Cardiopulmonary Flashcards
Right vs. Left side of Heart
Right = pumps blood from body to lungs Left = simultaneously pumps blood from lungs to body
Venous system
Blood flows TO the heart in veins. Enters right atrium, which squeezes into the right ventricle. Right ventricle contracts to send blood to lungs, CO2 exchange for O2, then oxygen-rich blood goes from lungs to left atrium. Left atrium contracts and sends blood into left ventricle, which contracts and sends blood into AORTA for systemic circulation.
Arterial system
Blood travels from AORTA to arteries and through progressively smaller BVs to networks of capillaries, where blood cells exchange O2 for CO2.
Input Valves of Heart
Mitral/Bicuspid (betw left atrium/ventricle) and Tricuspid (betw right atrium/ventricle)
Output Valves of Heart
Aortic Valve (into body from left ventricle) and Pulmonary Valve (into heart from right atrium)
Supplies oxygen-rich blood to heart tissue
Coronary Arteries
• LAD* = left anterior descending (*provides blood to left ventricle, and blockage interrupts blood supply to it; very serious consequences!)
• RCA = right coronary artery
Nodal vs. Purkinje tissue
Nodal = electrical impulses travel on these (from sinoatrial node)
Purkinje = where electrical impulses travel to, in order to cause atria to contract (which then causes ventricles to contract)
Ischemic Heart Disease (Ischemia)
Part of the heart is temporarily deprived of sufficient oxygen to meet demand. Most common cause is coronary artery disease (CAD).
Atherosclerosis
Narrowing of the arterial wall. Caused by platelets gathering/clogging and creating a lesion.
Myocardial Infarction (MI)
Heart attack. When chest pain (angina) cannot be relieved by rest or nitroglycerin. Emergency situation. Heart begins to die, and section of heart becomes damaged. If enough damage, heart stops pumping (CARDIAC ARREST).
OT for persons with Cardiac Compromise:
- Teach signs of fatigue
- Teach when rest breaks are needed
- Teach how to perform activities safely
- After 6 weeks of healing: graded exercise program
Congestive Heart Failure (CHF)
Can be caused by CAD or infections. Heart becomes progressively weaker over time, until heart is unable to pump effectively to meet demand and fluid backs up into lungs/body. Causes SOB, and puts greater workload on heart/further congestion, and enlarged/thickened heart.
• May be prescribed diuretics or low-sodium diet
• CHF cannot be cured, but can be managed with diet/meds/rest
Classes of Heart Disease
Class I: cardiac disease but no limits to physical activity. No undue fatigue, palps, dyspnea, angina
Class II: Cardiac disease with slight limits to activity; comfortable at rest; less than ordinary activity causes above.
Class III: Cardiac disease with marked limits to activity; comfortable at rest; less than ordinary activity causes above.
Class IV: Cardiac disease with inability to carry out physical activity without discomfort; symptoms of cardiac insufficiency or angina even at rest; discomfort increases with any activity.
Atrial Fibrillation
Irregular and ineffective contractions of both atria, often caused by volume overload. Blood clots (emboli) may develop as heart/blood flow slows.
Potential Outcomes of MI
- Arrhythmia (90% of cases)
- Heart failure
- Blood clots (thrombosis, embolism)
- Aneurysms
- Rupture of part of the heart muscle
- Inflammation of the sac around the heart (pericarditis)
- Death
Balloon Angioplasty
Common surgical procedure to correct circulatory problems associated with CAD.
Percutaneous Transluminal Coronary Angioplasty (PTCA) = catheter into femoral artery guided into coronary arteries, pinpoint lesion, balloon inflates to push plaque against artery wall, and then is removed. May include a stent.
Coronary Artery Bypass Graft (CABG) = If lesion is diffuse or PTCA reoccludes; diseased section of coronary arteries bypassed with healthy BVs (taken from other parts of body). Usually done through open chest surgery (sternotomy). Requires sternal precautions 6-8 weeks. High 10-year survival rate.
Implantable Cardioverter-Defibrillator (ICD)
Treats cardiac arrhythmias; paces heart muscle and delivers high-energy impulse to reset heart if dangerous arrhythmias develop.
Cardiac Ablation
Destroys small areas of heart that are emitting dangerous signals to cause irregular contractions. Tissue destroyed with electrical impulse.
Ventricular Assistive Devices (VADs) or Total Artificial Hearts
Option for end-stage heart failure or extremely sick waiting for transplant. Surgically-implanted mechanical circulatory support device; pumps blood mechanically; battery pack worn externally.
Phase 1 of post-MI tx
Inpatient Cardiac Rehabilitation
• monitored low-level physical activity
• self-care
• reinforcement of cardiac and post-surgical precautions
• energy conservation
• graded activity
• guidelines for appropriate activity levels at d/c
Phase 2 of post-MI tx
Outpatient Cardiac Rehabilitation
• begins at d/c
• exercise can be advanced while closely monitored on outpatient basis
• may be treated at home if not strong enough for outpt
Phase 3 of post-MI tx
Community-based exercise program
Borg Rate of Perceived Exertion Scale
Pt rates exertion after an activity based on this scale.
6 = no exertion felt
19 = extremely strenuous, like most strenuous thing person ever did
Sternal Precautions
To prevent trauma to new graft sites, incisions and sternum; lasts about 8 weeks after surgery:
• Do not lift more than 8 lbs
• Do not push/pull with arms when getting into/out of bed or chair
• Do not bring elbows above shoulders
• Avoid twisting and deep bending
• Hug a pillow when coughing or sneezing
• Do not drive until cleared by surgeon
• Report clicking or popping noises to surgeon
- May vary by location/surgeon/etc.
Ways to evaluate cardiovascular system response to work
- HR (pulse)
- BP (stethoscope)
- Rate-Pressure Product (RPP)
- ECG readings
Chronic Lung Diseases
- COPD (emphysema and/or chronic bronchitis)
- Sarcoidosis
- Asthma
- Idiopathic Pulmonary Fibrosis
- Cystic Fibrosis
Pulmonary Rehabilitation Guidelines
- Low- and high-intensity exercises are beneficial (higher is better)
- Arm exercises should be unsupported, against gravity, no resistance
- Leg exercises should be included
- Supplemental oxygen is helpful during rehab exercise
Dyspnea Control Postures
Reduce breathlessness with posture:
• Seated, pt bends forward slightly at waist while supporting upper body on table/thighs
• Standing, pt leans forward and props on a counter or shopping cart
Pursed-Lip Breathing (PLB)
Prevents tightness in airways by providing resistence to expiration. Improves air movement, releases trapped air, helps keep airways open.
1) Relax neck/shoulder muscles
2) Inhale slowly through nose for count of 2
3) Purse lips as if to whistle
4) Exhale slowly to count of 4
* Use when bending, lifting, or stair climbing
Diaphragmatic Breathing
Increases use of diaphragm to improve chest volume; place small book on base of sternum as a cue of diaphragmatic movement when breathing; inhale to raise book, exhale to lower through pursed lips.
Relaxation Techniques
Progressive muscle tensing/relaxing of body parts with breathing exercises can decrease anxiety and SOB.
Other tx options for Pulmonary Rehab
- PT chest expansion exercises
- Percussion/postural drainage to loosen secretions
- Vibration during expiration to loosen secretions
- Exhale with exertion (instead of holding breath/straining)
- Watch environment for humidity, pollution, extreme temps or stagnant air
What to look for in Cardiopulmonary pt interview
- signs of anxiety
- SOB
- confusion
- difficulty comprehending
- fatigue
- abnormal posture
- reduced endurance
- reduced ability to move
- stressful family dynamics
Metabolic Equivalent (MET)
Amount of oxygen required per kilogram of body weight. Lowest amount (bed rest) is 3.5 mL O2/kg body weight, or 1 basal MET. (Dressing = 2.5 METs, etc.)
Heart Rate (HR) – Appropriate vs Inappropriate response
Appropriate: increases with activity NO MORE than 20 beats/min above resting HR
Inappropriate: MORE than 20 beats/min above resting HR with activity; greater/equal 120, or drops/doesn’t rise with activity.
Blood Pressure (BP) - Appropriate vs Inappropriate response
Appropriate: Systolic BP rises with activity.
Inappropriate: SBP greater/equal 220 mm Hg postural hypotension (greater/equal 10-20 mm Hg drop in SBP, decrease in SBP with activity)
Signs and Symptoms - Appropriate vs Inappropriate response
Appropriate: Absence of adverse symptoms
Inappropriate: Excessive SOB; angina; nausea; vomiting; excessive sweating; extreme fatigue (rate of perceived exertion greater/equal 15); cerebral symptoms
