Cardiovascular and Pulmonary Disorders

Question 1

Myocardial infarction symptoms

Answer 1

• severe substernal pain for more than 20 minutes
• dyspnea
• indigestion, nausea, vomiting
• pain unrelieved by rest (unstable angina)
• more likely to happen to women

Question 2

left-sided heart failure symptoms

Answer 2

• tachycardia (high heart rate /over 100)
• dyspnea
• decreased endurance
• weakness
• fatigue

Question 3

right-side heart failure symptoms

Answer 3

• poor peripheral ciriculation
• LE edema
• decreased endurance
• decreased mobility

Question 4

NY Heart Association Functional Classification

Answer 4

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

Question 5

primary muscles of inspiration

Answer 5

diaphragm, intercostals

Question 6

accessory muscles of inspiration

Answer 6

• used when deeper inhalation is required
• strenocleidomastoid
• scalenes
• pecs
• trapezius

Question 7

pneumonia

Question 8

COPD symptoms

Answer 8

• 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

Question 9

Interventions for COPD

Answer 9

• prevention
• smoking cessation
• annual flu shot
• routine exercise program

Question 10

Eval for cardiopulmonary conditions

Answer 10

• impact of symptoms on functional performance
• pain/angina
• dyspnea
• fatigue
• palpitations (hearth rhythm)
• dizziness
• edema

Question 11

sternal precautions

Answer 11

• 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

Question 12

primary prevention

Answer 12

would be things such as a health fair or lecture

Question 13

secondary prevention

Answer 13

• where we can cease or slow down the progression of patients’ diseases by addressing their risk factors

Question 14

Borg scale

Answer 14

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

Question 15

signs of cardiac distress

Answer 15

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

Question 16

phases of cardiac rehab

Answer 16

• 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

Question 17

MET levels 1-2

Answer 17

1- Resting in bed
1.5- 2- easy activities while seated (eating, bed to chair transfers, washing face, brushing hair, drawing, knitting)

Question 18

MET levels 2-3

Answer 18

Seated activities that require minimal effort (dressing/undressing, sponge bath while seated), dusting, dishwashing, vacuuming)

Question 19

MET levels 3-4

Answer 19

Lighter work without exertion ( standing in warm shower, making bed, mopping, sweeping, seated on toilet)

Question 20

MET levels 4-5

Answer 20

Lighter activities (hot shower, raking, gardening, seated on bed pan)

Question 21

MET level 5-6

Answer 21

sex

Question 22

MET levels 6-7

Answer 22

basketball, skiing, walking w/ assistive devices, jogging, bicycling

Question 23

Pulmonary conditions

Answer 23

Chronic obstructive pulmonary disease (COPD) Emphysema
Bronchiectasis
Asthma
Cystic fibrosis
Sarcoidosis

Question 24

symptoms for pulmonary conditions

Answer 24

-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

Question 25

intervention approach for pulmonary conditions

Answer 25

- 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

Question 26

example of modifications for pulmonary conditions

Answer 26

- 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)

Question 27

eval for lymphatic drainage

Answer 27

- occupational based assessments - biomechanical assessments (UE ROM and MMT, pain, activity tolerance, endurance and edema)

Question 28

Lymphedema

Answer 28

Lymphedema is a chronic edema that results when a permanent mechanical obstruction of the lymphatic system creates a lymphatic overload.

Question 29

palpation sites for vitals

Answer 29

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

Question 30

Heart Rate

Answer 30

normal for adult- 60-100 bpm normal for infant- 120 bpm tachycardia- over 100 bpm bradycardia- less than 60 bpm

Question 31

Phase 1- Inpatient Rehab (Acute) Stage objectives

Answer 31

- 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

Question 32

Phase 1- Inpatient Rehab (Acute) Stage eval and intervention

Answer 32

- 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

Question 33

Phase 1- Inpatient Rehab (Acute) Stage precautions

Answer 33

- avoid isometric exercises - avoid overhead exercises - avoid lateral arm exercises and exercises that stretch chest

Question 34

Phase 2- Outpatient Rehab (Subacute) Stage focus

Answer 34

- educate on the importance of exercise - build up activity tolerance - improve ability to perform IADLs , work activities and community tasks - lifestyle changes

Question 35

Phase 3- Maintenance Stage

Answer 35

- community activities - maintenance gym program - weight training - cardiovascular training

Question 35

Phase 2- Outpatient Rehab (Subacute) Stage eval and intervention

Answer 35

- 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

Question 35

CPR guidelines

Answer 35

CAB- Compression, Airway and Breathing