Cardiopulmonary

Question 1

Acute coronary syndrome

Answer 1

pain or pressure radiating jaw, teeth, arm or mid back

* men and women present differently (women are more likely to go undetected ) have less signs (g.i pain)

Question 2

Myocardial infarction

Answer 2

lack of blood flow leading to tissue death (heart attack)

Question 3

Congestive heart failure (CHF)

Answer 3

heart muscle is stretched beyond ability to contract; ineffective pump (edema, SOB, fatigue, cough or SOB lying down)
*chronic condition, can live for years with it, specialized diet, should be weighed every day b/c storing more fluid)

Question 4

Cardiomyopathy

Answer 4

75% cases dilated: enlarged heart, decreased pumping and leads to CHF
*can be caused by many things

Question 5

Atrial fibrillation (afib)

Answer 5

abnormal heart rythm which usually leads to CHF

* increase risk of clots

Question 6

Hypertension (HTN)

Answer 6

high blood pressure due to narrowing of blood vessels 
*caused by many things 
systolic- 140mm Hg
dyastolic 90 mm Hg 
* 110/70 ideal for MD
*120/80 normal

Question 7

(CHF) coronary artery disease or coronary heart disease

Answer 7

buildup of plaque on wall of vessels

Question 8

bypass surgery or CABG

Answer 8

common
open heart procedure
transfer of donor vein-usually great saphenous from LE
sternotomy precautions for 6-8 wks folloign (determined by MD)

*collateral blood circulation for heart muscle
* Bypass (key hole surgery)
*risky infection
x2- 2 vessels grafted

Question 9

Sternal precautions

Answer 9

no push/pulling (cant use arms at all during transfer; keep arms crossed over chest- rocking motion to increase momentum and get up at 3) no grab bars
no lifting or picking up anything over 5lbs
no more than 90 degrees with arm- no shampooing
no retraction/no hands behind head- one arm at a time d
no driving or closing car door

Question 10

COPD

Answer 10

pulmonary dysfunction
progressive and irreversible destruction of alvelar walls
lungs lose elasticity and air is trapped
decrease air flow during expiration; lung cannot shrink
result of chronic bronchitis and emphsema
#5 cause of death

Question 11

respiratory arrest

Answer 11

may be related to recent surgical procedure, frail health or complex co-morbidities

may lead to anoxia and decline in cognitive processes

**MOCA assesses cog. loss @ rehab/afterwards
respiratory and cardiac issues can affect cog.

Question 12

Post op ICU

Answer 12

mobility
positioning- skin break down (fx position, splinting, towel rolls, cushions, low end devices)
Light ADL’s- oral care, face wash
incentive spirometer- do during rest after transfer to increase vital capacity

* #1 role- mobility
bed mobility - supine to sit 
bed to chair 
get pt. moving as much as possible
increase strength, endurance, cog.

Question 13

OT eval & treat

Answer 13

UE fx- limited to 90 (check to 90 only during UQS)
ADL performance (habits, routines, and roles)
home safety and accessibility- stairs, bathroom, rug/carpeting
endurance- most common -ability to do daily tasks, look at how they are sleeping- energy conservation in context to what their doing (give concrete examples/ look at pacing)
strength- look at during fx task (during oral care)
cog. & insgigh to limitations - monitor life style and chnages/ increase condition- pt education, weigh self everyday, diet
vocational abilities- assess and maniatin
incorporation of precautions (sternotomy) into ADL’s- cog. deficits and precautions look at risk

Question 14

OT eval & treat

Answer 14

Pt. self monitor and pacing ability- SOB, sternal precautions
pyschosocial- support pt; depression under dx- refer out to deal with it- only look at fx components
caregiver ed- know precautions
community re-entry- driving, routines
pt. ed- look at cog- make things clear, remind pt what they done/what they can do

** slide board
energy conservation
take vitals before and after
arm exercise- work heart muscles (dowel or cane/ 10-12 reps; rowing, chest press, side to side, up to 90 degrees, IR/ER) 
purse lip breathing *anxiety 

look at cog and memory 
asses cog: MOCA 
ROM/Passive (look at tightness)- responding to commands (lifting arms)
CAM- delarious/confused
mobility in bed (supine-sit)
look at endurance- EOB (sitting balance)
transfer to JErry chair if pt. shows ability 
watch telemetry machine (manage vitals).

Question 15

What are METS and how are they used

Answer 15

Metabolic Equivalent Level
1 MET= 3.5ML/02/min/kg body weight =oxygen consumption at rest
unit measure of O2 that body needs or a given act.
MET levels depend on skill level of person and environmental factors
Used in cardiac rehab to determine activity tolerance during rehab **

*done on out pt. basis 
good for higher level pt
** how much energy your burning 
- unit of O2 body needs for given task 
set up program

Question 16

What is cardiac rehab

Answer 16

PHASES OF CARDIAC REHAB
phase 1- acute- still in hospital- more stable cardiac pt with decreased co-morbidities
phase 2- out pt. or home health- typically out pt. 4 days/wk
phase 3- community program- once a month for tune ups, programs for diet/DM, health and wellness
phase 4- maintenance- every 6 mo. get weighed, increase ex. program, refer to comm. resources

Question 17

cardiac rehab candidates

Answer 17

post MI
post CABG (have to be stable and done w precautions) 
poor ventricular fxn
cardiomyopathy 
cardiac transplant -when cleared 
elderly-deconditioned 
assymptomatic at-risk population

Question 18

Not candidates for cardiac rehab

Answer 18

more complex/at risk 
Overt CHF
unstable angina (chest pain) 
serious arrythmia 
uncontrolled HTN

Question 19

What are general exercise precautions for the cardiopulmonary population

Answer 19

DVT
unstable angina 
increased BP- can tx if only slightly 
uncontrolled arrythmia-lead to blood clot
active pericarditis- any kind of infection around heart muscle 
temp of 100 or more- infectious process
no isometrics- cardiac pt increased BP
no val salva- breath holding 
no UE over head- sternal precautions 
no lateral UE ex- sternal 
sternal precautions
no driving 

*always be aware of cardiac hx
(SOB, chest pain)
change in pulse, facial color - stop act and rest
observe performance and feeling- use as guidelines (20 min ) if you still feel exhausted and unable to complete tasks after 20 min= to much, if able to continue/do tasks after 20 min= fine

DVT symptoms- redness, hard, swelling, most common in calf muscle, hot, painful
-clot that can travel to heart, lung, or brain can cause major blockage and lead to death
DONT MOBILIZE
-common in bed bound pt, not moving much

Question 20

exercise guidelines

Answer 20

HR- 20-30 bpm above resting - give rest breaks accordingly, watch for SOB, redness, dif talking (vital signs)
BP- 15-20mmHG from resting - stop and rest and re-measure
Monitor SOB, dizziness, chest pain, nausea, diaphoresis (cold,clamy, perspiration, low blood sugar), fatigue
work within MET level prescribed (ask for parameters)