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Geriatric PT > COMPS:Cardiopulmonary and Neurological Issues in Older Adults > Flashcards

COMPS:Cardiopulmonary and Neurological Issues in Older Adults Flashcards

1
Q

America’s leading health problem, AND leading cause of death

A

CVD

Cardiopulmonary disease

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2
Q

Tobacco

A
  • single largest preventable cause of death and disease in the US
  • Kills > 480,000 Am’s ea. year
  • >41,000 from secondhand smoke

*Higher nicotine addiction= harder to quit=more problems

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3
Q

Smoking and PAD

A

smoking more closely related to getting PAD than any other risk factor

PAD INCs 4x if you smoke or have hx of smoking

*Among adults aged >65→ 12-20% may have PAD→ Risk inc’s w/ older age combined w/ smoking or DM

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4
Q

WATCH YOUTUBE VIDEOS MENTIONED ON SLIDE 5!!!

A

*******

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5
Q

Heart Sounds

S1

A

Closing of mitral & tricuspid

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6
Q

Heart Sounds

S2

A

Closing of pulmonary & aortic

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7
Q

Heart Sounds

*Development of an S3 heart sound w/ exercise

A
  • S3 sound produced during passive LV filling
  • LOWER in pitch and may indicate CHF
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8
Q

Heart Sounds

What else are s/s of decompensated CHF?

A
  • INC SOB,
  • B/L pedal edema
  • crackles
  • JVD
  • gain 2-3lb
  • Cor Pulmonale → cond that causes R. side of heart to fail
    • LT HTN in the arteries of the lung and R. Vent can lead to cor pulmonale
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9
Q

R. Side vs. L. Side HF

A
  • R. Side→
    • periph swelling, congestion
  • L. Side→
    • SOB
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10
Q

Heart Sounds

A

APT-M 2245

  • Dr. Dieter’s
    • Aortic area
    • Pulmonic area
    • Erb’s Point
    • Tricuspid area
    • Apex (Mitral)→ where S3 most commonly heard
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11
Q

General Risk Stratification

Info gathered from PMH

A
  • Ejection Fraction (EF)
    • >/=60%→ NORMAL
    • 50-59%→ LOW RISK
    • 31-49%→ MOD RISK
    • =30%→ HIGH RISK
  • Hx of angina
  • Hx of arrhythmia’s
  • Hx of MI or CHF
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12
Q

Cardiac Meds

Usually Stepwise approach

Looking @ HTN..

A
  • Lifestyle mods
  • Progression of meds:
    • Diuretics→ ACE inhibitors→ Beta-Blockers→ Ca Channel Blockers
  • Will also use “Cocktails” of meds for Cardiac meds
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13
Q

Cardiac Meds

Diuretics

A
  • Lowers BP
  • Diff types
  • can cause electrolyte imbals
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14
Q

Cardiac Meds

Beta Blockers

-olol

A

-Olol

  • Blunt HR
  • Need to use RPE, talk test
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15
Q

Cardiac Meds

ACE Inhibitors

-pril

A

-pril

  • SE’s
    • Periph edema
    • chronic cough
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16
Q

Cardiac Meds

*Ca Channel Blockers

-ipine

A

-ipine

  • Blunt HR
  • Need to use RPE
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17
Q

Cardiac Meds

*Nitroglycerin

“nitro”

A

“nitro”

  • usually put under tongue for Angina
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18
Q

Cardiac Meds

*Digoxin (Digitalis)

*think Toxicity!!!

A
  • Used for A-Fib and/or CHF
    • For CHF→ reduces force of heart→ works less hard
  • *Toxicity→ more common in older adults
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19
Q

Cardiac Monitoring

3 methods:

A
  1. Mean Arterial Pressure (MAP)
  2. HR Recovery
  3. Angina Presentation Pattern
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20
Q

Cardiac Monitoring:

MAP

A
  • Avg blood pressure during cardiac cycle
  • “Perfusion pressure”
  • MAP= DBP + ⅓ (SBP-DBP
    • HIGH= inc risk stroke, organ failure
    • LOW= not enough blood to organs (ex. brain)
  • NORMAL= 70-110 mmHg
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21
Q

Cardiac Monitoring

*HR Recovery

A
  • Quick/easy measure of cardiac health
  • NOTE***= 12 beat recovery in 1 min
    • → higher mortality in next 6 yrs
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22
Q

Cardiac Monitoring

*Angina presentation patterns

A
  • MALES
    • L. shoulder
    • Neck
    • Jaw
    • Teeth
    • Upper back
  • FEMALES
    • Fatigue
    • Breathlessness
    • Pain mid-back (often missed**)
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23
Q

Pulmonary Monitoring

2 ways:

A
  1. Breath Sounds
    1. Looking for changes @ rest OR w/ exercise
  2. O2 Sats
    1. >/= 90% → NORMAL
    2. *Medicare will pay for O2 if =88%
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24
Q

Breath Sounds

Normal vs. Abnormal

A
  • Normal→ Bronchovesicular
  • Abnormal→
    • Crackles (rales)
    • Wheezing (rhonchi)
    • Stridor→ high pitched, foreign body (choking)
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25
Q

Breath Sounds

Abnormal→ Crackles (rales)

A
  • bottom lungs
  • Usually Inspiration
  • PNA, CHF
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26
Q

Breath Sounds

Abnormal→ Wheezing (rhonchi)

A
  • Usually Expiration
  • Asthma, COPD
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27
Q

Breath Sounds

Abnormal→ Stridor (think choking, kids)

A
  • HIGH pitched,
  • foreign body
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28
Q

Breath Sounds

Pitch

A

Low

Med

High

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29
Q

Breath Sounds

Intensity

A

Soft, medium, loud

  • Diminished/Soft→ Emphysema, hypERinflation, atelectasis
  • Loud/ringing→ PNA
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30
Q

VO2max

A
  • Point @ which 02 consumption does not inc w/ inc’d intensity
    • ml/kg/min OR L/min
  • Avg= 30-40ml/kg/min
  • 3.5ml/kg/min= 1 MET @ rest
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31
Q

VO2====

A

CO x (a-VO2)

  • CO x diff bw arterial and oxygen concentrations
    • diff in O2 drop
  • V= ventilation= pulmonary component
  • a= HgB carried in arteries (little “a” is arteries)
  • CO= Cardiac Output (SVxHR)
  • a-VO2== how much HgB “let go” in peripheral arteries
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32
Q

HR

A

beats/min

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33
Q

Stroke Volume

A

SV= EDV-ESV

  • Avg= 70mL
  • EDV= mL blood @ end of diastole (relaxation)
    • 110-130
  • ESV= mL blood @ end of systole (contraction)→ 2nd systolic
    • 30
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34
Q

Regulation of SV

A
  • Preload→ blood returning to heart or EDV
    • Frank-Starling Mech
      • Inc’ing preload== inc’ing SV until plateaus
        • SV plateaus bc we all have MAX SV
  • Afterload→ same as TPR
    • blood ejected OUT of heart influenced by pressure gen’d in ventricle compared to pressure in systemic vasculature
      • INC TPR== DEC SV
  • Contractility/Inotropy→ contraction of heart muscles
    • INC + inotropic (caffeine)= INC SV
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35
Q

Cardiac Output

A

CO= HR x SV

  • Vol of blood ejected out of L. ventricle into systemic vasculature per minute
    • blood ejected out of L. vent/minute
    • Avg= 70mL x 70bpm = 5L/min
36
Q

Cardiac Output

Coronary Blood Flow

A
  • perfuse myocardium during cardiac cycle
  • Myoglobin in the myocardium releases O2 during systole
  • Reg’d by ANS
  • *NOTE: SNS inc’s vasodilation
37
Q

Blood Pressure

BP

A

*measurement of arterial blood flow and resistance to that flow

  • BP= CO x TPR
    • *CO= HR x SV
  • Components:
    • Systolic
    • Diastolic
38
Q

Blood Pressure

MAP

A

MAP= (SBP + 2DBP)/3 or ⅓SBP + ⅔DBP

  • Ex. BP= 120/80
    • (120+2)(80))/3= ~90 MAP
39
Q

Blood Pressure

Mean Venous Pressure

A

MVP= CVP (Central Venous Pressure)

  • 0-8mmHg
  • Ohm’s Law
    • High resist to Low resist
40
Q

Pulse Pressure

A

PP= Systolic - Diastolic

ex. 120/80→ 120-80= 40PP

41
Q

a-VO2

A

how much HgB “let go” in peripheral arteries

42
Q

PVR

Pulmonary Vascular Pressure

A

Resistance that must be overcome to push blood through the circulatory system and create flow

43
Q

RR

Respiratory Rate

A

of breaths/min

NORM= 12-20

44
Q

Dyspnea

A

Diff or labored breathing

SOB

45
Q

Functional Outcome Measures

Be Familiar…

A
  • 2 min Step Tests
  • Walking Tests (6m or 2m)
  • TM Tests
  • Borg Scale
  • Dyspnea Scale
  • Angina Scale
46
Q

6MWT for…

A

Pulmonary and CV Dis. Pts

  • Stopwatch, hallway
  • HR before administration, self-selected speed, resting permitted, HR AFTER test and distance recorded, RPE determined
  • NO quantitative info on aerobic power
47
Q

Interventions:

Significant benefits of exercise in older adults:

A
  • improved max O2 uptake (VO2max)
  • reduction in coronary risk factors w/ program adherence
  • marked improvement w/ ex tolerance
  • adaptations in Sk. mm
  • reduction in symptoms
  • overall improvement in functional capacity and mental status
48
Q

Interventions:

Keep in mind…

A

Pts willingness to adhere to regular training that has appropriate intensity w/out producing limiting sx’s

49
Q

Guidelines for Aerobic Activity

What are we looking for?

OPTION 1

A

Option 1

2 hours and 30 mins (150mins or 30min/day 5d/week) of moderate intensity aerobic activity ea. week

*Muscle strengthening exercise on 2 or more days a week working all major muscle groups (legs, back, abs, chest, shoulders, arms)

50
Q

Guidelines for Aerobic Activity

Option 2

A

OPTION 2

1 hour and 15 mins (75mins) or vigorous intensity aerobic activity ea. week

*Muscle strengthening exercise on 2 ore more days a week working all major muscle groups

51
Q

Guidelines for Aerobic Activity

OPTION 3

A

OPTION 3

An Equivalent mix of moderate- and vigorous-intensity aerobic activity

*Muscle strengthening exercise on 2 or more days a week working all major muscle groups

52
Q

Aerobic Activities

Intensity

MODERATE

A

MODERATE

  • 60% MHR
  • 11-12 Borg
  • 3-4 Mod Borg***
  • Perceived Workload Scale→ fairly light/somewhat hard
  • Talk Test→ steady pace, not breathless
53
Q

Aerobic Activities: Intensity

Vigorous

A

Vigorous

  • 80%MHR
  • 15-16 on Borg
  • 5-6 Mod Borg***
  • Perceived Workload Scale→ Hard
  • Talk Test→ Very brisk walking, must take breath bw 4-5 words
54
Q

Rehab Dosage

Aerobic Capacity

A

See pics

Be familiar w/ zones

  • 50-60%→ Mod activity (maintenance/warm up)
  • 60-70%→ Weight control (Fitness/fat burn)
  • 70-80%→ Aerobic (cardio training/endurance)
  • 80-90%→ Anaerobic (Hardcore training)
  • >90%→ VO2max (Max Effort)
55
Q

Interventions

A balanced fitness training program includes____________

A

includes activities to inc flexibility, strength, and CV endurance

56
Q

Interventions:

The most effective exercise prescription begins w/ ____________

A

a type of aerobic activity the patient enjoys. A prescribed schedule of stepwise increments in freq, duration, and intensity gradually leads to an optimum lvl of fitness

57
Q

Interventions

CV and Pulmonary dysfunctions

A

REVIEW EXERCISE GUIDELINES IN CPPT!!!!!!!!!!!!!!!

58
Q

Interventions:

Many older adults w/ cardiopulmonary impairments require__________

A

supplemental O2 and it is considered a drug (>21%) when breathed in higher conc’s than that found in atm cond’s (20.98%)

59
Q

Intervention:

The most common reason for O2 use is _____________

A

arterial hypoxia. PTs working w/ pts who require supp O2 should have knowledge base of the pros and cons of O2 tx

60
Q

Interventions:

The pts exercise prescription may req _______________

A

modification of O2 dosage and this change should be discussed w/ pts physician

61
Q

MAJOR patho affecting older adults in US….

A

Parkinson’s (PD)

*majority of indiv’s are >50yo when dx w/ PD

62
Q

PWP may have wide variety of s/s w/ diff rates of dis. progression

Ex’s

A
  • Tremor
  • bradykinesia
  • rigidity
  • postural instab
  • deficits in motor planning
  • diff w/ dual-tasking
  • loss of automaticity
    • have to think about everything→ auto things no longer auto
  • dystonia
  • dec’d speed
  • altered stride rate
  • variable stride length
  • GI sx’s
  • soft voice
  • mumbled OR fast speech
  • loss of facial express (masked face)
  • trouble swallowing → dysphagia
  • diff chewing and probs communicating
63
Q

PWP

Ex and Rehab programs

A

must be tailored to the individual

*PWP need to dev. long-term exercise habits

64
Q

Data released from the National Parkinson’s Foundation’s Parkinson’s Outcome Project

A

shows PWP who start exercising earlier experience a significantly slower decline in QOL vs those who start later

65
Q

PD Eval

Do you have a hx of falls and near falls?

A

How many in last 2 yrs?

*Indicator of fx risk and lvl of impair.

66
Q

PD Eval

Do you see a neurologist regularly?

*Regular neuro care could save the lives of 1000s ea yr

A
  • If no→ refer to one!
  • If yes→ ASK:
    • Have you been staged using a formal scale?
      • Hoehn and Yahr Scale OR Unified PD Rating Scale
      • UPDRS rates PD as postural instability and gait disorder predominant (PIGD) OR Tremor Dominant
        • PIGD→ faster disease progress, more diff w/ ADLs, greater disability, more intellectual impairment, higher depression rates, lack of motivation
67
Q

postural instability and gait disorder predominant (PIGD)

A

PIGD→ faster disease progress, more diff w/ ADLs, greater disability, more intellectual impairment, higher depression rates, lack of motivation

68
Q

PD Eval

What is your current level of exercise participation?

A

PWP NEED to dev. long-term exercise habits

69
Q

PD Meds

What meds are you taking?

*name, dosage, timing and SEs→ “On/Off times”

*is pt tolerating meds? Has another provider prescribed additional meds? Did pt try a med and then stop?

Ex’s of meds:

A
  • Cholinesterase Inhibitors
  • Antipsychotics
  • L-dopa
  • SSRIs
  • Clonazepam
70
Q

PD Meds

Cholinesterase Inhibitors

A

*used to tx thinking changes in dementia

*can help w/ visual hallucinations, sleep disturbs, changes in thinking/behavior

71
Q

PD Meds:

Antipsychotics

A
  • Used to tx behavioral sx’s
  • MAY cause serious SEs in up to 50% of those w/ PD dementia
  • Can cause sudden changes in:
    • impaired swallowing
    • acute confusion
    • eps of hallucinations
    • appearance of worsening related to PD sx’s
72
Q

PD meds:

L-dopa

A
  • Chief tx for PD movement sx’s
  • can aggravate hallucinations and confusion in those w/ PD dementia
73
Q

PD meds:

SSRIs

A
  • Selective Serotonin Reuptake Inhibitors→ tx depression
74
Q

PD Meds:

Clonazepam

A

Can tx REM disorder

75
Q

PD Assessment

IPE Approach

A

see pics

76
Q

PD Tests and Measures

APTA Clinical Summary

*Evidenced Based approaches!!

A

Tests & Measures to perform

77
Q

PD Interventions:

4 Key Elements:

A
  1. Promotion of task specific phys activity and lifelong participation in ex. program
  2. Strategy training→ impacted by cognition
  3. Mgmt of 2* Sequelae
    1. lack of consensus regarding rehab and fatigue lvls
  4. Fall prevention and risk reduction
78
Q

PD Strategies

A

See pics of chart

79
Q

PD Strategies

Mid/Early Stages

A
  • Vigorous activity→ high intensity
  • Task specific practice of relevant skills
  • Standardized tx→ LSVT BIG
  • Cog decline begins to become apparent→ try to get ahead of this
  • retains ability to relearn motor skills
  • Maint of flex, strength, CV function
  • LSVT BIG
80
Q

PD Strategies

Mod/Middle Stage

A
  • Strategies similar to those used in Early stage, but w/ progress. LESS emphasis on impairs
  • Cog ability becomes an issue
81
Q

PD Strategies

Severe/Late Stage SAFETY

A
  • Focus on compensatory strategies and safety
  • Cog ability becomes issue
82
Q

PD Strategies

Types of activities

A
  • Resistance ex
  • aerobic cond (neuro protective)
  • balance re-ed
    • dancing, boxing
  • flexibility
83
Q

PD Strategies

Mgmt of 2* Sequelae

A

Lack of consensus regarding rehab and fatigue lvls

84
Q

PD Strategies

Dosage→ No consensus

A
  • Lack Larger scale studies report:
    • @ least 6 sessions of 45-60mins over 8 wks
    • @ least 2.5 hours/week slows decline in QOL
85
Q

1

PD Take Homes:

A
  • Tx demos significnt short-term benefits→ ESP early/mid-stage dis.
  • Need to teach long-term strategies and skills to maintain and slow progression
    • education on HEP
  • Clinicians should consider role of client cognition/non-motor sx’s and progress to compensatory strategies/education in LATER stage dis.
  • Utilize client preferences to maximize long term adherence and determine specificity of task
  • Specificity of task is shown to be HIGHLY IMPORTANT when selecting intervention strategies
86
Q

2

PD Take Homes

A
  • Task specific better than non-specific training
  • Dual task activity performance show better carryover
  • Auditory, rhythmic (music) cues help regulate walking (compared to visual or tactile)
  • No matter the intervention, intensity appears to be the KEY COMPONENT

Geriatric PT (7 decks)

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