Cardiovascular and Pulmonary Rehab Flashcards
Coronary Artery Disease (CAD) is also known as?
coronary atherosclerotic disease
What are parts of the anatomy of the heart?
- Left and Right Ventricles
- Left and Right Atriums
- Coronary Arteries
- Aorta
- Vena Cava
- Pericardium
- Myocardium
- Endocardium
- Valves
- SA node-pacemaker in right atrium
- P, QRS, T wave
T or F: Current estimates are that 1 in 2 have some type of cardiovascular disease
False; Current estimates are that 1 in 3 have some type of cardiovascular disease
T or F: Cardiovascular disease ranks first among all disease categories
True
T or F: Rehabilitation must be prepared to safely accommodate for the effects of dynamic changes into his or her evaluation and plan of care.
Rehabilitation must be prepared to safely accommodate for the effects of dynamic changes into his or her evaluation and plan of care –Pathologic –Physiologic –Medical –Surgical
What are some controllable risk factors?
•Smoking and tobacco use •Hypercholesterolemia (High blood cholesterol) •Hyperlipidemia (High blood lipids) –Ratio of LDL to HDL •HTN •Triglycerides •Physical inactivity •Obesity •Diabetes •Stress (Life change scale) –Eustress –Distress
What is the name of “good stress”?
Eustress
What are some predisposing risk factors?
•Physical inactivity •Obesity •Body mass index >30 kg (66 lbs) •Abdominal obesity –Men >40 in –Women >35 in •Family History of premature heart disease •Psychosocial factors •Job strain •Ethnic characteristics
What are some major independent risk factors?
•Smoking
•Hypertension (2 x greater chance for MI)
–HTN > 140/90
•Elevated serum cholesterol /total (LDL and HDL)
•Decreased high-density lipoprotein cholesterol (HDL)
–Normal total cholesterol level less than200 mg/dL
–LDL level below 100 mg/dL
•Diabetes mellitus
T or F: Blood pressure at 120/80 is normal.
False; 119/79 or below is normal. 120 is considered prehypertension.
What are some common diagnostic studies for heart disease?
•Blood tests
–CK- MB is an enzyme that shows up in the blood within 4-6 hours
–Troponin is a structural protein whose levels rise with heart damage after 3-6 hours
•Stress Echocardiogram
–Treadmill test
•Nuclear Stress Test
–Treadmill test done with radio active isotope
•Thallium Stress Test
•Electrocardiogram (ECG)
•Echocardiography (Cardiac echo)
•Chest X-ray
–Diagnostic for enlarged heart (CHF)
•Cardiac Catheterization (Coronary Angiography)
–Use of a catheter inserted into the blood vessel and dye is injected into coronary blood vessel
T or F: Heart disease is the leading cause of death for both men and women. Half of the deaths due to heart disease in 2009 were men.
True
T or F: Coronary heart disease is the most common type of heart disease. In 2009, 370,000 people died from coronary heart disease.
True
T or F: Every year about 525,000 Americans have a first heart attack. Another 210,000 who have already had one or more heart attacks have another attack.
True
T or F: In 2009, 610,000 people died of heart disease. Heart disease caused 26% of deaths—more than one in every four—in the United States.
True
T or F: In 2010, heart disease will cost the United States $316.4 billion. This total includes the cost of health care services, medications, and lost productivity.
True
What are some CAD signs and symptoms?
•Chest pain –radiation to left side •Shortness of breath •Nausea •Vomiting •Palpitations •Sweating •Women may experience more fatigue symptoms •Can also be silent
What is a reversible ischemic process caused by the temporary inability of coronary arteries to supply sufficient oxygenated blood to cardiac muscle?
Angina pectoris
The frequency of angina pectoris attacks depends on what?
Frequency of attacks depends on degrees of insufficiency, effectiveness of treatment and personality of individual
What are some of the signs and symptoms of angina pectoris?
–Sudden anterior chest pain
–Pressure sensation
–Burning in throat or jaw
–Discomfort between shoulder blades & shortness of breath
What is a multi-step process of the depositing of fatty streaks or plaques on artery wall?
CAD
T or F: Presence of these deposits eventually leads to arterial wall damage and sclerosis
True
What is the general term referring to a thickening of the arteries?
Atherosclerotic Heart Disease Atherosclerosis (ASHD)
What is a loss of elasticity to the arteries referred to?
Atherosclerotic Heart Disease Atherosclerosis (ASHD)
T or F: Atherosclerotic Heart Disease Atherosclerosis (ASHD) doesn’t lead to MI (Myocardial Infarction).
False; Atherosclerotic Heart Disease Atherosclerosis (ASHD) can lead to MI
What is the scientific name for heart attack?
Myocardial Infarction
T or F: A myocardial infarction is caused by an interruption of blood supply to part of the heart causing some of the heart cells to die
True
T or F: A myocardial infarction is due to an occlusion of an coronary artery secondary to a build up of plague resulting in ischemia causing tissue death
True
What is part of the medical management?
•Coronary Artery Bypass Graft (CABG) –Sternotomy •Angioplasty –Cardiac Catheterization with/without stent placement •Cardioversion •Cardiac pacemaker –Left side ROM limited secondary to PPM •Cardiac transplant •Valve replacement –Will require medication to prevent blood clots •Medications •Oxygen
What are two types of medical interventions?
Valve Replacement and Pacemaker, Coronary Artery Bypass Graft (CABG)
What are some OT considerations you should have with a Coronary Artery Bypass Graft?
•S/P CABG patient will need to brace chest/ sternum
•Usually done with a pillow (cough, sneeze, laugh)
•Follow MD guidelines make
the patient is hemodynamically
stable to resume therapy
•ROM
What is congestive heart failure (CHF)?
The inability of the heart to function as an effective pump.
T or F: In a CHF, the heart becomes stretched beyond its ability to contract efficiently
True
T or F: CHF is a condition where any of the four chambers of the heart lose its ability to keep up with the amount of blood that is flowing through the heart
True
CHF is also referred to as ?
Heart failure
What are some of the signs and symptoms of CHF?
•Increase in weight of 2-5 pounds over several days •Inability to sleep •Persistent dry hacking cough •Shortness of breath with normal activity •Swelling on ankles or feet •Swelling of the abdomen •Fatigue Signs •Cold, pale possibly cyanotic extremities •Weight gain •Peripheral edema •Hepatomegaly •Jugular venous distention •Crackles (rales) •Sinus Tachycardia •Decreased physical work capacity Symptoms •Dyspnea •Tachypnea •Paroxysmal nocturnal dyspnea •Orthopnea •Cough •Fatigue
What are some things you can do for cardiac rehabilitation?
- Multidisciplinary in nature
- Help reduce risk factors
- Modify activities of daily living
- Lifestyle change and psychosocial implications
- Patients often have other co- morbidities
- Three phased approach
T or F: Cardiac rehab is a four phased approach.
False; it is three phased approach
The first phase of cardiac rehab occurs when?
during inpatient hospitalization
What do you do in the first phase of cardiac rehab?
•Prevent muscle loss from bed rest
•Monitor ability to function
•Instruct on appropriate home activities
•Educate about individual/client risk factors
•Teach methods to reduce these risks
•MET level 2-4
•Assessment included review of lifestyle
–OTPF
•Begins as one to one treatment and can progress to group treatment if patient is stable
•Closely monitor response to exercise
•Most hospitals will have a clinical pathway depending on the type of cardiac event
Whats is METs used for?
Unit of measure to describe the amount of oxygen the body needs of given activities
What do the numerical values in MET mean?
•1 METS is consumption at rest
•1.0-2.5 METS
–Sweeping floors, table setting, making bed, moving lawn with riding mower, dishwashing
•2.6-4.0 METS
–Child care, bathing, walk , raking lawn
•4.0-6.0 METS
–Major house cleaning, moving furniture, cleaning gutters, weeding
•6.0-10 METS
–Carrying groceries upstairs, shoveling more than 16 lbs per minute, running
The second phase of cardiac rehab occurs where?
Outpatient based rehab
The second phase of cardiac rehab occurs when?
Occurs 1-2 weeks after discharge from hospital; runs 3 days a week for 4-8 weeks.
What are some of the goals of phase 2 for cardiac rehab?
–Continue assessment of cardiovascular response
–Limit the physiological and psychological effects of heart disease
–Reduce risk factors
–Maximize psychosocial and vocational status
T or F: Medicare covers for approved diagnosis
True
T or F: The phase II includes a multifaceted exercise program and education
True
What assessments are used in phase II of cardiac rehab?
•SF-36 (Eight measures)
–physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role emotional and mental health
•Borg RPE (Rate of perceived exertion scale)
•Working to increase a patients MET level
•Increasing MET level increases the number of activities they can potentially do
–5-6 METS
T or F: Phase III of cardiac rehab is community-based.
True; it has a larger group format
T or F: Phase III is a “benefit” under insurance.
False; it is not usually a “benefit” under insurance
T or F: There is more supervision in phase III.
False; there is less supervision
What are some places phase III can be located?
Locates in community hospitals, YMCA’s, health clubs
What professionals are phase III run by?
usually by exercise physiologists
What are some basic treatment concepts for patients with cardiac dysfunction?
•There is a linear relationship between HR and work
•20-30 beat increase from the resting value is usually safe
–Except when patient is on beta blockers
•Watch for disproportionate HR and increased recovery time with ADL’s
•HR can not be used in transplant patients
•Monitor BP
•Monitor pain response/ RPE (rating of perceived exertion)
•Notify MD if any recognizable symptoms of cardiac decompensation develop
What are some of the effects CHF may have on occupational performance?
•Muscle tone, strength and activity tolerance
•Cognitive changes
•Anxiety and Depression
•ADL’s
–Return to sexual activity if a person can walk up and down 2 flights without symptoms
•Work
•Leisure Activities
T or F: Chronic Obstructive Pulmonary Disease (COPD) is the 10th leading cause of death in US
False; it’s the fourth leading cause
T or F: It is chronic and 75% percent of persons with COPD say it limits their ability to do normal exertion
True
COPD include what three conditions?
It includes:
– Emphysema
–Chronic bronchitis
–Asthma
What is COPD?
Refers to a group of diseases that cause airflow blockage and breathing-related problems.
What is the key factor in the development and progession of COPD in the US?
In the United States, tobacco use is a key factor in the development and progression of COPD, but asthma, exposure to air pollutants in the home and workplace, genetic factors, and respiratory infections also play a role.
What is the key factor in the development and progession of COPD in the developing world?
In the developing world, indoor air quality is thought to play a larger role in the development and progression of COPD than it does in the United States.
What are some signs and symptoms of COPD?
•Dyspnea •Fatigue •Cough •Sputum production •Accessory muscle use (Use of shoulder musculature to compensate for lack of inspiratory pressure –Sternocleidomastoid, peck major/ minor and scalene •Depression •Weight gain with use of steroids
Incidence and Prevalence of COPD
•The CDC reports that the number of deaths related to COPD per 100,000 in 2006
–Males at 46.4
–Females at 35.3
•Males show a decrease of 11.0 since 1999
•Females no decrease
•NJ smoke free air act, 2006
What is part of the medical management of COPD?
- Treatment of COPD requires a careful and thorough evaluation by a physician.
- The most important aspect of treatment is avoiding tobacco smoke and removing other air pollutants from the patient’s home or workplace.
- Symptoms such as coughing or wheezing can be treated with medication.
- Respiratory infections should be treated with antibiotics, if appropriate.
- Patients who have low blood oxygen levels in their blood are often given supplemental oxygen.
T or F: Coughing and wheezing cannot be treated with medication.
False; it can
T or F: The most important aspect of treatment of COPD is avoiding tobacco smoke and removing other air pollutant from the patient’s home and workplace.
True
T or F: Oxygen is a form of medication
True
T or F: Patients who have low blood oxygen levels in their blood are often given supplemental oxygen.
True
What is emphysema?
- Progressive and irreversible destruction of the alveoli walls which causes the lungs to loose elasticity
- Alveoli are unable to hold their functional shape during exhalation
What is chronic bronchitis?
- Excessive sputum production and cough of at least 3 months duration at least 2 years in row
- Patient experiences sudden SOB and may cough or wheeze
- Tachypnea with prolonged expiratory phase
- Accessory muscle use
What is asthma?
•Inflammatory process that causes the bronchial tubes to spasm, narrowing the airway
•This inflammation causes the bronchial tubes to increase their production
–Smooth muscle constriction
–Mucus production (without infection)
T or F: Asthma is associated with
•Shortness of Breath (SOB)
•Wheeze or cough
True
What are some symptoms of asthma?
•Can have cardiopulmonary complications –Arrhythmia –Heart failure –Cardiac arrest •Tachypnea •Fatigue •Cyanosis
what are some of the OT goals and assessment?
•Promote independence on ADL’s
•Maximizing gas exchanges
– Improve ventilation and airway clearance
•Increasing aerobic capacity
•Increasing respiratory muscle endurance with ADL’s
•Increase patient’s knowledge of condition
•Improve energy conservation and work simplification
•Education in stress management
what are some of the OT interventions of COPD?
•Breathing techniques –Pursed lip breathing –Diaphragmatic breathing •Upper extremity function •Work Simplification and Energy simplification •Self enhancement •Stress management •ADL training –Use of adaptive equipment
