Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
90 Cards in this Set
- Front
- Back
|
HEart tissues (4)
|
pericardium- fibrous protective sac enclosing heart
epicardium- inner layer of pericardium myocardium- heart muscle endocardium- smooth lining of inner surface and heart cavities |
|
|
Right Atrium
|
receives blood from systemic circulation vis inf and sup vena cava and sends to RV during systole
|
|
|
right ventricle
|
pumps blood via pulm artery to lungs
|
|
|
left atrium
|
receives oxygenated blood from lungs (pulm veins); sends blood to left ventricle during systole
|
|
|
left ventricle
|
pumps blood via aorta through entire body. walls thicker and stronger than RV. high-pressure
|
|
|
Blood flow
|
systemic circulation to RA to RV then to lungs for oxygenation. Lungs to LA to LV then to body via aorta
|
|
|
heart valves
|
mitral (bicuspid)- between LA and LV
tricuspid- between RA and RV prevent backflow of blood |
|
|
SA node
|
main pacemaker of the heart. initiates sinus rhythm. Affects HR and strength of contraction
|
|
|
AV node
|
sympathetic and parasympathetic innervation. merges with bundle of His
|
|
|
Purkinje tissue
|
specialized conducting tissue of the ventricles
|
|
|
Conduction of heart beat
|
-impulse originates in SA node and spreads throughout both atria which contract together
-impulse stimulates AV node, transmitted down bundle of His to perkinje fibers -impulse spreads throughout ventricles which contract together |
|
|
arteries vs veins
|
Arteries transport oxygenated blood
veins transport deoxygenated blood back to heart |
|
|
baroreceptors and chemoreceptors
|
baroreceptors are main mechanism of controlling HR. Respond to changes in BP.
Chemoreceptors sensitive to changes in blood chemicals |
|
|
Coronary Artery disease
|
Atherosclerosis (thickening of blood vessel wall from accumulating lipids)
good prognosis with early detection angina pectoris, MI, CHF |
|
|
Angina pectoris
|
clinical manifestation of ischemia
*characterized by mild to mod chest pain -less than 20 min -imbalance in o2 supply d/t inc. demands on heart; exercise, stress, or vasospasm -stable-relieved with rest or nitro -unstable- risk for MI or sudden death. rest doesn't help |
|
|
Myocardial Infarction
|
prolonged ischemia, injury, and death of myocardium caused by occlusion of 1 or more coronary arteries resulting in necrosis of heart tissue
-transmural or non-transmural -inferior, lateral, or anterior |
|
|
Presenting signs and symptoms of heart attack
|
-severe substernal pain more than 20 min which may radiate to neck, jaw, arm
-dyspnea, rapid respiration, SOB -indigestion, nausea, vomiting -pain unrelieved by rest and/or nitro |
|
|
Congestive Heart Failure
|
-heart is unable to maintain adequate circulation
-may be caused by any cardiac issues -dec cardiac output -elevated end diastolic pressures (preload) inc heart rate -left or right heart failure |
|
|
Left heart failure
|
blood not adequately pumped into systemic circulation d/t inability of LV to pump blood out of lungs
-dyspnea (esp at night and in supine) -coughing, wheezing -weakness, fatigue -tachycardia -chest pain -confusion |
|
|
Right heart failure
|
blood not adequately returned from systemic circulation to heart d/t failure of RV
-edema, weight gain -nausea, anorexia -change in heart sounds -distention of jugular veins |
|
|
Classification of heart disease
|
AHA classifies according to patient's activity level based on METs (metabolic equivalent)
-basal metabolic rate= 3.5 mL of O2 per kilogram of body weight per minute -as person can perform same activity at lower pulse rate, they can be reclassified |
|
|
Heart Disease Class I
|
-heart disease. no limits to activity. no complaints
-Max MET 6.5 |
|
|
Heart dis Class II
|
Slight activity limit. comfort at rest. ordinary activity results in fatigue, pain, dyspnea, palpations
-Max MET 4.5 |
|
|
Heart disease Class III
|
marked limitation. comfort at rest. less than ordinary activity-fatigue, angina, palpations, dyspnea
-Max MET 3.0 |
|
|
Heart disease class IV
|
inability to do physical activity without discomfort. cardiac insufficiency.
-Max MET 1.5 |
|
|
Heart drugs
|
1. nitrates/ACE inhibitors- vasodilation. decrease preload
2. Beta blockers- reduce BP, HR 3. Calcium channel blocker- inhibit Ca, dec HR 4. Antiarrhythmics. 5. Antihypertensives 6. Digitals- treat CHF 7. Diuretics 8. Antithrombitics 9. Tranquilizers 10. Hypolipidemic agents 11. Anticoagulants |
|
|
angioplasty
|
-surgical dilation of blood vessel using small balloon-tipped catheter
-inserted through femoral artery -relieves obstructed blood flow in acute angina or acute MI -improves coronary blood flow, angina |
|
|
Intravascular stents
|
-pliable wire mesh to prevent occlusion in coronary or peripheral arteries
|
|
|
Revascularization surgery
|
-surgical circumvention of obstruction in a coronary artery using an anastomosing graft
-may need multiple grafts -improve blood flow but surgery results in deconditioning |
|
|
Transplantation
|
used in end-stage disease
-heterotopic: leaving natural heart and piggy-backing donor heart -Orthotopic: removing diseased heart and replacing with donor -HEart and lung transplant: replace both -problems with rejection, infection |
|
|
Ventricular Assistive Devices (VADs)
|
-implanted device (pump) to improve tissue perfusion and maintain circulation
-bridge to transplantation |
|
|
Arteriosclerosis Obliterans
|
-chronic, occlusive arterial disease of medium and large vessels
-associated with HTN, hyperlipidemia, CAD, diabetes -affects lower extremities |
|
|
Thromboangiitis obliterans (Buergers disease)
|
chronic inflammatory vascular occlusive disease
-most common in young males who smoke -begins distally and progresses proximally -pain, parasthesias, cold extremities, fatigue |
|
|
Diabetic angiopathy
|
inappropriate elevation of glucose levels and accelerated atherosclerosis
ulcers may lead to gangrene and amputation |
|
|
muscles of forced expiration
|
quadratus lumborum
intercostals rectus abdominis triangular sterni |
|
|
aspiration pneumonia
|
aspired material causes an acute inflammatory reaction with the lungs; usually found in patients with impaired swallowing (dysphagia)
|
|
|
pneumocystis carinii pneumonia
|
pulmonary infection caused by protozoa in immunocompromised hosts, most often post transplants and in people with HIV
|
|
|
Tuberculosis
|
airborn infection
-medical tx includes drug therapy -people with weakened immune systems may have to take longer (INH) -side effects of drug therapies: no appetite, nausea, vomiting. jaundice, fever, abdominal pain, tingling in fingers or toes, easy bruising, blurred vision, tinnitis (hearing loss) |
|
|
Risk factors for TB
|
-person with TB of the throat or chest can pass by sneezing or coughing
-people living with carriers are most at risk -weakened immune systems d/t: HIV, substance abuse, diabetes, scoliosis, cancer, kidney dis, low weight -people who have had TB within the last 2 years -babies and elderly -IV drug users |
|
|
TB infection
|
people who become infected and able to fight infection -no symptoms
-not contagious -usually have a positive TB test -can develop full blown TB if not treated |
|
|
Signs and symptoms of TB
|
-bad cough for more than 2 weeks
-chest pain -blood tinged sputum or phlegm -weakness or fatigue -weight loss -loss of appetite -chills/fever -night sweats |
|
|
Sequelae of TB
|
once infection settles into a person's lungs it can spread to other parts of the body
-kidney dysfunction -rood's disease in spine -spinal lesions -lesions in the brain |
|
|
COPD
|
disorder characterized by poor expiratory flow rates
-peripheral airway disease -chronic bronchitis -emphysema |
|
|
Peripheral airways disease
|
inflammation of distal conducting airways. Associated with smoking
|
|
|
Chronic bronchitis
|
chronic inflammation of the tracheobronchial tree with cough and sputum production lasting at least 3 months for 2 consecutive years
|
|
|
Emphysema
|
permanent abnormal enlargement and destruction of air spaces distal to terminal bronchioles
-leads to loss of lung parenchyma -results in airway dilation, premature airway closure, air trapping, hyperinflation |
|
|
Signs and symptoms of emphysema
|
-dyspnea on exertion
-diminished breath sounds, wheezing -prolonged expiratory phase -pursed lip breathing -enlarged dimensions of chest wall -chronic cough and sputum production -signs of right heart failure toward end |
|
|
Interventions for emphysema (COPD)
|
-smoking cessation
-short-acting and long acting bronchodilators -anticholinergic drugs -corticosteroids -flu and pneumonia vaccines -oxygen therapy |
|
|
Common angina and dyspnea rating scales
|
5 point scales with 0 as none and 5 as most difficulty/pain
10 point scales with 0 as nothing, 10 as severe dyspnea Borg scale for rating perceived exertion: 0 as no exertion to 20 as maximal |
|
|
OT Cardiopulmonary Assessment
|
-review medical record
-interview -symptoms: pain, dyspnea, fatigue, palpitation, dizziness, edema -past medical history -diagnostic tests -social history -discharge environment/anticipated level of activity |
|
|
Normal cardio values for infants and adults
|
Heart rate: infant 120 bpm, adult 60-80 bpm
BP: infant 75/50 adult 120/80 RR: infant 40 br/min adult 12-18 br/min |
|
|
pediatric HR range
|
120. Range 70-170
|
|
|
Hypertension
|
BP above 120/80
|
|
|
diaphoresis
|
excessive sweating associated with decreased cardiac output
|
|
|
Pallor
|
absence of rosy color in light skinned people associated with decreased peripheral blood flow, PVD
|
|
|
Rubor
|
dependent redness with PVD
|
|
|
Skin changes in pulmonary dysfunction
|
clubbing of fingernails, pale, shiny, dry, abnormal pigmentation, ulceration, dermatitis, gangrene
intermittent claudation: pain, cramping, fatigue during exercise relieved by rest. Typically in calf |
|
|
MET (metabolic equivalent) Stage 1
|
1.0-1.4 MET
-ADL/mob: sitting, self-feeding, wash hands and face, bed mob, inc sitting tolerance -exercise: supine A or AA to all extremities. Sitting A or AA exer to UE and LE Recreation: reading, radio, table games, light handwork |
|
|
MET stage II
|
1.4-2.0 MET
-ADL/mob: sitting, self-bathing, shaving, grooming, unlimited sitting, amb at slow pace in room -Exercise: sitting A ex to all extremities. No isometrics. -Recreation: seated crafts painting, sewing, no isometrics |
|
|
MET Stage III
|
2.0-3.0 MET
-ADL/mob: sitting shower in warm water, homemaking tasks w/ brief standing periods -exercise: seated wc mobility for limited distance. Standing A ex to all extremities and trunk, prog. increase. Balance and light mat activity. Progressive ambulation at 0 grade and comfortable pace. -recreation: seated card playing, crafts, piano, typing |
|
|
MET Stage IV
|
3.0-3.5 MET
-ADL/mob: standing shower, standing kitchen activity w/ energy conservation. Unlimited ambulation with 0 grade -exercise: continue previous standing exercise w/ progression. Balance activity w/ mild resistance. Begin slow stair climbing and cycling without resistance. -recreation: canoeing, golf putting, light gardening, driving |
|
|
MET Stage V
|
3.5-4.0 MET
-ADL/mob: stand washing dishes, wash clothes, iron, make bed -Exercise: progressive standing ex. Increasing speed of ambulation at 0 grade. 1.4 mph at 2% on treadmill. 7-10 lb of weight for UE and LE exercise. -Recreation: slow swimming, golfing, light home repair |
|
|
MET Stage V
|
-ADL/mob: Standing shower , mopping
-exercise: increase speed and grade -recreation: swimming, slow dancing, skating, volleyball, table tennis |
|
|
Occupations for 1.5-2.0 MET
|
desk work
driving typing |
|
|
Occupations for 2-3 MET
|
auto repair
radio, TV repair janitorial work typing bartending |
|
|
Occupations for 3-4 MET
|
brick laying
wheelbarrow machine assembly trailer-truck in traffic welding cleaning windows |
|
|
Occupations for 4-5 MET
|
painting, masonry
paper hanging light carpentry |
|
|
Occupations for 5-6 MET
|
digging garden
shoveling light earth |
|
|
Occupations for 6-7 MET
|
shoveling 10 min
|
|
|
Occupations for 7-8 MET
|
digging ditches
carrying 175 lb sawing hardwood |
|
|
Occupations for 8-9 MET, 10+ MET
|
shoveling 10 min
|
|
|
Eval and intervention for cardiopulmonary rehab during inpatient hospitalization
|
-initiate at bedside with monitored, functional assessment of self care and mobility
-if pt. is pain free, no arrhythmia, has regular pulse of 100 or less, initiate activity program -intense monitoring during activity |
|
|
Observing contraindications/precautions for cardiopulmonary rehab-OT
|
-monitor for SOB, chest pain, nausea, vomiting, fatigue
-adhere to activity guidelines and MET levels -watch for dec in systolic BP >20 mm/Hg -be alert to facial changes, expression -monitor HR -Monitor BP -O2 below 86% for pulmonary pt's, 90% for cardiac pt -monitor ECG for signs and symptoms of MCI -avoid isometrics -avoid overhead exercise or holding UEs above head for extended periods -avoid lateral arm mvmts or exercise that stretch lateral chest and pull incisions |
|
|
Ideal heart rates for Cardiopulmonary rehab
|
High risk pt: max 100 very light activity
<6 wks after MI/surgery: Max 120 light activity Recent bypass/CHF/cardiomyopathy: Max 130 Treadmill test: Target 60-80% pt's max HR |
|
|
Clicinal signs or diagnoses for which therapy should be stopped or contraindicated
|
-uncontrolled arrhythmias
-recent emolism, thrombophlebitis -dissecting aneurysm -severe aortic stenosis -acute systemic illness -acute MI -digoxin toxicity -acute hypoglycemia/metabolic disorder -3rd degree heart block -unstable angina |
|
|
Program focus for outpatient cardiopulmonary rehab
|
- begins when pt can carry out activity at MET level 3.5
-educate pt on importance of continued exercise - build up activity tolerance -improve IADL, community task -support smoking cessation and lifestyle changes |
|
|
Eval and intervention for outpatient cardiopulmonary rehab
|
-home eval
-consumer and family education -graded exercise program with increase of weight -begin with MET level 4.5 -resume sex at 5-6 MET level -practice functional activities in home -energy conservation -community activities -worksite eval |
|
|
Intervention during maintenance/training stage post cardiopulmonary rehab
|
-attend sessions once a week
-intervention as necessary for work, IADL, leisure -maintenance gym program |
|
|
Cystic fibrosis etiology and diagnosis
|
-genetically inherited recessive trait. both parents carriers
-chronic progressive lung disease, salt in the sweat -failure to grow properly -reduced life expectancy (26 yrs) -cardiac complications -5-10% have intestinal blockage -small percent of diabetes, cirrhosis |
|
|
Medical management of CF
|
-aerosol mist
-chest PT to loosen secretions -supplements and antibiotics **lead to exercise intolerance, poor nutrition |
|
|
OT eval for cystic fibrosis
|
-assess developmental delays d/t dec strength, endurance, and dec attention d/t pain
-determine equipment/assess environment -assess psychosocial status: family stress, fatigue, emotional stress |
|
|
OT intervention for cystic fibrosis
|
-energy conservation
-environmental adaptation to enhance performance -positioning to provide postural drainage -neurodevelopmental tx to improve endurance, posture -fine, gross, visual, cognitive development -parent education for treatment protocol and advocacy -observe respiratory/cardiac precautions |
|
|
Respiratory Distress syndrome (RDS) etiology and diagnosis
|
-insufficient production of surfactant d/t premature birth
-lung collapse after each breath -mom is treated 24 hrs before birth to stimulate surfactant production |
|
|
Medical management for RDS
|
-Mild: supplemental O2, CPAP
-Severe: intubation, vent -single dose of surfactant replacement |
|
|
Complications from RDS and effect on function
|
-risk of severe intracranial hemorrhage
-risk of bronchopulmonary dysplagia -risk of developmental delay -future intellectual development may be good -motor, sensory, cognitive, or language impairment from ICH -visual effects and hypotonia |
|
|
OT eval and intervention for RDS
|
eval: assess developmental delays and environment
Tx: -monitor development -facilitate sensori-motor and cognitive development -address psychosocial issues -parent education re handling, energy conservation -Adapt environment -observe medical precautions -refer to ophthalmologist, etc as needed |
|
|
Bronchopulmonary dysplagia (BPD) etiology and diagnosis
|
respiratory disorder often as a result of barotrauma
(infection, meconium aspiration, etc) -complication of prematurity -walls of immature lungs thicken, airway reduced -infants work harder than normal to obtain sufficient O2 |
|
|
Medical management/Complications of BPD
|
-months or years of O2 therapy and artificial ventilation!
-greater risk for hypotonia, develop. delay -feeding problems, brittle bones -brain damage -hearing loss |
|
|
BPD effect on function
|
-poor autonomic and sensory state regulation
-poor exercise/activity tolerance -reduced ability to socialize d/t illness and risk of infection -isolation and stress on child -risk for attachment disorder d/t dependence on technological equipment |
|
|
OT eval and intervention for BPD
|
eval:
-assess for developmental delays -assess environment for needed adaptation Intervention: -facilitate sensori-motor and cognitve development -address psychosocial issues that arise -adapt environment -parent education re feeding, handling -parent advocacy -observe all medical precautions |
