Cardiovascular and Pulmonary Disorders Flashcards
Myocardial infarction symptoms
- severe substernal pain for more than 20 minutes
- dyspnea
- indigestion, nausea, vomiting
- pain unrelieved by rest (unstable angina)
- more likely to happen to women
left-sided heart failure symptoms
- tachycardia (high heart rate /over 100)
- dyspnea
- decreased endurance
- weakness
- fatigue
right-side heart failure symptoms
- poor peripheral ciriculation
- LE edema
- decreased endurance
- decreased mobility
NY Heart Association Functional Classification
Class 1- no limitation in physical activity
Class 2- slight limitation of physical activity
Class 3- marked limitation of physical activity
Class 4- inability to carry on any physical activity without discomfort
primary muscles of inspiration
diaphragm, intercostals
accessory muscles of inspiration
- used when deeper inhalation is required
- strenocleidomastoid
- scalenes
- pecs
- trapezius
pneumonia
COPD symptoms
- complaint of dyspnea on exertion
- wheezing, diminished breath sounds
- pursed lip breathing
- enlarged chest (barrel chest)
- use of accessory muscles for breathing
- forward-leaning posture
- chronic cough
Interventions for COPD
- prevention
- smoking cessation
- annual flu shot
- routine exercise program
Eval for cardiopulmonary conditions
- impact of symptoms on functional performance
- pain/angina
- dyspnea
- fatigue
- palpitations (hearth rhythm)
- dizziness
- edema
sternal precautions
- No lifting objects > 8 lbs
- No pushing or pulling with UEs
- Elbows should not go above shoulders
- Avoid twisting/bending deeply
- Do not drive
- Use pillow when coughing & sneezing
- Do not reach behind back
primary prevention
would be things such as a health fair or lecture
secondary prevention
- where we can cease or slow down the progression of patients’ diseases by addressing their risk factors
Borg scale
6 no exertion
9 very light exertion (slow walk)
13 somewhat hard but feeling alright to continue engaging
15 hard, but if you continue it’s not too difficult
17 very hard/strenuous, have to push to engage & you are very fatigue
19 extremely strenuous activity
20 max exertion
signs of cardiac distress
Angina- chest pain
Dyspnea- shortness of breath
Orthopnea- dyspnea while supine
Nausea/vomiting
Diaphoresis- clammy skin and cold
Fatigue
Orthostatic- drop in BP due to change in position going from supine>sit or sit>stand
- It’s important we also monitor the patient’s response to activity by monitoring their heart rate and blood pressure constantly
phases of cardiac rehab
- 1-3 days post-heart attack (acute phase) stabilizing their condition
- Phase 1 -inpatient rehab (monitored lower level activity) (MET level 1-2)
- Phase 2- outpatient rehab (begins at discharge, exercise can be increased) (MET level 4-5)
Phase 3- community-based program
MET levels 1-2
1- Resting in bed
1.5- 2- easy activities while seated (eating, bed to chair transfers, washing face, brushing hair, drawing, knitting)
MET levels 2-3
Seated activities that require minimal effort (dressing/undressing, sponge bath while seated), dusting, dishwashing, vacuuming)
MET levels 3-4
Lighter work without exertion ( standing in warm shower, making bed, mopping, sweeping, seated on toilet)
MET levels 4-5
Lighter activities (hot shower, raking, gardening, seated on bed pan)
MET level 5-6
sex
MET levels 6-7
basketball, skiing, walking w/ assistive devices, jogging, bicycling
Pulmonary conditions
Chronic obstructive pulmonary disease (COPD) Emphysema
Bronchiectasis
Asthma
Cystic fibrosis
Sarcoidosis
symptoms for pulmonary conditions
-orthopnea- shortness of breath while supine
- dyspnea- shortness of breath; dyspnea on exertion is seen when the patient has SOB with engaging in activity
- tachypnea- increased respiratory rate
- apnea- pauses in breathing
- hypoxia- decreased oxygen in the body
- hypoxemia- decreased oxygen in the blood anoxia no oxygen
- Wheezing
- Cheyne-Stokes respiration- increased respirations with moments of apnea
- Respiratory arrest- patient stops breathing
intervention approach for pulmonary conditions
- Monitor their vital signs at all times
- Modify activities if you see their oxygen saturation levels go below 90%
- Promote engagement in activity as tolerable
- Avoid resistive exercises with those who had a thoracotomy or sternotomy
- Adhere to any aspiration or swallowing precautions they have in place
example of modifications for pulmonary conditions
- Avoiding tight clothing due to possible restricting the trunk & chest area
- Using AE as needed (ex: LB dressing equipment)
- Sitting to take a bath
- Sitting to complete meal prep
- Reorganizing commonly used items to be in a central location (ex: kitchen utensils in one area)
eval for lymphatic drainage
- occupational based assessments
- biomechanical assessments (UE ROM and MMT, pain, activity tolerance, endurance and edema)
Lymphedema
Lymphedema is a chronic edema that results when a permanent mechanical obstruction of the lymphatic system creates a lymphatic overload.
palpation sites for vitals
radial
- THE MOST COMMON MONITORING SITE
- radial wrist at base of thumb
temporal
- superior and lateral to eye
carotid
- on either side of anterior neck between strenocleidomastoid and trachea
- BEST REFLECTS CARDIAC FUNCTION
brachial
- medial aspect of antecubital fossa
- USED TO MONITOR BLOOD PRESSURE
Heart Rate
normal for adult- 60-100 bpm
normal for infant- 120 bpm
tachycardia- over 100 bpm
bradycardia- less than 60 bpm
Phase 1- Inpatient Rehab (Acute) Stage objectives
- patient/family education on disease process and recovery (energy conservation, work simplification, MET levels)
- improve ability to perform self-care activities and low-level functional activities
- decrease anxiety
- risk factor modification
- discharge to home
Phase 1- Inpatient Rehab (Acute) Stage eval and intervention
- started bedside with functional assessment of self-care and mobility
- begin with activities at MET level 1-2
- bed mob, static standing
- transfer from bed to chair
- bed bath, feeding, grooming at sink in sitting
- AROM, warm-up exercises
- wheelchair mob/ambulation in room
- vitals monitored before, during and 4-5 min after activity
- move to Phase 2 when they able to perform activities at MET level 3.5
- LOS is 5-14 days
Phase 1- Inpatient Rehab (Acute) Stage precautions
- avoid isometric exercises
- avoid overhead exercises
- avoid lateral arm exercises and exercises that stretch chest
Phase 2- Outpatient Rehab (Subacute) Stage focus
- educate on the importance of exercise
- build up activity tolerance
- improve ability to perform IADLs , work activities and community tasks
- lifestyle changes
Phase 3- Maintenance Stage
- community activities
- maintenance gym program
- weight training
- cardiovascular training
Phase 2- Outpatient Rehab (Subacute) Stage eval and intervention
- home eval
- family education
- graded exercise program w/ slow and gradual increase of weight
- begin with MET level 4-5
- perform functional activities in discharge environment
community activities - work site eval
CPR guidelines
CAB- Compression, Airway and Breathing
