Cardiac rehab

Question 1

Clinical presentation and etiology of myocardial infarction, coronary artery disease

Answer 1

Myocardial infarction: blood vessel plaque/thrombosis formation –> narrow or blockage or rupture of coronary artery –> reduce blood and oxygen supply to heart muscle –> ischemic

SSx: discomfort in chest, left shoulder…; SOB; fast or irregular heart beat; nausea

Question 2

Clinical presentation and etiology of congestive heart failure

Answer 2

Impaired function of ventricles –> affect ability to bump

LEFT ventricle dysfunction: fluid accumulate in left ventricle and flow back to the lung –> pulmonary edema

RIGHT ventricle dysfunction: fluid accumulate in right ventricle and flow back to the venous system –> peripheral edema

Question 3

Information collected in Ax

Answer 3

PEO-Person
1. OT profile (medical hx, personality e.g. easily get anxious/angry)
2. ROM (Goninometer)
3. muscle strength (MMT)
*assessed in context of activity due to precautions following sternotomy
4. Cognition (Adhere to precaution?)
5. Premorbid lifestyle (interview)

PEO-Environment

PEO-Occupation
1. premorbid and current ADL and IADL (BI, FIM, COPM)
2. Occupation: work/school

Question 4

Occupational performance issues

Answer 4

1. Precautions after surgery
2. Muscle loss during immobilization
3. Decreased functional ability in ADL IADL due to precaution and fatigue
4. Risk factors

Question 5

Treatment goal and plan
(Follow precaution after surgery)

Answer 5

Tx goal:
Follow precaution after surgery

Tx plan:
education on
- x lift >8 pounds
- x turning/twisting; hug a pillow when coughing
- x shoulder flexion/abduction >90’

Question 6

Treatment plan/Recommendation
(decreased ROM and muscle strength)

Answer 6

Tx goal:
Improve/restore ROM and muscle strength

Tx plan:
early mobilization
- 0-3 MET activity (bedside) e.g. strolling, sitting, dressing
- 3-6 MET activity e.g. housework
- 6-9 MET activity e.g. running

• progressive muscle strengthening + monitor vital sign
• Provide education on signs and symptoms of exercise intolerance

Question 7

Treatment plan/Recommendation
(Decreased functional ability in ADL IADL due to precaution and fatigue)

Answer 7

Tx goal:
restore functional ability (ADL, IADL)

Tx plan:
- individualized adaptive equipment/recommendation e.g. long handle sponge, socking aids

• energy conservation –> minimize fatigue and work of breathing
• Planning
• Prioritize
• Pacing
• Positive attitude
• Positioning
• Pursed-lip breathing

Question 8

Treatment plan/Recommendation
(Unhealthy lifestyle)

Answer 8

Tx goal: lifestyle redesign (Reduce risk factors after discharge)

Tx plan:
smoking, relaxation technique, unhealthy lifestyle/habit e.g. physical activity, low fat low sodium diet