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98 Cards in this Set
- Front
- Back
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coronary artery disease
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artherosclerotic dz.
narrows coronary arteries, results in ischemia to myocardium atherosclerosis MI angina pectoris CHF |
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Anigna pectoris
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ischemia presnting with mild to moderate chest pains (mainly chest and left arm. can radiate anywhere icluding neck and jaw)
can be stable or unstable |
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myocardial infarction
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prolonged ischemia and death of myocaridum
substernal pain for more than 20 mins dyspnea indigestion, nausea, vomitting unrelieved by restnitroglycerine |
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congestive heart failure
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body unable to maintain adaquate blood circulation
results: decreased cardiac output, elevated end diastolic pressures, increased HR, impaired ventriuclar contractility |
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left heart failure- CHF
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decreased cardiac output (let heart pumps blood to body).
Sx: dyspnea coughing weakness/fatigue tachycardia chest pain |
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orthopnea
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dyspnea that occurs lying flat
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right hear failure: CHF
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blood not adaquately returned from body to heart
Sx: peripheral edema nausea, anorexia change in heart sounds |
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How is heart disease classified by the American Heart Association?
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according to pt.'s activity level.
Based on METs Classes I - !V 4 is most affected |
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Basal metabolic rate
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3.5 ml of O2 per Kg body weight per min
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Class I
Heart dz. |
Heart dz. with no complaints
No activity limits Max MET = 6.5 |
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Class II
Heart dz. |
slight activity limit
comfort at rest ordinary activities result in fatigue, pain dyspnea, and palpitations Max MET = 4.5 |
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Class III
Heart dz. |
Marked limitation
comfort at rest less than ordinary activity fatigue, palpitations, dyspnea, angina pain Max MET 3.0 |
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Class IV
Heart dz. |
inability to carry out physical activity without discomfort
symptoms of heart failure appear at rest increased discomfort with any activity Max MET 1.5 |
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what is the indicator that a person can be reclassified in terms of heart disease
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performance of the same activity at a lower HR
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Signs of right-sided heart failure
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nausea
anorexia weight gain ascites right upper-quadrant pain increase in right atrial pressure of central venous pressure jugular venous distention +hepatojugular reflex right ventricular heave murmur of tricuspid insufficency hepatomegaly peripheral edema |
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Signs of left-sided heart failure
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fatigue
cough SOB DOE orthopnea PND diaphoresis tachycarida S3 gallop crackles confusion decreased urine output murmur of mitral insufficency |
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angioplasty
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surgical dilation of a blood vessel - uses small balloon tipped catheter
inseted through femoral A. removes obstructed blood flow in acute angina or actue MI results: improved coronary blood flow and left ventricular function |
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intravascular stents
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wire mesh implant s/p angioplasty to prevent restenosis /occlusion of arteries
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revascularization surgery
CABG |
surgical circumvention of an obsruction
improves coronary blood flow surgery results in deconditioning |
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transplantation
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end stage myocardial dz.
complications: infection, rejection, complicatioons of immunosuppresants |
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Thrombolytic therapy
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s/p acute MI
dissolves clot |
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Peripheral vascular dz.
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arterial or venous types
arterial: areteriosclerosis obliterans, thromboangitis obliterna, diabetic angiopathy venous dz.'s: varicose veins DVT chronic venous insufficeny lymphedema Raynauds |
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DVT
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inflammation of vein in association with thrombus
usually in LE contributing factor or complication of CVA or prolonged bed rest Sx: changes in LE temp and color, tenderness, pain |
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lymphedema
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excessive accumulation of fluid 2/2 obstruction of lymphatics
swelling of soft tissues in arms and legs |
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Raynauds phenomenon
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abnormal vasoconstriction reflex
exacerbated by exposure to cold or emotional stress |
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what are the primary muscles of inspiration
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diaphragm
intercostals |
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Chronic obsructive pulmonary dz.
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COPD
characterized by poor expiratoy flow rates -peripheral airways disease -chronic bronchitis -emphysema |
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Peripheral airway dz
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inflammation of distal conducting airways
associated wih smoking |
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Chronic bronchitis
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chronic inflammation of tracheobronchial tree
cough and sputum porduction lasting at least 3 mos for 2 consecutive years |
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emphysema
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abbnormal enlargement and destruction of air spaces distal to terminal bronchioles
may cause destruction of functional gas exchange units of lungs loss of recoil during exhalation and normal airway resistance during inspiration air trapping, premature airway closure |
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asthma
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increased reactivity of trachea and bronchi to various stimuli
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5 grade angina rating scale
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0 = no angina
1 = light, barely noticable 2 = moderate, bothersome 3 = severe, very uncomfortable 4 = most pain ever experienced |
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5 grade dyspnea scale
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0 = no dyspnea
1 = mild, noticable 2 = mild, some difficulty 3 = moderate difficulty, but can continue 4 = severe difficulty, cannot continue |
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10 grade angina/dyspnea scale
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0 = nothing
0.5 = very, very slight 1 = very slight 2 = slight 3 = moderate 4 = somewhat severe 5 = severe 6 = 7 = very severe 8 9 10 = very, very severe, maximal |
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caludication
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pain/discomfort in legs during walking; cramping
can be caused by poor circulation |
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intermittent claudication rating scale
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0 = no claudication pain
1 = initial, minimal pain 2 = moderate, bothersome pain 3 = intense pain 4 = maximal pain, cannot continue |
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Cardiopulmonary assessment
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Check for presenting Sx:
1. pain/angina (location, severity, type) 2. dyspnea severity, position, times 3. fatigue/percieved exertion (note severity, time, association with activities) 4. palpitations - note awareness of pounding, fluttering, racing, skipped beats 5. dizziness 6. edema(note location, measurements, time of day, resolution with activity) Include list of current meds |
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Borg scale of perceived extertion
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15 grade scale
6: no extertion at all 7 = extrememly light 8 9 = very light, little or no effort 10 11 = light 12 TARGET RANGE OF HOW YOU SHOULD FEEL WHILE EXERCISING 13 = somewhat hard 14 15 = hard (heavy) 16 17 = very hard (hardest work ever) 18 19 = extremely hard 20 = maximal exertion |
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Norm heart rate
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infant = 120 bpm
adult = 60-80 bpm |
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norm BP
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infant = 75/50
adult = 120/80 |
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norm RR
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infant = 40 br/min
adult 12-18 br/min |
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bacterial pneumonia
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intra-alveolar bacterial infection
gram positive = community accquired gram negative = usually in person w/chronic condition |
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pneumonia types
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bacterial PNA
viral PNA aspiration PNA TB pneumocystis Carinii PNA (in immunocompromised) |
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viral PNA
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affects alevoli
caused by viral agents |
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aspiration PNA
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aspirated material causes acute inflammatory reaction in lungs
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Tuberculosis
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airborne infection caused by bacterium
risk factors: -close contact with infected individual -immunocompromised -babies, children, elderly -people who have previously been infected |
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Sequelae of TB
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kidney dysfunction
Rood's dz: vertebral collapse >>compression of spinal cord -spinal lesions can occur w/motor, sensory, and bladder deficits lesions in brain can produce stroke-like Sx |
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chronic restrictive pulmonary diseases
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difficulty expanding lungs >> reduction in lung volumes
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pulmonary edema
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seepage of fluid from pulmonary vascular system into interstitial space
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importance of vital signs
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indicator of activity tolerance
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heart rate and age
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as an individual ages, resting HR may increase up to 100 BPM
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bradycardia
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< 60 BPM
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tachycardia
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>100 BPM
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normal BP range
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120/80
systolic norms = 110-140 diastolic norms = 60-80 |
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increased BP may be caused by...
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stress
pain hypoxia drugs disease |
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decreased BP may be caused by
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bed rest
drugs arhythmias blood loss/shock MI |
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hypertension
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BP above 120/80
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diaphoresis
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excessive sweating associated with decreased cardiac output
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When evaluating a cardiopulmonary pt., what 6 presenting Sx should you assess?
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1. pain/angina
2. dyspnea 3, fatigue/percieved exertion 4. palpitations 5. dizziness 6. edema |
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5 methods of assessing activity tolerance
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1. graded exercise test (done by PT or exercise phys)
2. observation of activities while monitoring vitals 3. monitor for dyspnea, angina, claudication pain 4. periodic monitoring of exertion (Borg scale) 5. Metabolic equivalent levels |
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Cardiopulmonary Stage I ADL
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1.0-1.4 MET
Sitting: self feeding, wash hands/face, bed mobility transfers progressively increase sitting tolerance |
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Cardiopulmonary Stage II ADL
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1.4 - 2.0 METS
Sitting: self-bathing, shaving, grooming, dressing in hospital unlimited sitting in room mobility, slow pace |
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Cardiopulmonary stage III ADL
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sitting: shower in warm water, light home-making with brief stadning
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Cardiopulmonary stage IV ADL
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3.0-3.5 MET
Standing: total ADL, washing w/ warm water, dressing; light homemaking with ECONS unlimited distance walking |
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Cardiopulmonary stage V ADL
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3-5-4.0 MET
Standing: washing dishes, washing clothes, making beds, hanging light clothes |
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Cardiopulmonary stage VI ADL
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standing: showering in hot water
mopping, raking, wringing clothes |
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When do you initiate an activity program with a person in stage I of cardiopulmonary rehab?
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Pain free
no arrhythmia pulse rate <100BPM intensely monitor during activity |
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Program focus for phase I of cardiac rehab
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this is inpatient rehab/hospitalization
-begins when medically stable - Econs/work simplification - increase knowledge of metabolic costs -self care and low level functional activity - decrease anxiety - support lifestyle change |
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Activities for MET level 1-2
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(phase 1 cardiopulm rehab)
-bed mobility -static stand -transfer bed to chair/commode - bed level bathing/feeding, grooming seated at sink - AROM/ warm up exercises - w/c mobility and in-room ambulation |
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Energy conservation and work simplification techniques
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self-pacing
monitor body position during activity organize daily activities and work areas delegate responsibilities |
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abdominal diaphragmatic breathing
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strengthen diaphragm, decrease need for neck and shoulder muscles in WOB, decreases energy required for activity
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pursed lip breathing
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controls RR
decreases rate of breathing helps move trapped air from lungs |
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breathing exercises
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during all exercises and activities
abdominal diaphragmatic breathing pursed lip breathing |
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when do you monitor vital signs
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prior to activity
at peak of activity immediately upon cessation of activity 4-5 mins following activity |
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when do you monitor exertion scales?
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prior to each activity
at peak of each activity 30 seconds before cessation immediately upon cessation 3-5 mins post activity |
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What is the target range for exercise/activity on the Borg scale
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12 = target range for exercise/activity
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What does a 6 indicate on the borg scale?
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no exertion at all
relaxed as lying in bed |
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what does a 9 indicate on the borg scale?
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very light exertion
little to no effort |
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what does a 17 indicate on the borg scale?
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very hard
how you feel with the hardest work you've ever done |
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what does a 20 indicate on the borg scale
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maximal exertion
don't work this hard |
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during activity, monitor cardiopulmonary pts for...
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SOB
nausea chest pains dizziness fatigue |
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What change in BP is considered significant enough to cease activity
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decrease in systolic greater than 20 mm/Hg
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Guidelines for Max heart rate
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-use facility guidelines
With activity: very high risk pt's = 100 BPM 6 wks s/p MI surgery = 120 with light activity recent bypass surgery, cardiomyopathy, or CHF = max HR 130 |
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guidelines for O2 Sat, cardiac and pulmonary pts.
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pulmonary pts = below 86%
cardiac pts = below 90% |
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Precautions for cardiopulmonary pts
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- avoid isometric muscle work, straining, breath holding
-avoid overhead exercise or holding UEs overhead for extended period of time - If there is a chest incision, avoid lateral arm movements and exercises that stretch/pull incision |
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Signs therapy should be stopped or contraindications
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-uncontrolled atrial/ventricular arrhythmias
-recent embolism/thrombophlebitis -dissecting aneurysm -severe aortic stenosis -acute MI -digoxin toxicity -acute hypoglycemia/metabolic disorder -3rd degree heat block -unstable angina |
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When can a pt. be discharged to stage II of cardiopulmonary rehab?
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when they can carry out activities at MET level 3.5
(ADL/light ADL in standing with econs strategies; unlimited walking) |
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Phase 2 of cariopulmonary rehab
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outpatient rehab/ convalesence phase
-educate pt. on importance of continued exercise -improve IADL, community, and work function -home eval -HEP w/ slow and gradual increase of weight |
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What MET level should you begin with in phase 2 of cardiac rehab?
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4-5 MET
(IADLs like washing dishes, making beds, light gardening, swimming, shower in hot water) |
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What MET indicates resumption of sexual activity
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5-6 METs
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What is phase 3 of cardiopulmonary rehab?
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Maintenance/training phase
-attend maintenance/training sessions -individual exercise programs with weight training and cardiovascular training |
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cardiac rehab, 0-2 wks
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inpatient phase
hospital clinical pathway |
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cardiac rehab, 2-5 wks
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transitional care (subacute facility)
or homecare or oupatient (up to 7 weeks) |
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cardiac rehab, 5 wks and beyond
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maintenance, lifelong
community facility or at home |
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OT eval of cystic fibrosis
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-Developmental delays?
(2/2 decreased endurance/strength and decreased attention 2/2 pain) -Econs -equipment needs -psychosocial (school absences/hospitalization, social isolation) |
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cystic fibrosis, OT intervention
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- econs
-environmental adaptations - positioning to promote postural drainage (abnormal secretions) -NDT to improve endurance and postural stability -fine/gross motor, visual motor, cognitive development -parent education (including advocacy) |
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respiratory distress syndrome
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insufficient production of surfacant to keep alveoli (air pockets in lungs) open
-assess fro developmental delays -assess the environment |
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bronchopulmonary dysplasia
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respiratory disorder as result of barotrauma (complication of prematurity)
-high inflating pressures -infection -meconium aspiration -asphyxia must work harder to obtain sufficent O2 for survival complications: hypotonia & gross motor delays feeding problems CNS delays conductive hearing loss |
