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103 Cards in this Set
- Front
- Back
coronary artery disease |
-Artherosclerotic dz. = narrows coronary arteries, results in ischemia to myocardium
Main Clinical Syndromes of CAD -Angina pectoris |
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Angina pectoris |
ischemia presenting with mild to moderate chest pains (mainly chest and left arm; can radiate anywhere including neck and jaw)
Brought on by increased demands on heart & Vasospasm 1. stable 2. unstable = highly dangerous potential sudden death |
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myocardial infarction |
-prolonged ischemia and death of area of myocardium |
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congestive heart failure |
body unable to maintain adaquate blood circulation |
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left heart failure- CHF
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decreased cardiac output (left side of heart pumps blood to body). |
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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 |
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How is heart disease classified by the American Heart Association? |
according to pt.'s activity level. |
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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 |
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Class II
Heart dz. |
slight activity limit |
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Class III
Heart dz. |
Marked limitation |
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Class IV
Heart dz. |
inability to carry out physical activity without discomfort |
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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 |
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Signs of left-sided heart failure
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fatigue |
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Medical Therapy Management for CAD |
-Nitrates/vasodilators/ace inhibitors -Beta blockers -CA2+ channel blockers -Antiarrhythmics -Antihypertensives -Digitalis --Diuretics -Antithrombitics
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angioplasty |
surgical dilation of a blood vessel - uses small balloon tipped catheter |
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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 |
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transplantation
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end stage myocardial dz. |
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Thrombolytic therapy
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s/p acute MI |
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Peripheral vascular dz. |
-arterial or venous types |
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DVT
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inflammation of vein in association with thrombus |
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lymphedema
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excessive accumulation of fluid - obstruction of lymphatics |
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Raynaud's phenomenon
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abnormal vasoconstriction reflex |
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what are the primary muscles and accessory muscles of inspiration |
Primary = diaphragm & intercostals
Accessory = sternocleidomastoid, scalenes, levator constarum, serratus, trapezius & pectorals |
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Chronic obsructive pulmonary dz. |
COPD |
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Peripheral airway dz |
inflammation of distal conducting airways |
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Chronic bronchitis
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chronic inflammation of tracheobronchial tree |
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emphysema
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abnormal enlargement and destruction of air spaces distal to terminal bronchioles |
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asthma
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increased reactivity of trachea and bronchi to various stimuli (allergens, exercise, cold) |
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5 grade angina rating scale
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0 = no angina |
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5 grade dyspnea scale
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0 = no dyspnea |
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10 grade angina/dyspnea scale
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0 = nothing |
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claudication
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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: |
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Borg scale of perceived extertion
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15 grade scale |
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Norm heart rate
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infant = 120 bpm |
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norm BP
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infant = 75/50 |
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norm RR
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infant = 40 br/min |
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bacterial pneumonia
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intra-alveolar bacterial infection |
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pneumonia types
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bacterial PNA |
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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 |
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Sequelae of TB
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kidney dysfunction |
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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 |
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5 methods of assessing activity tolerance
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1. graded exercise test (done by PT or exercise phys) |
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Cardiopulmonary Stage I ADL
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1.0-1.4 MET |
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Cardiopulmonary Stage II ADL
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1.4 - 2.0 METS |
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Cardiopulmonary stage III ADL
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sitting: shower in warm water, light home-making with brief standing
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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 |
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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 |
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Program focus for phase I of cardiac rehab |
this is inpatient rehab/hospitalization |
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Activities for MET level 1-2
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(phase 1 cardiopulm rehab) |
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Energy conservation and work simplification techniques
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self-pacing |
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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 (respiratory rate) |
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breathing exercises |
performed during all exercises and activities |
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when do you monitor vital signs
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prior to activity |
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when do you monitor exertion scales?
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prior to each activity |
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What is the target range for exercise/activity on the Borg scale
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12/20 = 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 |
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what does a 9 indicate on the borg scale?
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very light exertion |
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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 |
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guidelines for O2 Sat, cardiac and pulmonary pts.
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pulmonary pts = below 86% |
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Precautions for cardiopulmonary pts
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- avoid isometric muscle work, straining, breath holding |
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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 |
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Phase 2 of cariopulmonary rehab
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outpatient rehab/ convalesence phase |
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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 |
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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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Cystic Fibrosis |
Genetically inherited; both parents carriers
Effect on function: -Exercise tolerance -poor nutrition due to malabsorption may contribute to DD. |
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OT eval of cystic fibrosis |
-Developmental delays? |
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cystic fibrosis, OT intervention
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- econs (energy conservation) |
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respiratory distress syndrome |
insufficient production of surfacant to keep alveoli (air pockets in lungs) open |
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Respiratory distress syndrome's: Effect on fucntion |
for premature infants: visual defects hypotonia other health issue that impact on development |
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OT intervention for RSD |
-Monitor development -Facilitate sensori-motor/cognitive development -Parent education for: handling, positioning, -econs & facilitate normal development -Adapt environment -Observe medical precautions -Refer to ophthalmologist & other services if needed |
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bronchopulmonary dysplasia |
respiratory disorder as result of barotrauma (complication of prematurity) |
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OT intervention for Bronchopulmonary Dysplasia (BPD) |
-Facilitate sensori-motor/cognitive development -Parent education for: handling, positioning, -econs & facilitate normal development -Adapt environment -Observe medical precautions |