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OCCTH 584 > Cardio & Pulmonary > Flashcards

Cardio & Pulmonary Flashcards

1
Q

Name the 4 valves in the heart.

A

Tricuspid valve
Mitral valve
Pulmonary valve
Aortic valve

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2
Q

Where is the tricuspid valve located?

A

Between the right atrium and the right ventricle

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3
Q

Where is the mitral valve located?

A

Between the left atrium and the left ventricle

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4
Q

What are the 3 layers of the the heart walls?

A

Endocardium - Smooth surface for blood to flow
Myocardium - The muscle layer
Pericardium - Lubricates the heart and prevents too much diastole

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5
Q

What is diastole?

A

Phase of heart rhythm where the heart relaxes and blood fills the heart, usually the ventricles.

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6
Q

What is systole?

A

Phase of heart rhythm where the heart (usually the ventricles) contract and pump blood into the pulmonary and aortic trunks.

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7
Q

Describe the conduction or electrical system of the heart.

A

The electrical impulse begins in the sinoatrial (SA) node, located in the posterior right atrium. It travels through the walls of the atria, causing contraction, then it goes to the atrioventricular (AV) node near the tricuspid valve where the signal is slowed before entering the ventricles, allowing time for atria to fill. The impulse then continues through the ventricular walls, causing contraction.

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8
Q

What are the components of normal sinus rhythm on the ECG?

A

P wave: Atrial contraction
QRS complex: Ventricular contraction
T wave: Repolarization

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9
Q

What is arrhythmia?

A

Abnormal rhythms that deviate from normal sinus rhythm.

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10
Q

What is bradycardia?

A

Heart beating too slowly, < 60 bpm

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11
Q

What is tachycardia?

A

Heart beating too quickly, > 100 bpm

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12
Q

What is fibrillation?

A

Uncoordinated contractions of the heart

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13
Q

What is the most common arrhythmia managed by emergency physicians?

A

Atrial fibrillation or A-fib

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14
Q

True or False: Atrial fibrillation or A-fib is a life-threatening condition.

A

False. However, it can lead to blood pooling in the atria which are more likely to clot, leading to thrombosis and stroke.

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15
Q

What causes atrial fibrillation?

A

Abnormal electrical signals received by atria

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16
Q

What are the symptoms of atrial fibrillation?

A

Feeling of pounding or irregular heart beat
Shortness of breath
Tiredness
Dizziness or fainting

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17
Q

True or False: When patients are in rapid a-fib (> 120 bpm) they are often considered not appropriate for therapy.

A

True.

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18
Q

What is ventricular tachycardia?

A

Fast heart rhythm originating in one of the ventricles

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19
Q

What is ventricular fibrillation?

A

Uncoordinated contractions of the ventricles

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20
Q

True or False: Ventricular tachycardia requires immediate BLS interventions.

A

False. It is not immediately life-threatening, but could potentially be life-threatening as it could lead to ventricular fibrillation, asystole, and sudden death.

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21
Q

True or False: Ventricular fibrillation requires immediate BLS interventions.

A

True.

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22
Q

What are the two devices for arrhythmia?

A

Pacemaker

Implantable cardioverter defibrillator (ICD)

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23
Q

What does a pacemaker generally treat?

A

A slow heart rhythm

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24
Q

What do pacemakers do?

A

Monitors rhythm and generates electrical signals if needed

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25
Q

True or False: Wearers of pacemakers require lifelong follow-up.

A

True.

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26
Q

What does a implantable cardioverter defibrillator (ICD) generally treat?

A

Dangerous fast rhythms

Ventricular fibrillation

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27
Q

What do implantable cardioverter defibrillators (ICDs) do?

A

Continuously monitor rhythm and pace the heart if sensing a HR that is too fast. Send out one or several shocks to return the heart to normal rhythm if needed.

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28
Q

True or False: Wearers of implantable cardioverter defibrillators (ICDs) require lifelong follow-up.

A

True.

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29
Q

What is a precaution specific for implantable cardioverter defibrillators (ICDs)?

A

Avoid electromagnetic fields.

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30
Q

What are the post-pacemaker/ICD precautions?

A

No lifting, pushing, pulling more than 5 lbs, and no lifting arm above 90 degrees on side of insertion for ~6-8 weeks.

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31
Q

What is ischemia?

A

A restriction in blood supply, generally due to factors in the blood vessels (damage or dysfunction)

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32
Q

What is the most common cause of cardiac ischemia?

A

Atherosclerotic plaques in the coronary arteries

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33
Q

True or False: Healthy arteries have smooth, flexible walls that accommodate changes in blood flow.

A

True.

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34
Q

What is the function of the coronary arteries?

A

The coronary arteries branch off the aorta and supply the outer muscles of the heart with blood.

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35
Q

Which part of the heart walls do the coronary arteries supply?

A

Myocardium

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36
Q

What are the processes involved in coronary artery disease (CAD)?

A

Plaque forms, and the artery narrows, forming blood clots. Plaque ruptures, and the blood clots block the artery.

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37
Q

What are the non-modifiable risk factors for coronary artery disease (CAD)?

A

Age (men > 45, women > 55)
Genetics
Male gender (estrogen is a protective factor)
Ethnicity

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38
Q

What are the general modifiable risk factors?

A

Exercise, diet, medication

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39
Q

What is acute coronary syndrome?

A

The range of clinical presentations of coronary artery disease from unstable angina to acute myocardial infarction

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40
Q

True or False: Angina is not a disease.

A

True. It’s a symptom of coronary artery disease and does not cause lasting damage to the heart.

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41
Q

How does angina feel?

A

Chest pain or discomfort (heaviness, tightness)
Levine’s sign - Squeezing, heaviness in the neck, arms, shoulder blades, etc.
Sweating, fatigue, nausea, shortness of breath, lightheadedness

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42
Q

What is angina a warning sign of?

A

That the heart is unable to balance oxygen demand and oxygen supply.

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43
Q

What is stable angina?

A

Predictable pattern of occurrence
Caused by consistent precipitating factors
Controlled by rest and nitrates

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44
Q

What is unstable angina?

A

A change in previously established stable pattern, or a new onset of severe angina
Occurs without a cause
Lasts longer than typical stable angina
Does not respond well to nitro
Often the result of a ruptured unstable plaque

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45
Q

What is an unstable angina a warning sign of?

A

That a heart attack may happen soon

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46
Q

What is myocardial infarction?

A

Irreversible myocardial necrosis or cell death

Complete coronary occlusion by a thrombus or plaque rupture

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47
Q

What are the 2 types of myocardial infarction?

A

ST elevation myocardial infarction (STEMI)

Non-STEMI (NSTEMI)

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48
Q

Compare STEMI and NSTEMI in terms of occlusion.

A

STEMI - Complete occlusion of a single vessel. > 2 hours.

NSTEMI - Partial occlusion. 20 mins - 2 hours.

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49
Q

Compare STEMI and NSTEMI on loss of myocardium.

A

STEMI - Loss of large amounts of myocardium (full wall thickness injury).
NSTEMI - Loss of a small amount of myocardium.

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50
Q

Compare STEMI and NSTEMI on mortality.

A

STEMI mortality is 2 times greater than NSTEMI initially.

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51
Q

Compare STEMI and NSTEMI on troponin and CK levels.

A

They both have increase in troponin and CK levels.

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52
Q

What do troponin and CK levels indicate?

A

Troponin - Cardiac muscle death

CK levels - Any muscle death

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53
Q

What is used to diagnose myocardial infarctions?

A

ST segment depression/elevation in ECG

Troponin and CK levels

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54
Q

Compare STEMI and NSTEMI on ECG.

A

STEMI - ST segment is elevated.

NSTEMI - ST segment is depressed, or T wave is inverted.

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55
Q

What is cardiac arrest?

A

Abrupt cessation of normal circulation of blood due to failure of the heart to contract effectively.

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56
Q

True or False: Cardiac arrest can lead to myocardial infarctions.

A

False. Myocardial infarctions can lead to cardiac arrests.

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57
Q

How does cardiac arrest present, and how is it clinically diagnosed?

A

Cardiac arrest causes lack of oxygen to the brain, leading to loss of consciousness and abnormal or absent breathing.
Clinically diagnosed by absence of a pulse.

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58
Q

True or False: Cardiac arrests only occur due to cardiac distress.

A

False. Cardiac arrests can also occur due to non-cardiac causes, such as drowning or trauma.

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59
Q

What are the treatments for cardiac arrest?

A

Cardiopulmonary resuscitation (CPR) - Provide circulatory support
Defibrillation
Therapeutic hypothermia - Prevent reperfusion injury

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60
Q

What is the indication for defibrillation in cardiac arrest?

A 
Shockable rhythm (e.g. ventricular fibrillation) is present.
AED will not shock asystole.
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61
Q

What are the post-cardiac arrest considerations?

A

“Down time” - How long were they down?
Cardiogenic shock or damage to organs
Pain post-CPR, e.g. cracked ribs
Psychosocial effects, e.g. PTSD

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62
Q

What are the treatments for coronary artery disease and angina?

A

Medications - Nitro, beta-blockers, calcium channel blockers, lipid lowering
Interventional procedures - Angioplasty, stenting, bypass surgery
Lifestyle changes

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63
Q

True or False: After a cardiac event, we want to encourage remodeling of tissue.

A

False. We want to prevent remodeling so that the heart doesn’t grow back thick and weird.

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64
Q

What is heart failure?

A

A progressive condition where the heart weakens and results in impaired ability of the ventricles to pump blood and decreased cardiac output.

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65
Q

What is the cardiac cycle used as an indicator for?

A

Health of the heart

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66
Q

Blood pressure measurements are [atrial/ventricular] [systole/diastole] over [systole/diastole].

A

Ventricular systole over diastole

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67
Q

What is stroke volume vs. cardiac output?

A

Stroke volume - Amount of blood ejected in each contraction

Cardiac output - Amount ejected in 1 minutes

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68
Q

What is a normal stroke volume?

A

50-70 ml

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69
Q

What is a normal cardiac output?

A

4.7 L/min

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70
Q

How is stroke volume measured?

A

Through echocardiogram

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71
Q

What determines the preload?

A

Venous return - Dehydration, varicose veins, etc.

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72
Q

What determines the afterload?

A

Systemic circulation, e.g. high blood pressure

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73
Q

What is preload?

A

The left ventricular pressure at the end of the diastole

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74
Q

What is afterload?

A

The systemic vascular pressure that the heart must overcome to pump blood into the body

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75
Q

What is the ejection fraction (EF)?

A

The fraction of blood ejected by the (left) ventricle, relative to end diastolic volume.
Stroke volume/EDV.

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76
Q

What is the normal range of ejection fraction?

A

50-70%

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77
Q

What is end diastolic volume (EDV)?

A

Volume of blood in the ventricle after filling. ~120 ml

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78
Q

What does EF mean functionally?

A

EF is indicative of the heart’s pumping action. Less than 50% is indicative of reduced pumping action, and 35-40% may confirm diagnosis of systolic heart failure.

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79
Q

How is EF usually measured?

A

Echocardiography or cardiac catheterization

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80
Q

True or False: An individual can have heart failure with normal EF.

A

True. This would be diastolic heart failure with preserved ejection fraction (PEF).

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81
Q

What range of EF may require an implantable cardiac defibrillator (ICD), and why?

A

< 30%. May be at risk of life-threatening irregular heartbeats.

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82
Q

What are the heart failure treatment goals?

A

Slow progression of syndrome.
Control symptoms.
Improve function and QoL.

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83
Q

What are the etiology for most heart failures?

A

Ischemia (~2/3rds of heart failures) with or without myocardial infarction

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84
Q

What is cardiomyopathy?

A

Heart muscle disease, or deterioration of the function of the myocardium.

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85
Q

What are the 3 types of cardiomyopathy?

A

Dilated - Typical with ischemic disease
Hypertrophic - Usually due to systemic disease
Restrictive - Usually due to systemic disease

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86
Q

What is the EF levels in hypertrophic and restrictive cardiomyopathies?

A

Normal EF levels, because these types are often due to diastolic failure.

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87
Q

True or False: All cardiomyopathies present with the same symptoms.

A

True.

88
Q

What is hypertrophic cardiomyopathy?

A

Thick septum which can obstruct the aorta or not

89
Q

What are the possible complications of hypertrophic cardiomyopathy?

A

Fainting with activity (syncope)
BP drop with activity
Sudden cardiac death due to aorta obstruction
Ventricular and atrial arrhythmias

90
Q

What kind of jobs are counterindicated with hypertrophic cardiomyopathy?

A

High intensity sports or safety sensitive jobs

91
Q

What are the clinical presentations of hypertrophic cardiomyopathy?

A 
Dyspnea
Dependent edema
Orthopnea - Dyspnea when lying down
Fatigue
Weight gain
Weaknes
Cardiac asthma - coughing with exercising
Exercise intolerance
Cool extremities
Abdominal distension
Paroxysmal nocturnal dyspnea
Nocturia - Having to go to the bathroom frequently
92
Q

How does acute exacerbation of chronic heart failure present?

A

Increase in weight or 2-5 pounds or more in short periods (e.g. day)
Inability to sleep or needing to prop up on more pillows to sleep - Inability to lie flat
Persistent cough
Increased shortness of breath
Swelling and fatigue

93
Q

What are the NYHA Functional Classifications (FC) 1-4?

A

Class I: No limitation of activity. No symptoms of HF with ordinary activity.
Class II: Mild limitation of activity. Comfortable at rest or with mild exertion.
Class III: Marked limitation of activity. Comfortable only at rest.
Class IV: Complete rest needed. Symptoms of HF at rest.

94
Q

What are the pharmacological management methods of heart failure?

A

Diuretics - Expel water and ions through urine
Inotropes - Change the force of muscle contraction
Vasodilators - Dilate blood vessels
ACE inhibitors - Dilate blood vessels

95
Q

What are the indications for implantable cardioverter defibrillator (ICD)?

A

Presence of ischemic heart disease

EF < 30%

96
Q

What are the non-pharmacological management methods of heart failure?

A

Close medical monitoring

Lifestyle modifications

97
Q

What is HOLTER?

A

24-hour ECG tracing to evaluate arrhythmias during daily activities

98
Q

What is thallium stress test?

A

Using a radioactive substance to visualize blood flow

99
Q

What are some non-invasive diagnostic tests for cardiac health?

A 
Blood tests - Troponin and CK
ECG/EKG
HOLTER
Chest X-ray - Size of heart, fluid in/around lungs
Echocardiogram - Structure and function
Stress test - Treadmill
Cardiac computed tomography (CT) - Size, aortic disease, masses
Thallium stress test
100
Q

What is cardiac catheterization?

A

Long flexible catheters are inserted over a guide wire into a vessel and are guided towards the heart and into the coronary arteries and chambers of the heart.

101
Q

What is angiography?

A

Direct coronary artery dye injections

102
Q

What are assessed through angiography and for what?

A

Percent stenosis (blockage) - Less than 70% is usually just treated with medication
Location - Dilatability
Number of diseased vessels - Prognosis
Status of distal vessel - Bypassability

103
Q

What is percutaneous coronary intervention?

A

Angioplasty with permanent stenting

104
Q

What are the two cardiac interventions for coronary artery disease?

A

Angioplasty

Coronary bypass grafting

105
Q

What dictates which cardiac intervention is chosen for coronary artery disease?

A

Number of vessels blocked
1-2 vessels blocked: Angioplasty with stenting
>3 vessels blocked: Bypass

106
Q

What is plano-ballon angioplasty?

A

A small balloon on the catheter is blown up at the site of the stenosis, which creates some structure for the stent.

107
Q

What type of activities are contradindicated for stents?

A

Activities with high risk of injury

108
Q

How is blood prevented from clotting on stents?

A

Dual antiplatelet therapy - Drug-eluding stent and anti-platelet or anti-coagulation drugs for 1 year post surgery

109
Q

What is coronary artery bypass graft (CABG)?

A

Blockages are not removed but instead bypassed by creating a new pathway for blood flow with use of a vessel braft

110
Q

What are the graft sites for myocardial revascularization, and what are the pros and cons of each site?

A

Greater saphenous vein - Need to reverse for the correct orientation of valves. Can have more swelling in the legs.
Internal mammary artery - Constricts and dilates, which veins do not. More difficult and time-consuming.

111
Q

What is cardiopulmonary bypass?

A

Heart-lung machine. Clamps the aorta and takes over the heart/lung function.

112
Q

What are the cons of the cardiopulmonary bypass or heart-lung machine?

A

Associated with neurological after-effects, e.g. vision/sensory changes, cognition changes, etc.

113
Q

What are possible complications post-CABG?

A 
Infection
Acute renal failure
Cerebrovascular complications
Memory problems or confusion
Nerve injury or muscle spasms
Changes in vision, vocal cord function, or dysphagia
114
Q

Why do CABG patients require more time in recovery and rehabilitation?

A

They become orthopedic patients because of the sternum broken during the bypass surgery.

115
Q

What is sternotomy?

A

Incision separating sternum to allow access to heart during open heart surgery.

116
Q

What are sternal precautions?

A

Implemented after a median sternotomy.
No lifting, pushing, or pulling more than 10 lbs. for 6-10 weeks.
No lifting one arm above your head.
No hyperextending when pushing up from chairs or reaching behind your back.

117
Q

What is sternal dehiscence?

A

Separation of the sternum bone.

118
Q

How are sternal dehiscence and sternal wound infection related?

A

Sternal dehiscence is directly related to development of sternal wound infection.

119
Q

What is mechanical circulatory support?

A

A mechanical pump that is surgically implanted to provide pulsatile/non-pulsatile flow of blood to supplement or replace the heart function in patients with advanced heart failure.

120
Q

True or False: Mechanical circulatory support is a long-term treatment.

A

False. It can be short-term or long-term.

121
Q

What is intra-aortic balloon pump?

A

A balloon pump inserted into the aorta which reduces the workload on the left ventricle and increases cardiac output.

122
Q

What are two types of inpatient mechanical supports for cardiac patients?

A

Intra-aortic balloon pump

Extracorporeal membrane oxygenation (ECMO)

123
Q

What is extracorporeal membrane oxygenation (ECMO)?

A

A machine that temporarily provides both cardiac and respiratory support to patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their function.

124
Q

What are the OT roles for patients undergoing ECMO?

A

Skin breakdown
Prevent contractures
Passive ROM
Surface positioning

125
Q

What is ventricular assist device (VAD)?

A

A device used to help the heart pump blood throughout the body when the heart is too weak. Originally designed for short-term use, now can be long-term use or destination therapy.

126
Q

Ventricular assist devices (VADs) are [pulsatile/non-pulsatile].

A

Non-pulsatile. They generate continuous flow.

127
Q

What are the types of VADs?

A

Axial flow - One or more impellers propel blood forward through a combination of torque and velocity.
Centrifugal - Disc-shaped impellers add energy though centrifugal force and circumferential velocity.

128
Q

Which structures do VADs connect? Which structure does it bypass?

A

The pumps connect the apex to the aorta.

The device bypasses the left ventricular function.

129
Q

What are the possible complications of VADs?

A

Risk of clots and stroke
Risk of falls - Affected heavily by preload because it is a continuous flow. Can be fatal due to anti-coagulation.
Injections

130
Q

How are mechanical support devices used?

A

As a bridge to decision, a bridge to transplant, or as a destination therapy

131
Q

What population is eligible for heart transplantation?

A

End-stage heart failure or severe coronary artery disease

132
Q

What is a permanent complication of heart transplantation?

A

Immunosuppressant medication

133
Q

What is valve stenosis vs. regurgitation?

A

Stenosis: The opening of valve is two narrow, interfering with forward flow of blood.
Regurgitation: The valve doesn’t close properly, causing significant backflow of blood.

134
Q

True or False: Valve problems often lead to heart failures.

A

True.

135
Q

What are the symptoms of valve problems?

A

Similar to heart failure

136
Q

What other procedure is valve surgery often mixed with?

A

CABG

137
Q

What are the types of heart valve surgery?

A

Repair of valve
Mechanical valve
Tissue valve

138
Q

What are minimally invasive procedure for valves?

A

Transcatheter aortic valve implantation

Mitral clip

139
Q

Who are minimally invasive procedures for valves good for?

A

Individuals who are frail, sick, and would not tolerate surgery.

140
Q

For younger, healthier individuals, what procedures are recommended for AV and MV repair/replace?

A

AV: Ministernotomy
MV: Minithoracotomy

141
Q

What is pulmonary heart disease?

A

Enlargement of the right side of the heart as a result of beating against long-term high blood pressure in the lungs, which leads to heart failure.

142
Q

What are acute causes of pulmonary heart disease?

A

Pulmonary embolism

Acute respiratory distress syndrome (ARDS)

143
Q

What are some chronic causes of pulmonary heart disease?

A

Pulmonary vasoconstriction
Anatomic changes in vascularization
COPD or emphysema
Pulmonary hypertension

144
Q

What are the symptoms of pulmonary heart disease?

A

Same as heart failure
Enlargement of liver due to fluid build up
Cyanosis

145
Q

What is the most common cause of pulmonary embolism?

A

Clots originating in lower extremities or deep vein thrombosis (DVT).

146
Q

What are the 3 common symptoms of pulmonary embolism?

A

Sudden and unexplained shortness of breath
Chest pain
Cough that may bring up blood-tinged sputum

147
Q

What are the 3 major risk factors for pulmonary embolism?

A

Stasis or not moving
Endothelial injury in the lungs
Hypercoagulable states

148
Q

What are the treatments for pulmonary embolism?

A 
Supplemental oxygen
Bronchodilators and steroids
Lifestyle modifications
Pulmonary rehabilitation
Breathing techniques
Anxiety management
Cognitive assessment and compensation strategies
149
Q

True or False: Ventricular fibrillation is the cause of most cardiac arrests.

A

True.

150
Q

What is atherosclerosis?

A

Build up of plaques

151
Q

What is another set of precautions for sternotomy other than the universal sternal precaution?

A

“Keep Your Move in the Tube” (KYMITT) - Keep elbows tucked into the sides while lifting, pushing, pulling, or raising the arms above the head.

152
Q

What are the 3 considerations to make as an OT for cardiac patients?

A
  1. Understanding the previous level of function
  2. How far away are they from their baseline?
  3. What does this patient need to be able to go home safely?
153
Q

What are the steps of care for a client after a cardiac event?

A
  1. Cardiac intensive care or Cardiovascular intensive care - Critical care
  2. Cardiovascular or cardiac ward - Rehabilitation and discharge planning
  3. Discharge from acute care
  4. Cardiac rehabilitation
  5. Community-based rehabilitation
154
Q

What are the primary OT goals in cardiac critical care?

A

Assess if client is ready for intervention in terms of medical status
Early mobilization to prevent muscle loss, contracture, and delirium
Positioning to prevent contractures and pressure injuries and education
Provision of adapted equipment to promote autonomy, or achieve one of the above goals

155
Q

What are some barriers to intervention in the critical setting?

A 
Medical acuity
Level of consciousness
Activity orders
Lines, tubes, drains, ventilators
Endurance and activity tolerance
Housekeeping - Scans, procedures, timing
156
Q

What kinds of assessments should be done for clients in the critical setting?

A

Physical - MMT, ROM, Braden scale
Cognitive - Delirium, amnesia
Environment - Informal

157
Q

What is the RASS score?

A

Richmond Agitation and Sedation Scale. Measures state of consciousness on the spectrum of agitation and sedation.

158
Q

What score in the RASS should be maintained before transferring down a client to the ward?

A

0

159
Q

What is the CAM-ICU?

A

Confusion assessment method for the ICU. Screens for signs and symptoms of delirium. If CAM-ICU positive, delirium is present.

160
Q

What is the GOAT?

A

The Galveston Orientation and Amnesia Test. Measures recovery from trauma/amnesia.

161
Q

What is the turning and positioning system (TAPS)?

A

Wedges that nurses can use to help reposition the patient on their sides to remove some pressure from the posterior aspect of the body

162
Q

What are the interventions that can be used to protect skin integrity for a client on the ICU?

A

Mattresses
Cushions
Prevalon boots
Turning and positioning system (TAPS)

163
Q

What are the interventions that can be used for positioning for a client on the ICU?

A

Splinting

Informal positioning with towel rolls and foot boards

164
Q

What are the interventions that can be used to maintain cognition for a client on the ICU?

A

Orientation to date/day/time
Memory books
Delirium management prevention strategies

165
Q

How long is the typical length of stay (LOS) for cardiac patients?

A

2-5 days

166
Q

What are possible complications associated with longer ICU stays?

A

Higher mortality rates
Delirium
Medical complications
Pneumonia and infection

167
Q

At which point are cardiac patients transitioned to the ward?

A

Extubated and on 3 L oxygen with 93-96% oxygen saturation (SpO2).
Delirious, unable to follow commands consistently.
Requires 2 person assist to go from lying to sitting.

168
Q

What are the primary OT goals on the cardiology ward?

A

Discharge planning:
ADL retraining
Optimization of functional mobility and cognition
Education
Equipment prescription for transition home

169
Q

What are BNP and NT-proBNP levels indicative of?

A

Heart failure

170
Q

True or False: Sternal precautions are associated with high risk of wound healing complications.

A

True.

171
Q

True or False: Sternal precautions are associated with higher mortality rates and prolonged or repeat hospitalizations.

A

True.

172
Q

Why have universal sternal precautions been under review?

A

They often lead to negative, long-term outcomes and impede recovery. They also reinforce fear of activity leading to muscle atrophy and abnormal shoulder girdle movements.

173
Q

In what ways is “Keep your move in the tube” more effective than universal sternal precautions?

A

Return to normal activities are quicker.
Anxiety is alleviated.
Healthcare costs are reduced.

174
Q

What are the pacemaker precautions?

A

A bedrest order usually for 4 hours post-op.
No lifting, pushing, or pulling more than 10 pounds for 6-8 weeks.
No shoulder flexion or abduction more than 90 degrees for 6-8 weeks.
Ice to the site for 24 hours.

175
Q

What are the implications to functional activity when wearing a ventricular assist device (VAD)?

A

Sternotomy precautions post-op
ADL retraining
Energy conservation and education around activity tolerance
Outpatient cardiac rehab

176
Q

True or False: Wearers of a ventricular assist device (VAD) can usually return to functional activities with modifications.

A

True.

177
Q

How might cognition be impacted if a client’s ICU stay is longer than 5 days?

A

ICU-acquired delirium

178
Q

What are the 3 types of delirium?

A

Hyperactive
Hypoactive
Mixed

179
Q

What are the risk factors for delirium?

A

Age
Previous cognitive impairment (MCI or CVA)
Physical comorbidities (Peripheral vascular disease, renal disease, a-fib)
Time intubated
Operative complications

180
Q

What are the 4 areas assessed by the confusion assessment method (CAM)?

A
  1. Acute onset or fluctuating mental status
  2. Inattention
  3. Altered level of consciousness (RASS)
  4. Disorganized thinking
181
Q

How is the confusion assessment method (CAM) scored?

A

Items 1 and 2, plus items 3 and/or 4 → CAM Positive → Indicative of delirium

182
Q

If a client has delirium, should a cognitive assessment be completed?

A

No. The best practice is to wait until delirium has resolved before performing any formal cognitive screening.

183
Q

How can cardiovascular disease and atherosclerosis contribute to cognitive decline?

A

Lower cardiac output due to restriction in flow can alter oxygenation to the brain.

184
Q

What type of edema is most common in cardiac patients?

A

Pitting

185
Q

What are the medical interventions for edema management?

A

Diuresis
Vasodilators
Medication
CPAP or BiPAP

186
Q

When is compression therapy counterindicated?

A

Patients in uncontrolled heart failure. The compression can put a strain on their heart, exacerbating their condition.

187
Q

Before attempting to compress, what are other strategies that you can test?

A

Thrombo-embolism deterrent stockings
Sequential compression devices
Mobility - Using ankle pumps

188
Q

What is the golden question to ask after the OT initial assessment of cardiac client?

A

How far is the patient from their baseline, and what do you as an OT need to do to help them get closer to it?

189
Q

What are the physical goals to be met in OT interventions?

A

AROM/PROM programs
Increasing activity tolerance
Equipment recommendations to reduce falls risk and promote energy conservation

190
Q

What are the cognitive goals to be met in OT interventions?

A

Delirium management and prevention strategies
Memory books
Incorporation of family or primary supports into therapy

191
Q

What is the range of heart rates in cardiac patients that should be observed during activities?

A

60-100 bpm

192
Q

What is the range of oxygen saturation (SpO2) in cardiac patients that should be observed during activities?

A

> 90%

88-92% for patients with COPD or CHF

193
Q

What should be done for patients who are not able to maintain an SpO2 > 90%?

A

Supplemental oxygen

194
Q

What is the range of respiratory rates that should be maintained in cardiac patients during activities?

A

12-20 breadths per minute

195
Q

What is a breathing technique that can be used for shortness of breath?

A

Pursed lip breathing.
Inhale through nose with mouth closed, exhale slowly over 4-6 seconds through pursed lips.
This keeps the airway open for longer period of time and prolongs exhalation.

196
Q

What position promotes optimal airway expansion and movement of diaphragm?

A

Upright position

197
Q

What is the “talk test”?

A

Being able to carry on a regular conversation while performing an activity. Inability means you are overworking the heart.

198
Q

What is the Borg scale?

A

Also called rating of perceived exertion. Measures physical activity intensity level on a 6-20 scale (or 1-10 for the modified version).

199
Q

What are the guidelines for activity tolerance for cardiac patients?

A

Activity should not cause pain, shortness of breath, muscle pain, fatigue, dizziness, or lightheadedness.
You should be able to carry on a conversation while doing the activity.

200
Q

True or False: You do not need to be cleared by an MD to return to driving.

A

False.

201
Q

What are the possible discharge locations from a cardiology ward?

A

Home with or without additional equipment/support
Inpatient rehab facility
Outpatient rehab facility
Alternate level of care (e.g. palliative)

202
Q

What is the goal of outpatient cardiac rehabilitation?

A

Create sustainable health outcomes for individuals with heart disease through secondary prevention.

203
Q

What is the OT role in cardiac rehab?

A

Develop activity guidelines for return to work and leisure.
Facilitate independence through the use of equipment, education, activity modification, and connection to resources.
Stress management and education.
Post-op complication management.

204
Q

What are some ways to determine the energy cost of activities?

A

Stress test or METS
Maximal Fitness Testing
Timed Up and Go
6-Minute Walk Test

205
Q

How much is 1 MET in kcal/kg/hr and in ml/kg/min?

A

1 kcal/kg/hr or 3.5 ml/kg/min

206
Q

In METs, how much should day-to-day tasks be?

A

~45% of max MET level

207
Q

How often and for how long should peak exertional level activities be performed per day?

A

1 time per day for 15 minutes

208
Q

In METs, how much should peak exertional level activities be?

A

~70% of max MET level if symptomatic.

~80% of max MET level if asymptomatic.

209
Q

What does the Edmonton Frail Scale measure?

A

Grades fitness and frailty.

210
Q

What does the Duke Activity Status Index measure?

A

Estimates functional capacity and provides corresponding MET recommendation.

211
Q

What does the Timed Up and Go (TUG) measure?

A

Fall risk and balance progress.

212
Q

What does the 6-Minute Walk Test measure?

A

Aerobic capacity and endurance.

213
Q

True or False: Clients can go back to their old lifestyles once their stay at the hospital is finished.

A

False. Self-management and secondary prevention in heart disease are critical. Education should focus on these topics.

214
Q

How does COVID-19 impact the heart?

A

When lungs aren’t working properly, the heart has to work harder to pump blood, which puts a lot of stress on the heart for people already livign with heart disease, diabetes, high blood pressure, or previous strokes.

215
Q

What are the complications of COVID-19 during and after recovery?

A

High incidence of stroke
More severe, longer deliriums
Longer, more complicated recoveries
COVID crash - Make it out of critical care then rapidly deteriorate
Brachial plexus injuries due to proning in ICU

OCCTH 584 (10 decks)

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