Week 3: Vitals, OTF, FIM Flashcards
What type of clients were baseline vitals are needed?
- Clients recovering from recent trauma/illness/hospitalization/secondary diagnoses
- Clients with current or previous cardiovascular/cardiopulmonary conditions
- Clients who are not very active or who have limited aerobic activities
- Client’s with general fatigue or debility
The very young and very old (older than 65)
- Level or amount of activity
- Emotional status of person
- Physiological status of client
- Environmental temperature
- Client’s age
Factors influencing vital signs
What are some things contributing to physiological status of client?
Illness, disease, use of medication, trauma
What are some possible adverse and potentially dangerous responses to activity and exercise?
- Confusion
- Slow reactions of movement or response to directions
- Lethargy
- Fatigue
- Decreased response to verbal or tactile stimulus
- Fixed gaze or eyes rolling back in someone’s head
- Complaints of nausea, vertigo, decrease in BP, pupil constriction/dilation
- Loss of consciousness/fainting
- Diaphoresis (profuse sweating)
Blood pressure is at which pressure?
brachial arterial pressure (major vessel which takes blood away from heart)
T/F: Pressure of circulating blood increases as it moves further away from heart
False. Pressure of circulating blood decreases as it moves further away from heart
is BP at the time of contraction of left ventricle heart
Systolic pressure
is the BP at the time of the rest period of the heart
Diastolic pressure
5 phases of Korotkoff’s Sound
Phase 1: first, faint, clear tapping sound which gradually increases (first indication of systolic pressure of an adult)
Phase 2: murmur or swishing quality present
Phase 3: sounds become crisp and louder than before
Phase 4: distinct and abrupt muffling of sounds until a soft, blowing sound is heard (initial indicator of the diastolic BP)
Phase 5: muted sound, disappearance of sound, also known as second diastolic pressure phase
distinct and abrupt muffling of sounds until a soft, blowing sound is heard (initial indicator of the diastolic BP)
Phase 4
Faint, clear tapping sound which gradually increases (first indication of systolic pressure of an adult)
Phase 1
sounds become crisp and louder than before
Phase 3
muted sound, disappearance of sound, also known as second diastolic pressure phase
Phase 5
murmur or swishing quality present
Phase 2
What are 2 specific Korotkoff sounds to record in BP?
Second sound and the first faint/muted sound… that is the BP to record
For more accurate reading, client can’t have coffee ,cigarette, or done strenuous exercise in last 30 mins
Normal BP?
120 mm of mercury/80 mmHg
Systolic 120-139
Diastolic 80-89
Pre-Hypertension
Systolic 140-159
Diastolic 90-99
Stage 1 Hypertension
Systolic 160+
Diastolic 100+
Stage 2 Hypertension
Age, obesity, physical inactivity, nicotine/salt/alcohol use, arteriosclerosis, DM, kidney disease, race, diet, dehydration, size & condition of arteries, arm position, cardiac output, etc…
Factors contributing to HTN
known as the “silent killer”
Hypertension
Abnormal when Diastolic pressure increases more than _____ mmHG during the activity
Diastolic pressure increases more than 10-15 mmHg during the activity
Systolic BP with vigorous exercise is normal to go up by _____ mmHG. Anything greater would be significant.
Systolic BP with vigorous exercise is normal to go up by 40-60 mmHG.
T/F: It is normal with exercise for systolic BP to go up by 50-60 mmHG
False. 40-60
Diastolic pressure increase by how many mmHG during exercise?
10-15
Can assess by observation or touch: rate, rhythm, depth, character
Respiration Rate
What is normal RR for adults?
12-18 respirations per minute
What is normal RR for kids?
30-50 respirations per minute
Can assess by observation or touch:
Rate = number of breaths per minute
Rhythm = regularity of the pattern
Depth = amount of air exchanged with each respiration
Character = deviations from normal, resting, or quiet respiration
Respiration Rate
RR, what is number of breaths per minute?
Rate
RR, what is Depth?
Amount of air exchanged with each respiration
RR, what is rhythm?
regularity of pattern
RR, what is character?
deviations from normal, resting, quiet respiration
2 ways people breathe?
Upper thoracic or abdominal breather
T/F: With respiratory distress, a person can demonstrate both thoracic and abdominal breathing
True
Age Emotional status Physical activity Air quality Altitude disease/illness
Factors Affecting respiration
indirect measure of the contraction of the left ventricle of the heart
Heart Rate
Normal Adult HR
60-100
Normal newborn HR
100-130
Normal kid HR
80-120
Medications Emotional status Age and gender Temperature of environment Infection (recall dysphagia signs and symptoms) Physical activity/condition Cardiopulmonary disease
Factors affecting HR
Pulse rate should return to normal pulse rate approximately ___ minutes after activity.
3-5 mins
What arteries used for HR?
Carotid and Radial
even beats w/good force to each beat
strong and regular
even beats w/weak force to each beat
weak and regular
both strong and weak beat/force but regular beat
irregular
weak force to each beat, and irregular heart beats
thready
HR under 60
bradycardia
HW over 100
tachycardia
For adults, acceptable normal range for temperature
96.8 to 99.3
Time of day
Age
Emotional status
Environmental temperature
Infection (remember dysphagia signs & symptoms)
Site of assessment (oral cavity can fluctuate depending on hot/cold food or beverage)
Physical activity
Factors affecting Temperature
What is oxygen saturation?
Measures the client’s oxygen saturation level in the blood
T/F: Should be maintained above 90% at rest & during activity
True
Pain Analog Scale
1-10 (10 being most pain)
Biomechanical FOR Concerned with:
Musculoskeletal capacity
Peripheral nerve involvement/dysfunction
Cardiopulmonary system dysfunction (related to endurance)
Best suited for clients with isolated/selective motor control
Biomechanical FOR
T/F: Biomechnical best suited for clients with an intact central nervous system (Pedreti & Pasquinelli, 1990) because clients must be able to perform smooth, isolated movements.
True
True or False: After ROM, strength, and endurance are regained, the client will automatically regain function
False. Research shows that improvement of biomechanical components alone does not necessarily improve engagement in occupation.
What assumptions of biomechanical FOR?
- Occupational performance requires the ability to move the limbs and the endurance to sustain activity/movement until a goal is accomplished.
- Purposeful activities can be used to treat loss of ROM, strength, and endurance
Assessing endurance…
Part of the Biomechanical FOR, but mainly done during occupational performance evaluation & linked to the Rehabilitation FOR “Activity tolerance”
What is definition of endurance?
Sustain effort and resist fatigue
- Related to cardiopulmonary and muscular function
- Related to intensity, duration, and frequency of activity
Endurance
3 things related to endurance?
intensity, duration, frequency
______ endurance is the ability of the whole body to sustain prolonged rhythmical activity”
“Cardiopulmonary endurance is the ability of the whole body to sustain prolonged rhythmical activity” Relates to the demand for oxygen created by muscular work: Muscular work à need for oxygen
_____ Ability (of a muscle or muscle group) to sustain intensive activity”
muscular
of repetitions per unit of time
dynamic assessment
Amount of time a contraction can be held
static assessment
Intensity: rated as light, moderate, or heavy work or based on WHAT LEVELS?
MET
metabolic equivalent levels
MET light house keeping?
1.5-4
MET heavy home maintenance?
4.5-6
APHRO
activity position of activity heart rate rest break needed? other signs of fatigue
“Patient tolerated 60 mins. of seated activity for OT assessment without rest breaks. No c/o fatigue.”
Sample documentation
How to increase endurance?
To increase muscle endurance, the OT must increase the # of repetitions of a specific motion, or add to the resistance of the activity…cardiopulmonary precautions must be considered!
FIM - 4
Minimal Assistance - performs 75%
FIM - 6
Modified independence
FIM - 1
Total assistance - less than 25%
FIM - 7
Complete independence
FIM - 2
Maximum assistance - patient performs 25%-49%
FIM - 3
Moderate Assistance - patient performs 50-74%
What does grooming consist of?
oral care (brushing only), hair grooming (brushing only), washing face, washing hands (drying too) - also shaving and make up
What does bathing consist of?
washing, rinsing, drying body from neck down (exclude neck and back) in tub, shower, or sponge bath
Dressing PJ/hospital gown does not count!
Only clothes they wear in public
What does toiling consist of?
Maintaining perineal hygiene, adjusting clothes before and after using toilet
What consists of toilet transfer?
getting on and off toilet
What consists of social interaction?
getting along and participating with others, represents how one deals with one’s needs and with others
Social Interaction FIM: patient interacts appropriately in most situations, only occasionally loses control. May require more time to adjust
6 - modified independence
Social Interaction FIM: may require encouragement to initiate participation
5 - supervision
Problem Solving: solves routine problems 75% time
4 - minimal assistance
Problem solving: recognizes problems when present, make appropriate decisions, carries out steps to solve complex problems until task completed
7 - complete independence
Activities such as managing checking account, participating in discharge plans are called…
complex problem solving
Includes asking for assistance during transfer, asking for new milk when milk is missing, asking for utensils when missing
routine problem solving
Memory: patient appears to have mild difficulty recognizing faces, remembering daily routines. May use self initiated or environmental cues, aids.
6 - modified independence
Memory; require prompting only under stressful conditions but no more than 10% of time
5 - supervision
List Client Factors
Values, beliefs, spiritual, body functions, body structures
List occupations
work, play, leisure, rest and sleep, social participation, education, ADL, IADL
List performance skills
motor skills, process skills, social interaction
List performance patterns
habit, routine, ritual, roles
Lis context and environment
cultural, personal, temporal, virtual, social, physical
Dressing, feeding, functional mobility, bladder, sex, eating
ADLs
care of others, child rearing, driving, computers, cooking
IADLs
What is goal of ADL/IADL training?
client and family learn to adapt to the life changes or situations and to participate as fully as possible in those occupations that are meaningful.
What 5 things to consider when analyzing ADL?
O Assessing client factors O Performance skills O Performance patterns O Physical and social environment O Clients contextual framework
describes client’s occupational history, patterns of living, interests, values, and needs
occupational profile
T/F: Feasibility of ADL assessment or ADL training should be determined by the OT in concert w/ client, supervising physician, and others rehab team members
True
T/F: Partial/complete performance analysis important to assess ADL performance; interview not enough
true. Ideally OT assess performance of activities in the context/environment where they usually take place or under simulated conditions
Should start with relatively simple/safe tasks from ADL/IADL list and progress to more difficult/complex
requires 25% physical or verbal assistance of one person to complete safely (performs 75% or more of task)
minimal assistance
requires 50% physical or verbal assistance of one person to complete safely (performs 50-74% task)
moderate assistance
client requires physical or verbal assistance for 51-75% of an activity by one person (performs 25-49% of task)
maximal assistance
client requires more than 75% physical or verbal assistance (performs less than 25% of task); Ex. Performs 1 or 2 steps of the activity or very few steps)
dependent/total assistance
standard assessment to evaluate executive skills required to perform IADLs; can be used to determine is person safe to remain at home and how much assistance is required
Executive Function Performance Test
Most basic IADLs required to stay home alone?
prepare/retrieve a simple meal, employ safety precautions and exhibit good judgment, take medication, get emergency aid if necessary, system for managing toileting , method to allow for rest periods
the most common type of heart disease in which there is a narrowing of the blood vessels that supply the heart due to the buildup of plaque, which can eventually lead to myocardial infarction (MI), angina (chest pain, discomfort, or tightness), or other complications.
Coronary heart disease (CHD
The average age at first MI for men?
64.5
The average age at first MI for women?
70.3
is the leading cause of death for both genders in the United States?
heart disease
high cholesterol, hypertension, diabetes, cigarette smoking, overweight & obesity, poor diet, physical inactivity, and alcohol use main factors for…
coronary heart disease
___ can be caused by heart disease, myocardial infarction, or any other condition in which the cells responsible for the electrical conduction of the heart are affected.
Arrhythmia
____ can cause MI, cardiac arrest, or stroke.
Arrhythmia
Change in pattern of angina or shortness of breath
Heart palpitations or “fluttering” feeling in chest
Feeling lightheaded, dizzy, or confused; fainting or near-fainting spells
Experiencing more fatigue than expected
Unusual pain or discomfort in muscles or joints after exercise
Sweating
Blood pressure falls 20 mm Hg or more, or heart rate is 20 beats per minute or more over resting heart rate
Signs of cardiac event
What is first sign of CHD?
MI (heart attack)
shortness of breath, persistent coughing or wheezing, edema, fatigue, lack of appetite, nausea, confusion, impaired thinking, and increased heart rate
Sign of CHF (heart failure)
blue skin, low blood pressure, difficulty breathing, feeding problems, and inability to gain weight. (Minor heart defects often do not produce noticeable symptoms.)
Congenital heart disease
pain/discomfort in the jaw, neck, or back; feeling weak, lightheaded, or faint; chest pain/discomfort; pain or discomfort in arms or shoulder; shortness of breath
myocardial infarction
Role Checklist, Occupational Performance History Interview II (OPHI-II), Performance Assessment of Self-Care Skills (PASS), COPM
Occupation Focused assessments for CHD
Beck Depression Inventory-II (BDI-II), measures of pain, measures of muscle strength, monitoring vital signs (e.g. blood pressure, heart rate)
Client factor assessment for CHD
Teaching energy conservation techniques to minimize stress placed on heart
Retrain in ADLs
Environmental adaptations
Educating client and family member about risk factors of cardiac conditions
Lifestyle modifications - ex. Identify new occupations that allow client to participate satisfactorily without inducing cardiac stress
Medication management
Recommendations of support group and resources within community
Common OT interventions for CHD
muscles are stiff and weak (most common)
Spastic CP
slow, writhing, involuntary movement
Athetoid CP
muscle weakness, poor coordination, tremors
Ataxic CP
combines spastic and athetoid
Mixed
premature birth, low weight, inadequate nutrients in utero, blood type incompatibility, bacterial infections, oxygen deprivation, severe jaundice
Risk factors for CP
motor disorders characterized by impaired voluntary movement and muscle control. Can result from prenatal, perinatal, or postnatal brain injury occurring before age 5
CP
combines spastic and athetoid
Mixed CP
Difficulties with CP?
cognitive delays speech difficulty seizure disorders feeding problems impaired vision & hearing abnormal sensation and perception difficulty with bowel control breathing problems secondary to poor posture skin conditions
Secondary conditions in adults?
musculoskeletal changes (increased spasticity and decreased strength, endurance, flexibility) Pain Fatigue Arthritis Fractures Osteoporosis
CP precautions?
Seizure disorders
Difficulty breathing
Impaired vision/hearing
Abnormal sensation/perception
What decrease muscle stiffness and allow for more controlled movement & increased function when used with OT?
Botox
Anticonvulsant drugs do what to CP?
treat seizures
Baclofen pumps for CP?
relax muscles and control tremors & spasticity
Benzodiazepines?
manage spasticity
Selective dorsal rhizotomy surgery?
reduce muscle tone
any condition or disease that affects or is located in the lungs
Pulmonary conditions
emphysema, asthma, cystic fibrosis, pneumonia, tuberculosis
COPD?
chronic obstructive pulmonary disease, includes emphysema and chronic
bronchitis.
more than 4% of adults aged 18 and older were living with a diagnosis of _____
chronic bronchitis
_____ diseases are the fourth leading cause of death in the US
chronic lower respiratory
T/F: Almost all causes of COPD are due to long term exposure to lung irritants, most commonly cigarette smoke.
true
Comorbidity with depression, hypertension, high cholesterol, and osteoporosis
Pulmonary disease
Medication therapy for pulmonary disease?
inhaler
Interdisciplinary Interventions for PD?
pulmonary rehab, medication therapy, oxygen therapy
Interventions for PD?
energy conservation teaching, i.e. breathing techniques, retraining in
ADLs (grading to reduce excessive strain), upper extremity strength and ROM training,
education, lifestyle modification, medication management, recommendation of support
groups
