
• Vital Signs (e.g. heart rate, oxygen saturation, blood pressure, respiration rate)
• Inspection (e.g. cyanosis, clubbing; rate, rhythm, depth; in-drawing, accessory muscle use)
• Palpation (e.g. position of the trachea, diaphragmatic excursion, sites of chest pain/tenderness)
• Percussion (e.g. resonant, hyper-resonant, dull)
• Auscultation (e.g. vocal sound, breath sounds, adventitia)
• Cough (e.g. effective, ineffective)
• Sputum (e.g. colour, consistency)
2. EKG interpretation of common arrhythmias
3. Mobilization (independent; with supervision/assistance)
• Bed mobility
• Transfers
• Gait/Ambulatory status (with/without mobility aid; with supervision/assistance)
4. Functional Capacity Measures (6 MWT, self-paced walk, shuttle walk)
5. Balance (sitting, standing, walking)
6. Posture (affecting chest expansion)
7. Strength/Endurance (sufficient for safe mobilization)
8. Range of Motion (e.g. UE/thoracic ROM for thoracic/cardiac/abdominal surgery and COPD
9. Graded exercise testing monitoring EKG, HR, Sp02, RPE/RPD, and/or blood glucose
Analysis and Planning
The student will learn to collect and analyze assessment findings and apply these to the identification of
goals and the development of treatment plans, in keeping with the practices of the clinical setting.
• Formulate and articulate evaluation findings
• Establish short and long-term patient-centered goals
• Develop effective treatment plans
Treatment Techniques
The student will become knowledgeable about a number of treatment methods, but may only practice
some. All students should endeavour to obtain practice with a variety of treatment techniques, in
keeping with the practices of the clinical setting.
1. Mobilization (e.g. bed mobility; transfers from bed to std., chair; walking within a room; stairs;
prescription of mobility device)
2. Safe management of tubes and lines (including peripheral intravenous catheters, IVs, Foley, chest
tubes, surgical drains, endotracheal tube)
3. Oxygen titration
4. Improved ventilation / breathing exercises - may include:
• Mobilization
• Deep Breathing (e.g. thoracic expansion exercises - diaphragmatic breathing, lateral costal
breathing)
• Volume augmentation (e.g. sniffing, breath stacking, inspiratory holds)
• Facilitated Breathing / Manual Techniques (e.g. rib springing)
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5. Secretion mobilization
• Mobilization
• Active Cycle Breathing Technique (ACBT),
• Forced expiratory technique/huffing, autogenic drainage,
• Postural drainage, percussions (manual/mechanical), expiratory manual vibrations
• Devices (e.g. PEP, Flutter, acapella, VEST, etc.)
6. Secretion clearance
• Huff, cough, manual assisted cough
• Suctioning –non-intubated, with/without oral or nasal airways
• Suctioning -intubated, tracheal/stoma cough assist
Note: In-exsufflation, lung volume recruitment, inspiratory muscle training, use of breath stacking
mask are not taught until winter term (January-March)
7. Managing dyspnea
• Pursed lips breathing,
• Positioning for SOB,
• Energy conservation
8. Implement Exercise Training
• Prescription of adapted programs appropriate for special CR populations such as the critically ill,
acutely ill, chronic respiratory and cardiac patients – may include:
o Aerobic exercise prescription
o Resistance exercise
o AROM, AAROM, PROM
• Thoracic mobility: supine and sitting postural exercises
9. Discharge planning
• Referrals to community programs/agencies
• Interprofessional collaboration
Patient Education/Self- Management
1. Post-MI activity progression
2. Managing dyspnea
3. Recognizing exacerbations of COPD condition and action plan
4. Nitroglycerine self-administration
5. Smoking cessation
6. Use of bronchodilators/puffers
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REFERENCES
Required textbooks:
• American College of Sports Medicine. (2013). ACSM’S Guidelines for Exercise Testing and
Prescription (9th ed.) Lippincott.
• Frownfelter D. & Dean, E. (2012) Cardiovascular and Pulmonary Physical Therapy. (5th ed).
• Heart Attack and Back, Heart failure, Cardiac surgery patient education pamphlets –students have
each received a copy.
• Paz, JC & West, MP (2014). Acute care handbook for physical therapists (4th Ed.) Elsevier: St. Louis
Clinical practice guidelines/ reviews/position statements:
• WRHA MI management: WRHA website with MD orders, MI care map, MI teaching record,
Nitroglycerin Medication Teaching Sheet,
• CPM Position Statements : Routine Practices and Oxygen management by Physical Therapists
• Canadian Thoracic Society Pulmonary Rehabilitation
Guidelines: http://www.respiratoryguidelines.ca/sites/all/files/CTS_2013_Pulmonary_Rehab_Patie
nt_Brochure_FINAL.pdf
• Canadian Thoracic Society, COPD Action
Plan: http://www.respiratoryguidelines.ca/sites/all/files/CTS_COPD_updated_Action_Plan_editable
_PDF.pdf
• Canadian Thoracic Society , Pharmacotherapy in
COPD: http://www.respiratoryguidelines.ca/sites/all/files/cts_copd_slim_jim_2008_english.pdf
• Canadian Nurses Association, Position Statement: Tobacco: The role of health professionals in
smoking cessation joint statement: https://www.cna-aiic.ca/~/media/cna/page-content/pdfen/ps42_tobacco_role_health_prof_smoking_cessation_jan_2001_e.pdf?la=en
• Brooks, D. et al (2001). A Clinical Practice Guidelines for suctioning the airway of the intubated and
nonintubated patient Can Respirator J Vol 8(3). 163181. http://www.respiratoryguidelines.ca/sites/all/files/Suctioning_the_Airway_Guidelines_2001.p
df
• Brooks, D. et al (2002). Discharge criteria from perioperative. Chest: Vol 121; pp 488494. http://www0.sun.ac.za/Physiotherapy_ICU_algorithm/Documentation/abdominale%20chirurg
ie/References/Brooks_2002.pdf
Recommended textbook:
• Goodman, C. & Fuller, K. (2009). Pathology – Implications for the Physical Therapist. (3rd ed.)
Saunders.
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