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sounds, or S4 heart sounds during treatment may be detected and could indicate a decline in cardiac function during activity. This finding should be brought to the attention of the nurse and physician.
    6.
    Breath soul/ds: Refer to Chapter 2 for a discussion of lung
    auscultation and the interpretation of breath sounds.
    • The presence of or increase in bibasilar crackles during activity
    may be indicative of acute CHE Activity should be terminated and
    the nurse and physician notified.
    7.
    fCC rhythm: Refer to the section on ECC and the section
    Rhythm and Conduction Disturbance.
    •
    When treating pacients who are being continuously monirored
    by an ECC, it is important to know their baseline rhythm, the most
    recently observed rhythm, what lead is being monitored, and why
    they are being monitored.
    •
    It is important to recognize their normal rhythm and any deviations from this norm. It is also important ro recognize changes that could indicate a decline in cardiac status. Examples of declining
    cardiac status include the following:
    •
    Onset of ST changes (elevation or depression of more than 1
    mm) could indicate ischemia
    •
    Increased frequency of PVCs (trigeminy to bigeminy or couplets)
    •
    Unifocal PVCs to multifocal PVCs
    • Premature atrial contractions to atrial flutter or atrial fibrillation
    • Atrial flutter to atrial fibrillation
    • Any progression in heart blocks (first degree to Mobitz I)
    • Loss of pacer spike capturing (pacer spike without resultant
    QRS complex on ECC)
    • The physical therapist should also be able to recognize signs and
    symptoms of cardiac decompensation and immediately notify the
    physician if any develop (see Figure 1 - 1 0). It is important to record
    any signs noted during activity and other objective data at that

    CARDIAC SYSTF�1
    69
    time. Other signs and symptoms include weakness, fatigue, dizziness, lightheadedness, angina, palpitations, and dyspnea. It is important to record any symptoms reported by the patient and any
    objective information at that time (ECG readings; SP, HR, and
    RPP measurements; breath sounds).
    Clinical Tip
    Patients should be encouraged to report any symptom(s),
    even if they think it is trivial.
    References
    I. American Heart Association. 2001 Heart and Stroke Statistical Update.
    Dallas: American Heart Association, 2000.
    2. Moore K (cd). Clinically Oriented Anatomy (3rd ed). Baltimore: Williams & Wilkins, 1 992.
    3. Guyton AC (ed). Textbook of Medical Physiology (9th ed). Philadelphia: Saunders, 1 996.
    4. Cheitlin MD, Sokolow M, McUroy MB (eds). Clinical Cardiology (6th
    ed). Norwalk, CT: Appleton & Lange, 1 993.
    5. Braunwald E (cd). Heart Disease: A Textbook of Cardiovascular Medicine (4th cd). Philadelphia: Saunders, 1 992.
    6. Davis D (ed). How co Quickly and Accurately Master ECG Interpretation (2nd cd). Philadelphia: Lippincott, 1992.
    7. Hillis LD, Firth BG, Willerson JT (eds). Manual of Clinical Problems in
    Cardiology. Boston: Liede, Brown, 1 984.
    8. Task Force of the European Sociery of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use.
    Circulation 1 996;93: 1 043-1 065.
    9. Bernsron G, Cacioppo JT, Quigley KS. Autonomic determinism: the
    modes of autonomic control, the doctrine of autonomic space, and the
    laws of auronomic constraint. Psychol Rev 1 99 1 ;98:459-487.
    1 0. Urden LD, Davie JK, Thelan LA (eds). Essentials of Critical Care Nursing. St. Louis: Mosby, 1992.
    I I . Cohen M, Michel TH (eds). Cardiopulmonary Symptoms in Physical
    Therapy Practice. New York: Churchill Livingsrone, 1 988.
    1 2. Woods SL, Sivarajian Froelicher ES, Underhill-Motzer S (eds). Cardiac
    Nursing (4th ed). Philadelphia: Lippincorr, 2000.

    70 ACtJTE CARE HANDBOOK FOR PHYSICAL THERAI'ISTS
    1 3. Bickley LS (ed). Bare's Guide to Physical Examination and History Taking (7th ed). Philadelphia, Lippincott, 1999.
    14.