Cardiopulmonary Rehab & GI System & Ca

Question 1

MET

Answer 1

Metabolic Equivalent of Task (MET) > physiological measure expressing the energy cost of physical activities; Must take into consideration phys status, act patterns, reported exertion level

Question 2

Energy conservation & work simplification techs

Answer 2

Pacing, monitor body position, organization of daily activities and work areas, delegate responsibilities

Question 3

Abdominal diaphragmatic breathing & PLB

Answer 3

Strengthen diaphragm, decreases need to use neck/shoulder muscles, decreased energy required for activity & controls resp rate/helps remove trapped air from lungs

Question 4

Absolute Contraindications for Cardiac Rehab

Answer 4

Acute MI (w/in 2 days), unstable angina, uncontrolled cardiac arrhythmia, acute PE or pulmonary infarction, acute pericaditis/myocarditis or acute aortic dissection

Question 5

Relative Contraindications for Cardiac Rehab

Answer 5

L main coronary stenosis, mod stenotic valvular heart disease, electrolyte abnorm, severe arterial HTN, tachyarrhythmias or bradyarrhythmias, hypertophic cardiomyopathy/other outflow occlusions, mental/phys impairment leading to inability to exercise adequately or high-degree atrioventricular block

Question 6

CAB

Answer 6

Compressions - Airway - Breathing; exception is newborn babies (30:2)

Question 7

CF

Answer 7

Gentically inherited autosmal recessive trait - both parents must be carriers. Life span 30s-40s and sometimes more.

Question 8

CF Eval

Answer 8

Assess for developmental delays related to decreased strength & endurance & decreased attn d/t pain. Assess environment w adaptions for energy conservation. Assess psychological status.

Question 9

CF Tx

Answer 9

Energy conservation, environmental adaptations, position to promo postural drainage, NDT to improve endurance/postural stability, facilitation of fine, gross, visual, cog and psychosoc development, parent edu including advocacy skills, tx protocols & teacher edu including energy con techs, encourage phys act, playground precautions, observe medical precautions

Question 10

RDS

Answer 10

Resp Distress Syndrome. D/t premature birth. Characterized by insuff production of surfactant to keep alveoli (lung air pockets) open > lungs collapse after each breath

Question 11

RDS Tx

Answer 11

Monitor development, facilitate sensori-motor/cog development, address psychosco issues, parent edu regarding handling, positioning, energy con & methods to facilitate norm development, adapt environment as needed, observe medical precautions, referral as necessary

Question 12

Bronchopulmonary Dysplasia (enlargement of organ)

Answer 12

Resp dx often as a result of barotrauma: High inflating pressures, infection, meconium aspiration, asphyxia. Complication of prematurity. Walls of immature lungs thicken, making exchange of O and CO2 more difficult. Mucus lining & airway diameter reduced > months/years of O therapy and artificial ventilation

Question 13

Bronchopulmonary Dysplasia Tx

Answer 13

facilitate sensori-motor/cog development, address psychosco issues, parent edu regarding feeding, positioning, energy con & adapt environment as needed, observe medical precautions

Question 14

Praxis Deficits of Gastrointestinal System

Answer 14

Inability to effectively chew & coordinate tongue mvmts to propel bolus to base of tongue, residual food centrally located in oral cavity, diff w bolus formation

Question 15

Sensory Impairments of Oral Cavity

Answer 15

Lack of awareness of residual food > pocketing food & spillage into airway when vocal cords are open > choking

Question 16

Weakness of Tongue/Base of Tongue Structures

Answer 16

Insufficient propulsion of bolus to pass base of tongue into pharyngeal cavity; Lack of closure at cricopharyngeal junction > interference w normal timing of swallowing sequence

Question 17

Vocal Cord Paralysis

Answer 17

Insufficient closure of vocal folds during pharyngeal phase of swallow > if vocal cord fail to meet/close to protect airway, aspiration could occur

Question 18

Diminished Esophageal Motility (muscle contraction to move food)

Answer 18

Bolus sits in esophagus and can slowly either move toward stomach or upward to pharynx > person feels food is stuck in esophagus or aspirates when food propels upward

Question 19

Bedside Swallow Eval

Answer 19

Assess level of alertness, ability to follow instructions, level of awareness of impairment and orientation to activity. Assess sensory/motor components of swallowing. Assess ability to manage own secretions (hearing and clinical observation)

Question 20

Modified Barium Swallow (MBS)

Answer 20

In diagnostic radiology suite (swallow team and radiologist). Pt seated upright - must have adequate balance, supervised at all times. Trial boluses admin laced with barium of puree, thick, solid and thin. Video records moving xray of swallow; if aspirates=test ceases

Question 21

Flexible Endoscopic Esophageal Swallow (FEES)

Answer 21

May be done at beside or in office. Food consistencies laced w green food coloring. Flexible endoscopic catheter containing mini video camera passed thru nasal into pharyngeal cavity.

Question 22

Tx for Gastrointestinal Dx

Answer 22

Provide fam-centered intervention to determine acceptable dinner table interactions. Work w person toward developing new roles/occs to transition from old. Provide ongoing edu/info to fam regarding pt feeding/nutrition. Pyschosoc intervention

Question 23

Gastric Esophageal Reflex Disease (GERD)

Answer 23

Involves lower esophageal/gastric sphincter. Food enters stomach and mixes w stomach acid/digestive juices. Lower esophageal sphincter closes insuff; stomach contraction propels acid/acidic bolus into esophagus >heartburn, indigestion or mild chest pain. Other symptoms: regurgitating, feeling somethings stuck in throat

Question 24

GERD Tx

Answer 24

Test: MBS or Flexible endoscopy. Sleeping w more than 1 pillow for elevation. Drug therapy. Diet mods w less spices, smaller/frequent meals & lower alcohol intake. Stress mngt.

Question 25

Neurogenic Bowel

Answer 25

Sympathetic nerve impairment, generally occurring in pts who have SCI above T-6 level; loss of control of anal sphincter/flaccidity > incontinence. Autonomic dysreflexia can result!

Question 26

Risk Factors of Kidney Disease

Answer 26

DM, HTN, Lupus

Question 27

Tx for Kidney Disease

Answer 27

Prevention & early intervention. Control of HTN/DM, diet, meds, exercise, stress reduction & smoking cessation.

Question 28

Impact of Renal Disease on Client Factors

Answer 28

Motor dysfunction including fatigue, pain, weakness, edema; Nuropathy; Vision loss; Cog dysfunction including delusions/dementia; Anxiety, depression, mood/adjustment d/o

Question 29

Stress Incontinence

Answer 29

Local damage to bladder sphincter associated w aftereffects of bearing children, morbid obesity, weakening of accessory musculature associated w norm aging

Question 30

Tx for Stress Incontinence

Answer 30

Kegels to strengthen pelvic floor, time emptying routines, incont. support garments, meds, potentially e-stim

Question 31

Stage 1 Cancer

Answer 31

Tumor present, no perceived spread of disease; Lesion operable; Prognosis good > not in lymph nodes/no metastatic lesions

Question 32

Stage 2 Cancer

Answer 32

Localized spread of turmor; Lesion is operable/removed w margins; Spread is limited & usually responds well to tx (5yr survival rate=50%)

Question 33

Stage 3 Cancer

Answer 33

Extensive evidence of prim tumor that has spread to other organs; Tumor can be surgically debulked but some cells may remain; Deeper spread of the tumor cells in lymphatics (5yr survival rate=20%)

Question 34

Stage 4 Cancer

Answer 34

Inoperable prim lesion; Survival rate is dependent on depth/extent of tumor spread as well as tumor response tx (Multiple metastases)

Question 35

Pre-op Ca Tx

Answer 35

Fx’al assessments and prep for post op phase/care; Pt/fam edu on recovery/follow up care

Question 36

Post-op Ca Tx

Answer 36

Tx planning based on pt med status and blood level guidelines. Post-op precautions. Hemo levels: Adult males: 14-18 gm/dl - Adult women: 12-16 gm/dl - Elder men: 12.4-14.9 gm/dl - Elder Women: 11.7-13.8 gm/dl

Question 37

Tx for Ca

Answer 37

Rehab of motor, sensory, neurobehavioral & cog impairments; Psychosoc support; Promo of health supporting behaviors

Question 38

Palliative Care for Ca

Answer 38

Prevent/relieve suffering thru early ID, assessment, pain tx; Address physical, psychosoc and spiritual needs; Enhance QOL by supporting engagement in occs; Consider environment/contextual and client factor that could lim abilities/satisfaction; fam collaboration thru whole process

Question 39

Hospice Care for Ca

Answer 39

Support QOL, provide pt w as much control as possible, Be present/accountable/listen/counsel; Encourage planning for death, Empower life celebration/reflection; Refer for legal support if needed