Cardiopulmonary Flashcards
Acute coronary syndrome
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)
Myocardial infarction
lack of blood flow leading to tissue death (heart attack)
Congestive heart failure (CHF)
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)
Cardiomyopathy
75% cases dilated: enlarged heart, decreased pumping and leads to CHF
*can be caused by many things
Atrial fibrillation (afib)
abnormal heart rythm which usually leads to CHF
* increase risk of clots
Hypertension (HTN)
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
(CHF) coronary artery disease or coronary heart disease
buildup of plaque on wall of vessels
bypass surgery or CABG
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
Sternal precautions
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
COPD
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
respiratory arrest
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.
Post op ICU
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.
OT eval & treat
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
OT eval & treat
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).
What are METS and how are they used
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
What is cardiac rehab
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
cardiac rehab candidates
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
Not candidates for cardiac rehab
more complex/at risk Overt CHF unstable angina (chest pain) serious arrythmia uncontrolled HTN
What are general exercise precautions for the cardiopulmonary population
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
exercise guidelines
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)
