Cardiovascular system and MET levels

Question 1

Blood flow

Answer 1

RA to RV –> lungs for oxygenation –> LA receives oxygenated blood from lungs –> LV –> pumps blood to the body via aorta

Question 2

SA node

Answer 2

pacemaker of the heart
systole (contraction) diastole (relaxation)
controls blood flow and normal perfusion
SA node dysfunction: irregular heart rhythm, atrial fibrillation, and increases risk of stroke

Question 3

arteries

Answer 3

transport oxygenated blood from areas of high pressure to low pressure in body tissues

Question 4

capillaries

Answer 4

blood vessels that connect arteries and veins
exchange nutrients and fluid between blood and tissues

Question 5

veins

Answer 5

transport dark, unoxygenated blood from tissues back to the heart

Question 6

hyperkalemia

Answer 6

increase in potassium usually greater than 5.0 mEq/L to 5.5 mEq/L
produces EKG changes
may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis

Question 7

hypokalemia

Answer 7

decrease in potassium (less than 2.5 mmol/L)
EKG changes, arrhythmias, ventricular fibrillation

Question 8

hypercalcemia

Answer 8

increase in calcium
more than 12 mg/d
increases HR

Question 9

hypocalcemia

Answer 9

decrease in calcium
depresses heart action
less than 8.8 mg/dL
most commonly include paresthesia, muscle spasms, cramps, tetany, circumoral numbness, and seizures.

Question 10

CAD: Atherosclerosis

Answer 10

plaques/lesions on arteries
thickening of blood vessel wall
risk factors: age, fam history, smoking, high BP, high cholesterol, diabetes, obesity, sedentary

Question 11

symptoms of CAD

Answer 11

angina (chest pain) - pressure/ache near left arm and chest
can be stable or unstable

Question 12

myocardial infarction

Answer 12

prolonged ischemia, injury, and death of an area of the myocardium caused by occlusion of 1 or more coronary arteries, leads to necrosis of heart tissue
*pain may be misinterpreted as indigestion
chest pain, dyspnea, nausea (women are more likely to have symptoms mistaken for something else like flu or acid reflux)

Question 13

chronic heart failure (CHF)

Answer 13

• heart is unable to maintain circulation
• causes: CAD, hypertension, congenital heart disease
• left or right sided

Question 14

classification of heart failure

Answer 14

based on functional capacity
Class I - no limitation
Class II - slight limitation with activity, comfort at rest
Class III - moderate limitation
Class IV - inability to do physical activity

Question 15

classes of objective assessment of CVD

Answer 15

Class A - no evidence of cardiovascular disease, no symptoms
Class B - objective evidence of minimal disease, mild symptoms
Class C - moderate - severe disease, marked limitations
Class D - severe disease, symptoms even at rest

Question 16

diagnostic procedures

Answer 16

chest x ray, ECG, holter monitor (ECG over 24 hrs), echocardiogram (ultrasound to see sizes of vessels), stress test, catherization, pulmonary function test

Question 17

interventions for CFH

Answer 17

• dietary and lifestyle (low salt and cholesterol)
• medications to manage specific aspects of cardiac function

Question 18

side effects for OT to be aware of - anticoagulants (blood thinners)

Answer 18

brushing or cuts (may take longer to stop bleeding)

Question 19

side effects for OT to be aware of - beta blockers (reduce HR)

Answer 19

may not have the expected inc in HR/BP during activity
adjust parameters and utilize the rate of perceived exertion (RPE) scales

Question 20

surgical interventions

Answer 20

angioplasty (get rid of obstruction), stents, revascularization, transplant, ventricular devices, pace makers

Question 21

peripheral vascular disease (PVD) - arterial

Answer 21

arterial: occlusive (PAD), inflammatory (Buerger’s)
raynauds (spasm of small arteries, vasoconstriction)

Question 22

s/s PVD

Answer 22

pain (usually LEs)
skin changes
ulcers

Question 23

venous diseases PVD

Answer 23

• varicose veins
• DVTs: can lead to CVA, early mobility is important, leg pumps

Question 24

lymphedema PVD

Answer 24

chronic and progressive disorder
accumulation of fluid from obstructed lymphatics
Stage 0: no visible changes in limbs, slight tingling
Stage 1: reversible, limb is soft and pitting
Stage 2: irreversible, risk for infection
Stage 3: (elephantiasis) extreme, skin changes

Question 25

MET levels

Answer 25

metabolic equivalent levels
determine the energy expenditure required for activity performance

Question 26

<1.5 METs

Answer 26

very light activities
kissing, hugging, folding a towel while seated, knitting, reading

Question 27

1.5 - <3 METs

Answer 27

light activities
grooming while seated, making the bed 1.5
ADLs standing
stretching
putting away groceries
sexual activity 2.8

Question 28

3 - <6 METs

Answer 28

moderate activities
sweeping, vacuuming, changing linens 3.3
meal prep and cooking
moderate yard work
mowing a lawn 5.5

Question 29

6 to <10 METs

Answer 29

vigorous activities
scrubbing a bathroom 6.5
carrying boxes/furniture up stairs 9.0

Question 30

10+ METs

Answer 30

very vigorous activities
cross country skiing
running
swimming

Question 31

rehab for lymphedema

Answer 31

measurement of lymphedema swelling (circumferential girth measurement - volumeter)
short stretch compression bandages (worn 24 hrs/day)
manual lamp drainage - massage and passive range of motion to assist with lymph flow
elevation to drain
low-mod exercise, relaxation, deep breathing
phase 2: self management and daily home program

o Edema not impacted my humidity or time of day, it is what it is
o Volumeter procedure: place arm in and don’t move it because that would impact results

Question 32

Buerger’s disease

Answer 32

also known as thromboangiitis obliterans
affects blood vessels in the body, most commonly in the arms and legs. Blood vessels swell, which can prevent blood flow, causing clots to form. This can lead to pain, tissue damage, and even gangrene (the death or decay of body tissues)

Question 33

grading scale for peripheral pulses

Answer 33

0 - absent pulse
1+ diminished pulse
2+ normal pulse, easily palpable
3+ full pulse, increased strength
4+ bounding pulse

Question 34

grading scale for edema

Answer 34

1+ mild, small indentation, less than 1/4in pitting
2+ moderate, easily identified, returns to normal within 15 sec, 1/2in pitting
3+ severe, 15-20 sec rebound, 1 in pitting
4+ very severe, over 30 sec, 1+in pitting

Question 35

contraindications for lymphedema rehab

Answer 35

no strenuous activities, jogging, ballistic movements, or rotational motions because they will exacerbate lymphedema

pressures >45mmHg are contraindicated (compression pumps - limited benefits)