Chapter 8 Cardiovascular and Pulmonary System disorders Flashcards
1
Q
Function of Cardiovascular system
A
- Devlivers oxygen to organs and tissues
- Removes carbon dioxide and other by-products from the body
- Assist with body temperature regulations
2
Q
Layers of heart tissue
- Pericardium
- Epicardium
- Myocardium
- Endocardium
A
- Pericardium - fibrous protective sac enclosing heart
- Epicardium - inner layer of pericardium
- Myocardium - heartmuscle, the major portion of the heart
- Endocardium - smooth lining of the inner surface and cavities of the heart
3
Q
Heart chambers
- Right atrium
- Right ventricle
- Left atrium
- Left ventricle
A
- RA - recieves blood for systemic circulation, during systole(contraction)blood is sent into RV
- RV - pumps blood via the pulmonayr artery to the lungs for oxygenation, low pressure pulmonary pump
- LA - receives oxygenated blood from the lungs, during systole, bood is sent into the left ventricle.
- LV - Pumps blood via the aorta throughout the entire systemic circulation, high-pressure systemic pump
4
Q
Blood flow
A
systemic circulation -> RA->RV->lungs(for oxygenation)->LA->LV->body via aorta
5
Q
Coronary circulation
- Right coronary artery
- Left coronary artery
A
- RCA - supplies right atrium, most of right ventricle, and the inferior wall of left ventricle, atrioventricular node(AV) and bundle of His, 55% supplies the sinoatrial(SA) node
- LCA - supplies most of the left ventricle
- Left anterior descending (LAD) supplies the anterior wall of the left ventricle
- Left circumflex supplies the left anterior and lateral posterior wall fo the left ventricle and 45% of the SA node
6
Q
Ion concentrations
- Hyperkalemia
- Hypokalemia
- Hypercalcemia
- Hypocalcemia
A
- Hyperkalemia - increased postassium ions, decreases the rate and force of contractions and produces EKG changes
- Hypokalemia - decreased potassium ions, produces EKG changes, arrhythmias, may progress to ventricual fibrillation.
- Hypercalcemia - increased calcium concentration, increases heart rate
- Hypocalcemia - decreased calcium concentration depresses heart action
7
Q
Atherosclerosis
- Etiology
- Onset
- Risk factors
- Prognosis
A
Atherosclerosis - a narrowing of the lumen of coronary arteries resulting in ischemia to the myocardium.
- Etiology - thickening of the intimal layer of the blood vessel wall from the focal accumulation of lipids
- Onset - depending upon presence or absence of risk factors
- Risk Factors - 2 or more risk factors increase the risk of CAD
- non-modifiable risk factors:age, sex, race, significanct famiy history
- Modifiable risk factors: cigarette smoking, highblood pressure, elevated cholesterol levels, inactivity
- contributing right factors: diabetes, obesity, stress
- Prognosis - good with early detection and treatment
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8
Q
Main Clinical Syndromes of CAD
A
- Angina pectoris
- Myocardial infarction
- Congestive heart failure
- OT intervention sternal precautions and home program guidelines
9
Q
Angina pectoris
- Description/symptoms
- Types
- Stable Angina
- Unstable Angina
A
- Description/symptoms - Mild to moderate substernal chest pain/discomfort, felt as pressure or dull ache in the chest and left arm. Also can be felt in neck, jaw, back, arm. last 20 mins. Caused by imbalance of oxygen supply and demand. Brought on by increased demands on the heart such as exertion/exercise, emotional upsets, smoking, extremes fo temperature, overeating, tachyarrhythmias.
-
Types
- Stable angina - exertional angina, relieved with rest
- Unstable angina - coronary insufficientcy with risk for myocardial infarction or sudden death, presents with low level activity or rest.
10
Q
Myocardial infarction (MI)
- Symptoms/Descriptions
- Precipitating factors
- Results of impaired ventricular function
A
- Symptoms/Descriptions - Prolonged ischemia resulting in injury/death of an area of the myocarium caused by occlusion fo one or more of the coronary artieries.
- Severe substernal pain of more than 20 mins duriation which may radiate to neck, jaw, arm, epigastric area
- Dyspnea, rapid respiration,
- Indigestion, nausea, vomiting
- Precipitating factors - atherosclerotic heart disease with thrombus formation, coronary vaso spasm or embolism, cocain toxicity
- Results of impaired ventricular function - decreased stroke volume, cardiac output, and ejection fraction. Increased end diastolic ventricular pressure
11
Q
Congestive heart Failure (CHF)
- Signs associated with Right-sided heart failure
- Signs associated with left-sided heart failure
A
- Right-sided heart failure - blood is not adequately returned from the systemic circulation to the heart
- nausea, right upper quadrant pain.
- Left-sided heart failure - blood is not adequately pumped into systtemic circulation, inability of left ventricle to pump blood out of lungs, increases in ventricular end diastolic pressure and left pressures with
- fatigue, cough, dyspnea, diaphoresis
12
Q
Chronic obstructive pulmonary disease (COPD)
- Types
- Signs and Symptoms
- Interventions
A
- Types - peripheral airways disease, chronic bronchitis, emphysema
- Signs and symptoms - Dyspnea on exertion, diminished breath sounds, wheezing, Chronic cough, disease advancement may result in patient becoming emaciated, signs of right heart failure due to secondary pulmonary hypertension
- Interventions - Smoking cessation, oxygen therapy (reduce levle of dyspnea, decrease pulmonayr HTN, improve cognitive function and exercise tolerance)
13
Q
Cardiovascular Pulmonary System
Assessments
A
- Review medical record.
- Note Dyspnea during functional activities, fatigue, exertion, dizziness that accompany postural changes, pain, location, edema, angina
- mobility assessments - bed mobility, transfers, wheelchair mobility, ambulation status,
- ADL - Self care, household management tasks, leisure activities, community activities, note level of function and type of assistance required.
14
Q
Occupational Therapy Cardio pulmonary rehab
Phase1 Inpatient rehab/ Hospitalization stage (Inpatient)
- Program focus
- Eval
- Intervention
A
- Program focus - patient education, increase knowledge of energy conservation and work simplification principles, improve ability to conduct self-care tasks, decrease anxiety, support smoking cessaion, and dietary modificatin efforts if warranted
- Eval - initiated at bedside. assess fatigue/levels, monitor vital signs at rest, during activity and after activity
- Intervention
- energy conservation - pace self, monitor body position during activities, organize activities and work areas, delegate responsibilities
- breathing exercises - diaphragmatic breathing, pursed lip breathing
- monitor vital signs - take before, during, after.
- Max HR 100-120
- STOP if systolic BP decrease 20mm/hg
- STOP if O2 is less than 90%
- observe/for SOB, chest pain, nausea, vomiting, dizziness, or fatigue
- avoid isometric muscle work, straining, breath holding
- avoid overhead exercises or holding UE over head for extensive time periods
- avoid lateral arm movements and exercises that stretch chest and pull incision
- stress management training
- ADL training, dressing of one extremity at a time, frequent rest breaks
- signs/symptoms for which therapy should be stopped/contraindications
- uncontrolled atrial/ventricular arrhythmias
- recent embolism/trombophlebitis
- disecting aneurysm
- severe aortic stenosis
- Acute systemic illnes
- acute MI
- unstable angina
15
Q
Occupational Therapy Cardio pulmonary rehab
Phase 2 Outpatient Rehab/ Convalescence stage
- Program focus
- Evaluation/Intervention
- Lenght of stay
A
- Frequency of visits depends on teh clinical needs of the patient
- Program focus - Educate patient on the importance of continued exercise, build up activity tolerance, improve ability to carry out IADL and community tasks, Improve ability to perform work activities support person’s efforts in smoking cessation and lifestyle changes as needed
- Eval/Intervention - Home eval, consumer, family education, graded exercises program iwht slow and gradual increase of weight. start with MET level 4-5 gradually increase as pateitn’s tolerance improves. practice of funcitonal activites in the discharge environment, use of energy conservation techs
- Length of stay - dependent on patient’s physical and mental status, progress through MET levels, activity tolerance and prognosis
