Chapters 8 & 9 Disorders

Front 1

ATHEROSCLEROSIS

Back 1

Disease process that narrows the lumen of the coronary arteriesresulting in schemia to the myocardium

Etiology: Thickening of the blood vessel wall from the accumulation of lipids

Risk increases with age and presence of risk factors

Risk factors: Cigarette smoking, high BP, elevated cholesterol levels, inactivity, diabetes, obesity, stress

Front 2

ANGINA PECTORIS

Back 2

Clinical manifestation of ischemia characterized by mild to moderate substernal chest pain/discomfort
Usually lasts less than 20 minutes
Represents imbalance in myocardial oxygen supply and demand

Front 3

STABLE ANGINA

Back 3

Classic exertional angina; relieved with rest and/or sublingual nitroglycerin

Front 4

UNSTABLE ANGINA

Back 4

(preinfarction, crescendo angina): Coronary insufficiency with risk for myocardial infarction or sudden death; pain is difficult to control; presents with low level activity or rest

Front 5

MYOCARDIAL INFARTION

Back 5

Prolonged ischemia, injury and death of an area of the myocardium caused by occlusion of one or more of the coronary arteries

Precipitating factors: Atherosclerotic heart disease with thrombus formation, coronary vasospasm or embolism, cocaine toxicity

Symptomology/presenting sings and symptoms:
1. Severe substernal pain of more than 20 minutes
2. Dyspnea, rapid respiration
3. Indegestion, nausea and vomiting
4. Pain may be misinterpret as indigestion
5. Pain unrelieved by rest and/or sublingual nitroglycerin

Front 6

CONGESTIVE HEART FAILURE (CHF)

Back 6

Cardiac failure; heart is unable tomaintain adequate circulation of the blood to meet the metabolic needs of the body

Etiology: CAD, valvular disease, congenital heart disease, HTN, infections

Abnormalities: Decreased cardiac output, elevated end diastolic pressures (preload), increased heart rate; impaired ventricular contractility

Front 7

LEFT HEART FAILURE

Back 7

Blood is not adequately pumped into systemic circulation due to in inability of the LV to pump blood out of the lungs

1. Dyspnea, day and night
2. Cough, rales, wheezing
3. Tachycardia, change in heart sounds
4. Chest Pain
5. Nasea
6. Weight gain / anorexia

Front 8

RIGHT HEART FAILURE

Back 8

Blood is not adequately returned from the systemic circulation to the heart; due to failure of right ventricle, increased pulmonary artery pressures

1. Peripheral edema: weight gain, dependent, edema, venous statis
2. Nausea, anorexia
3. Change in heart sounds
4. Fatigue
5. Cough, shortness of breath

Front 9

CLASS 1 - HEART DISEASE CLASSIFICATION

Back 9

Heart disease, no limits to activities; no complaints
Max MET: 6.5

Front 10

CLASS 2 - HEART DISEASE CLASSIFICATION

Back 10

Slight activity limit; comfort at rest; ordinary activity, results in fatigue, pain, dyspnea, palpitations
Max MET: 4.5

Front 11

CLASS 3 - HEART DISEASE CLASSIFICATION

Back 11

Marked limitations; comfort at rest; less than ordinary activity - fatigue, palpitations, dyspnea, and angina pain
Max MET: 3.0

Front 12

CLASS 4 - HEART DISEASE CLASSIFCATION

Back 12

Inability to carry out physical activity without discomfort; see symptoms of cardiac insufficiency present at rest; increased discomfort with any activity
Max MET 1.5

Front 13

ARTERIOSCLEROSIS OBLITERANS

Back 13

Peripheral Vascular Disease - Arterial Disease
Chronic, occlusive arterial disease of medium and large-sized vessels
Associated with hpyertension, hyperlipidemia, CAD, and diabetes
Affects primarily lower extremities

Front 14

THROMBOANGIITIS OBLITERANS (BERGER'S DISEASE)

Back 14

Peripheral Vascular Disease - Arterial Disease
Chronic inflammatory vascular occlusive disease
Most common in young males who smoke
Begins distally and progresses proximally in both lower and upper extremities
Symptoms include: pain, paresthesias, cold extremities, diminished temperature sensation, fatigue, risk of ulceration and gangerene

Front 15

DIABETIC ANGIOPATHY

Back 15

Peripheral Vascular Disease - Arterial Disease
Inappropriate elevation of blood glucose levels and accerlerated artherosclerosis; neuropathies is a a major problem; ulcers may lead to gangrene and apmutation

Front 16

DEEP VEIN THROMBOSIS (DVT)

Back 16

Peripheral Vascular Disease - Venous Disease
Inflammation of a vein in assiciation with the formation of a thrombis; usually occurs in LE
1. May be a contributing factor to or a complication of CVA or the result of prolonged bed rest during serious illness
2. Signs and symptoms inclde a change in LE temperature, color circumference, appearence, or tenderness/pain. These require immediate medical attention

Front 17

LYMPHATIC DISEASE (LYMPHEDEMA)

Back 17

Peripheral Vascular Disease - Venous Disease
Excessive accumulation of fluid due to onstruction of lymphatics; causes swelling of soft tissues in arms and legs

Front 18

RAYNAUD'S PHENOMENON

Back 18

Abnormal vasoconstriction reflex exacerbated by exposure to cold or emotional stress; affects largely females

Front 19

TUBERCULOSIS

Back 19

Etiology: An airborne infection caused by bacteruim

Symptoms:
A bad cough for more than 2 weeks
Chest pain
Blood tinged sputum or phlegm
Weight loss
Loss of appetite
Chills/fever
Night sweats

Front 20

PERIPHERAL AIRWAY DISEASE

Back 20

Type of COPD
Inflammation of the distal conducting airways

Front 21

CHRONIC BRONCHITIS

Back 21

Chronic inflammation of the tracheobronchial tree with cough and sputum production lasting at least 3 months for 2 consecutive years

Front 22

EMPHYSEMA

Back 22

Permanent Abnormal enlargement and destruction of air spaces distal to terminal bronchioles; may result in destruction of the functional units for gas exchange (acini)

Etiology: Imbalance in enzymes causing tissue breakdown

Front 23

COPD SIGNS/SYMPTOMS

Back 23

1. Primary complaint of dyspnea on exertion
2. Dimished breath sounds, wheezing
3. Prolonged expiratory phase
4. Barrel chest, hypertrophied accessory muscles, forward leaning posture
5. Presence of a chronic cough and sputum production will vary depending upon hx of infection
6. Disease advancement may result in patient becoming cachercic (emaciated), sings of right heart failure due to secondary pulmonary hypertension

Front 24

ASTHMA

Back 24

An increased reactivity of the trachea and bronchi to various stimuli

Signs and symptoms:
1. wheezing
2. dyspnea
3. chest pain
4. facial distress
5. non-productive cough

Front 25

CHRONIC RESTRICTIVE DISEASES

Back 25

Etiologies vary
Disease are all characterized by difficulty expanding the lungs causing a reduction in lung volume

Front 26

PULMONARY EDEMA

Back 26

Excessive seepage of fluid from the pulmonary vascular system into the interstitial space
May eventually cause aveolar edema

Front 27

MET LEVEL 1.0-1.4 (STAGE I)

Back 27

ADL/Mobility: self-feeding, wash hands and face, bed mobility, transfers, progressively increase sitting tollerance

Exercise: Supine active or active assistive exercise to all extremties; sitting: active or active assistive to head, neck and LE only, include deep breathing

Recreation: Reading, radio, table games (noncompetitive), light hondwork

Front 28

MET LEVEL 1.4-2 (STAGE II)

Back 28

ADL/Mobility: Sitting: Self-bathing, shaving, grooming and dressing in hospital; unlimited sitting; slow paced ambulation

Exercise: Active exercise to all extremities, progressively increase reps; NO ISOMETRICS

Recreation: Sitting: crafts

Front 29

MET LEVEL 2.0-3.0 (STAGE III)

Back 29

ADL/Mobility: Sitting: Showering in warm water, homemaking tasks with brief standing periods to transfer light items, ironing

Exercise: W/C mobility, limited distances
Standing: Active exercise to all extremities, may include balance exercises and light mat activities without resistance

Recreation: Sitting: card playing, crafts, piano, machine sewing, typing

Front 30

MET LEVEL 3.0-3.5 (STAGE IV)

Back 30

ADL/Mobility: Standing: Total washing, dressing, shaving, grooming, showering in warm water, kitchen/homemaking activities with energy conservation; Unlimited distance walking

Exercise: Active exercise, continue to increase repetitions and speed, balance and mat activities with mild resistance; may being slow stair climbing

Recreation: Candlepin bowling, canoeing, golf putting, light gardening, driving

Front 31

MET LEVEL 3.5-4.0 (STAGE V)

Back 31

ADL/Mobility: Washing dishes, washing clothes, hanging light clothes, making beds

Exercise: Continue active exercise, increase repetitions and speed

Recreation: Slow swimming, light carpentry, golfing (using cart), light home repairs

Front 32

MET LEVEL 4+ (STAGE VI)

Back 32

ADL/Mobility: Showering in hot water, hanging and/or wringing clothes, mopping, stripping and making beds, raking

Exercise: Continue active exercise, increase repetitions and speed

Recreation: Slow dancing, swimming, ice or rolling skating (slowly), volleyball, badmiton, table tennis (noncompetitive) light calisthenics

Front 33

PULSE/HEART RATE

Back 33

Normal adult HR: 70 bpm; range 60-80 bpm
Pediatric: newborn, 120 bpm; range 70-170 bpm
Tachycardia: greater than 100 bpm
Bradycardia: Less than 60 bpm

Front 34

BLOOD PRESSURE

Back 34

Adult BP: <120/<80mm Hg (systolic/diastolic); range between 110-140 systolic, 60-80 diastolic
Pediatric: 1 month: 80/45; 6 years: 105-125/60-80

Front 35

RESPIRATORY RATE

Back 35

Adult: 12-18 br/min
Infant: 40 br/min

Front 36

CYSTIC FIBROSIS (CF)

Back 36

Genetically inherited autosomal recessive trait, gene mutation; both parents must be carriers

Chronic, progressive lung disease; salt concentration in the sweat; decreased release of certain enzymes by the pancreas; certain abnormalities revealed on x-ray; failure to grow properly

Complications: Life expectancy reduced to 26 years; Cardiac symptoms are a possible complication; diabetes, cirrhosis, and rectal prolapse are rare complications; five to ten percent of children present with intestinal blockage

Front 37

CYSTIC FIBROSIS EVAL AND TREATMENTS

Back 37

Eval: ***** for developmental delays related to decreased strength and endurance and decreased attention; ***** the environment; assess psychological status

Intervention: Energy conservation; environmental adaptations to enhance performance; positioning to promote postural drainage; neurodevelopmental treatment to improve endurance and postural stability; facilitation of fine, gross, visual motor, cognitive and psychosocial development; parent education; observation of medical precautions

Front 38

RESPIRATORY DISTRESS SYNDROME (RSD)

Back 38

Etiology: premature birth; insufficient production of surfactant to keep air pockets in the lungs open.

Function: Intellectual development of infants who receive the latest treatments appears to be good
Motor, sensory, cognitive, language delays, visual defects, hypotonia, and other health issues may develop

Front 39

RESPIRATORY DISTRESS SYNDROME EVALUATION AND INTERVENTION

Back 39

Eval: Assess for developmental delays and assess the environment

Intervention:
Monitor development
Facilitate sensoimotor and cognitive development
Provide parent education regarding handling, positioning, energy conservation, and methods to facilitate normal development
Adapt environment as needed
Observe medical precautions
Refer as necessary to ophthalmologist and other relevant services

Front 40

BRONCHOPULMONARY DYSPLASIA (BPD)

Back 40

Etiology: Result of barotrauma; high inflation pressure, infection, meconium, aspiration, asphyxia
Complication of prematurity
The walls of the immature lungs thicken, making the exchange of oxygen and carbon dioxide more difficult
The mucous lining of the lug is reduced along with the airway diameter

Complications:
Greater risk for hypotonia
Feeding problems
CNS problems, can lead to delays or impairments in motor, sensory, speech and cognition functions
Recurrent otitis media can lead to conductive hearing loss that can affect the development of speech and language as well as cognition

Function: Poor autonomic ans sensory state regulation, poor exercise/activity tolerance, reduced ability to socialize due to long period s of poor health, isolation and stress on the child and family members can lead to psychosocial problems, greater risk for attachment disorder

Front 41

BRIOCHOPULMONARY DYSPLASIA (BPD) EVALUATION AND INTERVENTION

Back 41

Eval: Assess for developmental delays and assess environment related to energy conservation, positioning and enhanced occupational performance

Intervention:
Facilitate sensor-motor and cognitive development
Address psychosocial issue that arise
Adapt environment
Provide parent education regarding handling, positioning, feeding, energy conservation and appropriate environmental adaptations
Parent advocacy related to acquiring necessary services and equipment
Observe all medical precautions

Front 42

DYSPHASIA AND SWALLOWING DISORDERS CAUSES

Back 42

1. Facial paralysis
2. Praxis/motor planning
3. Sensory impairment of the oral cavity
4. Weakness of the tongue/base of tongue structures
5. Weakness of the elevation of the pharynx during swallow
6. Vocal cord paralysis
7. Penetration of the bronchioles/bronchi by the bolus when aspiration occurs
8. Clinical aspiration
9. Diminished esophageal motility

Front 43

RELATIONSHIP OF SWALLOWING DYSFUNCTION TO OCCUPATION

Back 43

1. Disruption of the person's role relative to his/her family unit/decreased ability to comfortably eat at a dinner table
2. Disruption of ability/decreased comfort level for eating out in public
3. Alteration of self-concept concerning life roles and appearances

Front 44

DYSPHASIA AND SWALLOW DISORDERS INTERVENTION

Back 44

1. Provide family-centered intervention to determine an acceptable dinner table alternative to interaction
2. Work with person toward developing new roles and occupations to transition from old role
3. Provide ongoing education and information to family regarding person's feeding/nutrition

Front 45

GASTRIC ESOPHAGEAL REFLEX DISEASE (GERD)

Back 45

Lower esophageal sphincter inefficiently closes; stomach contraction propels acid/acidic bolus back into the esophagus

Intervention:
1. Sleeping with more than one pillow (elevating the head to discourage regurgitation associated with body posture)
2. Drug therapy
3. Diet modification: less spice and small meals on a more frequent basis
4. Stress management

Front 46

SMALL BOWEL OBSTRUCTION

Back 46

Etiology: secondary to scar tissue and radiation of the abdomen

Rehabilitation issues:
1. Self-care aspects of stoma care must be addressed for a person with decreased fine motor skills
2. Decreased mobility of gross movements that cause traction on the healing scar (bending, stooping, foot/lower leg related self-care)
3. Altered appetite in post-operative phase

Front 47

NEUROGENIC BOWEL

Back 47

Etiology: Sympathetic nerve impairment, generally occurring in person who have spinal cord injury above the T-6 level (loss of control of anal sphincter, sensory loss resulting in a lack of awareness of feces in the bowel, motor loss)

Flaccidity of muscles results in incontinence

Autonomic dysreflexia, an extreme rise in blood pressure can result

Front 48

KIDNEY DISEASE

Back 48

Risk factors: DM and HTN

Impact on performance skills/client factors
1. Motor dysfunction (fatigue, muscle pain, edema limiting mobility, weakness)
2. Sensory system function (neuropathy, vision loss)
3. Cognitive dysfunction (altered body image, delusions due to sepsis/toxicity, dementia)
4. Perceptual/neurobehavioral dysfunction (dementia/infarct related, stroke related)
5. Psychological/emotional dysfunction (anxiety, depression, mood disorders)

Front 49

KIDNEY DISEASE - IMPACT ON OCCUPATIONAL PERFORMANCE

Back 49

1. Self-care (alternation in urination, sexuality, need for adaptive equipment, energy conservation/work simplification, altered mobility)
2. Instrumental Activities (housekeeping, community mobility, meal preparation, management of personal finances, leisure/sport activity)
3. Impact on performance context: social contexts and cultural contexts)

Front 50

STRESS INCONTINENCE

Back 50

Etiology: Local damage to bladder sphincter associated with the afteraffects of bearing children, mobid obesity, and weakness of accessory musculature associated with normal aging

Intervention:
1. Kegal exercises
2. Timed routines for emptying bladder
3. Lifestyle adjustments to use incontinence supporting garments
4. Medications
5. Electrical stimulation may be used if client fits the parameters of recover for the condition

Front 51

STAGE 1 CANCER

Back 51

Tumor present, no perceived spread of disease
Prognosis good: no spread of disease to lymph nodes, no metastatic lesions

Front 52

STAGE 2 CANCER

Back 52

Localized spread of tumor
Lesion is operable and can be removed with margins
Spread is limited and usually responds well to treatment
Mean 5 years survival rate is ~50%

Front 53

STAGE 3 CANCER

Back 53

Extensive evidence of a primary tumor that has spread to other organs int he body
Tumor can be surgically debulked, but some cells remain behind
Widespread evidence of cancer throughout multiple organs of the body
Mean 5 year survival rate is ~20%

Front 54

STAGE 4 CANCER

Back 54

Inoperable primary lesion
Survival is dependent on depth and extent of the tumor spread as well as the ability to have the tumor respond to therapy
Multiple metastases
Mean 5 year survival rate is <5%

Front 55

PRE-OPERATIVE CANCER TREATMENTS

Back 55

Pre-operative functional assessments and preparation of the client for post-operative phase and care

Client and caregiver education concerning recovery and follow up care/functional expectations and client engagement

Front 56

POST-OPERATIVE CANCER TREATMENTS

Back 56

Intervention planning based on a client's medical status and blood value guidelines that can affect safety during activity (platelets, hemoglobin level)

Precautions related from structural change from surgery: dependent on the location of the tumor and the procedures done

Front 57

CONVALESCENCE CANCER TREATMENTS

Back 57

Rehabilitation of motor impairments, sensory impairments, cognitive impairments, and neurobehavioral impairments

Psychological support to enhance coping ability during recovery from cancer treatment phase

Development of health supporting behaviors with follow-up support

Front 58

END OF LIFE CARE CANCER TREATMENTS

Back 58

Support QOL as disease advances and function status declines
Provide client with as much control as they can desire to have to their day to day life and lifestyle-support
Be present, be accountable, listen and counsel as possible concerning progression of disease and sense of liminality
Encourage planning for death, control over goodbyes, funeral arrangements, advanced directives, etc
Empower life celebration and life reflections
Refer for legal support (if requested)

Front 59

SCLERODERMA

Back 59

Rheumatic, connective tissue disease associated with impaired, immune response

Etiology: unknown

Front 60

LIMITED SCLERODERMA

Back 60

Skin involvement (with a good prognosis)
Linear scleroderma (bands of thicker skin, with good prognosis)

Front 61

SYSTEMIC SCLERODERMA

Back 61

Systemic sclerosis of internal organs, which is life threatening
CREST Syndrome with good prognosis
-Calcinosis (calcium of the skin)
-Raynaud's phenomenon
-Esophageal dysnfunction
-Sclerodactyly of fingers and toes
-Telangiectasis or red spots covering the hands, feet, forearms, face and lips

Front 62

SCLERODERMA INTERVENTION

Back 62

1. Raynaud's phenomenon
-Keep fingers and toes warm
-Dress in layers
-Drug therapy
-Biofeedback
2. Pulmonary artery problem: drug therapy and oxygen
3. Gastrointestinal problems: drug therapy, dietary modification, treatment of infections
4. Fibrosis of skin: protective gloves, drug therapies
5. Myositis: inflammatory muscle disease; cessation of exercise, drug therapy
6. Fibrosis of the lungs: drug therapy

Front 63

SEQUALAE OF SCLERODERMA

Back 63

1. Poor circulation, as in Raynaud's phenomenon: dress in layers; biofeedback, education for skin inspection, activity modification to prevent trauma

2. Contractures: splinting at optimal resting length for hands/wrist to slow progress of contractures, silicone gel on palms, electrical/mechanical vibration to stimulate muscles

3. Facial disfigurement: self-esteem, work on adjusting to changing appearance, support groups

4. Thoracic spinal lesions (resulting in papaparesis, neurogenic bowel/bladder, altered mobility, and altered ADLs): neuro rehabilitation

5. Space occupying lesion in the brain producing stroke-like symptoms: rehabilitation for functional deficits

Front 64

ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

Back 64

Etiology: Infection by the human immunodeficiency virus (HIV)
HIV attacks the lymphatic system, the system that protects the body's immunity to opportunistic infections

Front 65

SEQUALAE OF AIDS/HIV INFECTION

Back 65

1. Generalized lymphadenopathy/enlarged lymph nodes
2. Fever
3. Diarrhea
4. Lack of energy
5. Neurological impairments (cognitive impairment, affective changes, sensory changes, basic ADL impairments, myelophathy, periphereal neuropathy
an visual impairments

Front 66

HEPATITIS

Back 66

Etiology: A viral infection

Type A: contaminated seasfood, protective immunization possible

Type B, C, and other identified forms: Body and blood borne exposure, protective immunization possible for type B

Front 67

SEQUELAE OF HEPATITIS

Back 67

1. Fever
2. Fatigue
3. The over contribute to decrease tolerance for activity participation and lack of energy

Front 68

METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)

Back 68

An infection of the skin; more seriously infections on skin; or infection surgical wounds

The infection is resistant against treatments from known antibiotics, even broad spectrum antibiotics

Front 69

DIABETES

Back 69

Type 1: Insulin-dependent; autoimmune, genetic, environmental factors (5-10% of cases)

Type 2: None-insulin dependent; older age, obesity, etc (90-95% of cases)

Gestational diabetes: develops during pregnancy (usually resolves after pregnancy)

Front 70

DIABETES COMPLICATIONS

Back 70

1. Fatigue
2. Urinary disturbance
3. Visual loss
4. Periphereal neuropathy (amputations)
5. Poor general health/increased rate of infectious diseases
6. Hypoglycemia (vagueness, dizziness, tachycardia, pallor, weakness, diaphoresis, seizures)
7. Hyperglycemic crisis
- Ketoacidosis: sings include dehydration, rapid and weak pulse, acetone breath
-Hyperosmolar coma: signs include stupor, thirst, polyuria and neurological abnormality

Front 71

DIABETES REHABILIATATION

Back 71

1. Preventive exercise
2. Education concerning compliance and need for medical management
3. Psychological and emotional support
4. Lifestyle readjustment to complications when and if they occur (low vision, safety assessment and intervention, physical adaptations)
5. Protective issues regarding periphereal neuropathy (safety assessment, education, skin care, pain management, adaptive equipment, IADL support)
6. Early attention to wound management
7. Assistance in problem solving and modifying self-care changes

Front 72

OBESITY ANDBARIATRIC REHABILIATION

Back 72

1. Lifestyle redesign
2. Inpatient rehabilitation tertiary care: devices and equipment to maximize participation in ADLs
3. Co-morbidities: cardiopulmonary, biomechanic effects of hips, knees, ankle and foot; increased risk of pressure ulcers; increased occurrence of lymphedema; increased heat intolerance; increased risk of practitioner injury when poor body mechanics

Front 73

LYME DISEASE

Back 73

Etiology: tick bites

Rehabilitation:
1. Treat join pain and welling
2. Treat nervous system abnormality (pain, Bell's palsy, Meningitis)

Front 74

PRESSURE/DECUBITUS ULCERS STAGES

Back 74

Stage 1: Skin is intact with visible nonblanchable redness over localized area, typically bony prominence

Stage 2: Involves the dermis with partial thickness loss which presents as shallow open ulcer that can be shiny or dry

Stage 3: Involves full thickness tissue loss with subcutaneous fat possibly visible

Stage 4: Involves full thickness tissue loss with bone, tendon, or muscle visible or directly palpable

Unstageable pressure ulcers: Involves full thickness tissue loss in which the wound bed has slough and/or eschar (scab or dark crusted ulcer) which cover the base of the ulcer

Front 75

PRESSURE/DECUBITIUS ULCERS INTERVENTION

Back 75

1. Prevention is the most effective intervention (w/c cushions, flotation pad, and pressure relief beds)

2. Train the individual and/or caregivers in positions and weight-shifting techniques and schedules and in proper skin care

43. Train in proper skin care

4. Encourage adequate intake of fluids and food to maintain nutrition, promote healing and achieve a recommended body weight

Front 76

PHASE 1: INPATIENT REHABILITATION/HOSPITALIZATION PHASE
PROGRAM FOCUS

Back 76

1. Increase knowledge of energy conservation and work simplification principals/techniques
2. Increase knowledge of MET levels and cost of activities
3. Improve ability to carry out self-care and low level functional activities
4. Decrease anxiety
5. Support in smoking cessation and dietary modifications efforts if warranted
6. Discharge to home

Front 77

PHASE 1: INPATIENT REHABILITATION/HOSPITALIZATION PHASE
EVALUATION

Back 77

1. Initiate at bedside with a monitored, functional assessment of self-care and mobility
2. If person is pain free, exhibits no arrhtyhmia, and has a regular pulse (less than 100) activity program is initiated

Front 78

PHASE 1: INPATIENT REHABILITATION/HOSPITALIZATION PHASE
TREATMENT/ACTIVITY PROGRAM

Back 78

1. Begin with activities at MET level 1.2 (bed mobility, static standing, transfers from bed to chair/commode, bed bath, feeding, grooming at sink sitting, AROM, w/c mobility/walking in room)
2. Energy conservation technique education
3. Breathing exercises (abdominal breathing and pursed lips breathing)
4. Monitor vital signs
5. Use exertion scales
6. As activity tolerance improves, increase MET level of activities gradually
7. Education on heart disease/support groups


Generally discharged to phase 2 when they can tolerate at MET level of 3.5; typical stay 5-14 days

Front 79

PHASE 1: INPATIENT REHABILITATION/HOSPITALIZATION PHASE
CONTRAINDICATIONS FOR THERAPY

Back 79

Therapy should be stopped if:
1. Uncontrollable arrhythmia
2. Recent embolism, thrombophlebtis
3. Dissecting aneurysm
4. Severe aorticstenosis
5. Acute systemic illness
6. Acute MI
7. Digoxin toxicity
8. Acute hypoglycemia
9. Third degree heart block
10. Unstable angina

Front 80

PHASE 2: OUTPATIENT REHABILITATION/CONVALESCENCE STAGE
PROGRAM FOCUS

Back 80

1. Educate patient on the importance of continued exercise
2. Build up activity tolerance
3. Improve ability to carry out IADL and community tasks
4. Improve ability to preform work activities
5. Support person's efforts in smoking cessation and lifestyle changes as needed

Front 81

PHASE 2: OUTPATIENT REHABILITATION/CONVALESCENCE STAGE
EVALUATION AND INTERVENTION

Back 81

1. Home evaluation
2. Consumer and family education
3. Graded exercise program with slow and gradual increase of weight
4. Being with activities at MET level 4-5, gradually increasing as patient's tolerance improves
5. Resumption of sexual activity usually at 5-6 MET level as per physician recommendation
6. Functional activities in the discharge environment
7. Energy conservation techniques and compensatory techniques in daily tasks
8. Community activities
9. Work site evaluation if applicable

Front 82

PHASE 3: MAINTENANCE/TRAINING STAGE

Back 82

1. Patients generally attend maintenance/training session once a week following the completion of Phase 2
2. Groups may be integrated into individual exercise program
3. Occupational therapy intervention is provided as necessary for IADL, leisure pursuits and work
4. Maintenance gym program (weight training to maintain strength and Cardiovascular training to maintain cardiopulmonary health)