Willard and Spackman - Cardiac and Pulmonary Conditions Flashcards
Cardiac Conditions
Any condition that originates in and/or affects the heart
Conditions are often diagnosed following a cardiac event
If condition is identified before event
General practitioner conducts first stages of diagnosis via a physical exam. Checks: blood pressure, cholesterol, blood glucose, family medical history
To further evaluate condition, diagnosis and develop treatment plan, cardiologist may use: electrocardiogram, ultrasound, chest X-ray, stress test, angiogram, cardiac enzyme blood test, cardiac catheterization
Coronary Heart Disease (CHD)
- Most common heart disease
- plaque buildup which narrows blood vessels that supply heart
- Can lead to heart attack, angina (chest pain, discomfort or tightness) or other complications
Myocardial Infarction (MI) aka Heart Attack
Insufficient oxygenated blood flow causes damage or death to portion of cardiac muscle
During MI, person may enter cardiac arrest
Congestive Heart Failure
Different types:
- left-sided systolic heart failure
- left-sided diastolic heart failure
- right-sided heart failure
- chronic and progressive condition
- heart does not sufficiently pump blood to maintain body’s need for oxygenated blood
- Different from cardiac arrest
Congenital Heart Defects
- present from birth, caused by abnormalities in prenatal development in of the structures or blood vessels of heart
- defects vary and can include abnormal heart valves or holes in the walls of the heart
- diagnosis often made at birth or in early infancy after presentation of symptoms, diagnosis sometimes made during pregnancy
Arrhythmia
- a change in the normal electrical impulses that generate heartbeat
- most are harmless, but could result in cardiac arrest
Cardiac Arrest
- sudden loss of heart function, death within minutes
- May be reversed and life saved if CPR is performed OR a defibrillator is used immediately
Incidence and Prevalence
One in 3 US adults (approx. 82.6 million) have at least one cardiovascular disease (cardiac condition, as well as stroke and hypertension)
16.3 million have CHD, 5.7 have heart failure, and 650K have heart defects
CHD Cause
CHD caused by atherosclerosis
Atherosclerosis - narrowing of vessels from a buildup of plaque in the artery walls that supply the heart
Risk factors: high cholesterol, hypertension, diabetes, smoking, obesity/overweight, diet, inactivity, alcohol use
Genetics likely plays a role, but unclear if cause is actually shared environment/lifestyle choices
MI Cause
MI caused by blood flow being stopped or impeded to the coronary artery (often by blood clots in arteries after piece of plaque breaks)
CHF Cause
CHF caused by several compounding conditions (hypertension, CHD, MI, congenital heart defects & diabetes)
Congenital Heart Defects
Congenital heart defects develop due to genetics, environmental factors or behavior/lifestyle choices on behalf of mother (uses drugs, smokes, drinks during pregnancy)
Arrhythmia Cause
Arrhythmia caused by HD, MI or conditions where cells responsible for electrical conduction are affected
a. Could be result of congenital conditions, side effects to medications or use of addictive substances
b. Can cause MI, cardiac arrest or stroke
Signs of cardiac event
- change in pattern of angina or shortness of breath
- heart palpitations/”fluttering”
- lightheadedness, dizziness, confusion, fainting or near-fainting
- more fatigue than expected
- unusual pain in joints/muscles after exercise
- sweating
- drop in BP of 20mm Hg or more or HR 20 BPM or more over resting rate
Interdisciplinary Interventions - Surgery
- Angioplasty (AKA percutaneous coronary intervention PCI) - balloon inserted into artery and inflated to widen blockage and increase blood flow (or a laser on tip of catheter to vaporize plaque). Often used with stenting
- Stenting - wire mesh tube props coronary artery open
- Atherectomy - catheter with rotating shaver trims away plaque
- Coronary Artery Bypass Graft (CABG, “Cabbage”, AKA open heart surgery) - rerouted blood flow by grafting vessels from other parts of the body to the blocked artery
- Minimally invasive bypass - bypass performed via video monitors and scopes through small ports in the chest
- Transmyocardial revascularization (TMR) - lasers drill ~1mm holes into heart walls to relieve severe angina
- Valve replacement - artificial valve replaces abnormal/diseased valve
- Radiofrequency (or catheter) ablation - corrects arrhythmias by destroying small amount of cardio cells which cause the abnormal heartbeat
- Insertion of Left ventricular assist device (LVAD) - assists with pumping chamber
- Defibrillator or pacemaker implantation - maintains normal heartbeat
- Cardiomyoplasty - assists in pumping heart by wrapping skeletal muscle around heart and stimulated via pacemaker-like device
- Heart transplant - when heart is irreversibly damaged
Cardiac Rehabilitation
- Education and counseling to manage condition
- increased physical fitness
- reducing symptoms
- finding support
- smoking cessation
- dietary and nutrition counseling
- psychological and emotional effects counseling
Occupational Therapy Evaluations for Cardiac Conditions
Focuses on what client needs, wants or is expected to do and any factors that may impact performance
Begins with assessments followed by specific evaluation of the potential impact of cardiac condition on occupational performance
Occupation-focused Assessments for Cardiac Conditions
- Role checklist
- Occupational performance history interview
- Occupational self-assessment, version 2.2
- Performance Assessment of self-care skills
- Canadian occupational performance measure
- Short form-36
- Activity card sort
- Reintegration to normal living scale
Client factor assessments for Cardiac Conditions
- Beck Depression Inventory II
- Borg rating of perceived exertion scale
- measures of pain
- measures of muscle strength
- vital signs monitoring
Occupational Therapy Interventions for Cardiac Conditions
OTs are frequent members of cardiac rehab teams
Precautions should be taken to prevent overexertion
HR and BP monitored regularly, alert team of changes
Common interventions:
- energy conservation techniques to reduce stress on heart
- ADL retraining (grading to reduce strain, assistive devices, suggestions for sexual activity w/o overexertion)
- environmental adaptations
- education on risk factors and how to remain healthy/functional
- lifestyle modification - new/alternate occupations w/o cardiac stress
- medication management
- support group recommendations
Occupational Therapy and the Evidence for Cardiac Conditions
- greater need for long term rehab and lifestyle OT as more people live or survive cardiac conditions/emergencies
- Interdisciplinary cardiac rehab effective at decreasing death and improving quality of life, increasing return to work, increased ADL and IADL function, decrease LOS, increase independence
- CHF and CHD often result in ADL and IADL declines, requiring assistive devices and community services
- In-home rehab effective in increasing physical health and decreasing symptoms
- Community-based groups shown to provide mutual support system that assists in transition to home/community dwelling after hospital
- Paucity of evidence in availability and use of OT in schools and other settings for children with congenital heart defects
Caregiver Concerns for Cardiac Conditions
- relatives always experience stress, anxiety, lower quality of life
- increased risk of death following diagnosis of loved one
- benefit from education on supporting family members and keeping self healthy
Pulmonary Conditions
- Chronic obstructive pulmonary disease (COPD) - airflow blockages create breathing problems.
- Emphysema - type of COPD. Permanent damage to alveoli (CO2 and O2 exchange). Shortness of breath, difficulty exhaling.
- Chronic bronchitis - Type of COPD. Inflammation and scarring of bronchial tube lining.Produces thick mucus and restricts airflow. Diagnosed when person has mucus-producing cough most days of the month, 3 months of the year for two years w/o underlying disease.
- Others: Asthma, Cystic fibrosis, Pneumonia, tuberculosis
- Of these, OTs most likely to encounter COPD
Prevalence of Lung Disease
- In 2009, > 2% (4.9 million) US adults 18+ years living with emphysema
- In 2009, > 4% (9.9 million) US adults 18+years living with chronic diagnosis
- Chronic lower respiratory disease is 4th leading cause of death in US
- Death rate stable, but with growing population, this indicates number of deaths from COPD is increasing
Cause and Etiology of Lung Disease
- Almost all cases of COPD due to exposure and inhalation of lung irritants. Most common irritant is cigarette smoke. Other forms of tobacco smoke can cause disease as well (cigars, pipe)
- Risk is greater for developing COPD in first-hand inhalation, but both first and second-hand inhalation common
- Other substances that can cause COPD: air pollution, duct, chemical fumes
- Genetic condition alpha-1 antitrypsin (AAT) deficiency (low levels of lung protective protein) has increased risk for COPD, especially if a smoker
Interdisciplinary interventions for Lung Disease
- Pulmonary rehab: multidisciplinary, therapeutic, educational, teaches physical and psychosocial strategies
- Smoking cessation programs
- Team members may include: respiratory therapist, thoracic surgeon, physicians, nurses, PTs, psychologists, social workers, nutritionists.
Medication therapy for Lung Disease
- Inhalers or anti-inflammatory drugs often prescribed for COPD for maintenance or as-needed
- Antibiotics to fight potential contraction of illnesses
Oxygen therapy for Lung Disease
- supplementation when lungs don’t meet body’s oxygen needs.
- supplement type determined by respiratory therapist or physician
- Compressed oxygen containers, liquid oxygen, oxygen concentrators
Surgery for Lung Disease
Lung transplants, lung volume reduction (removing damaged portions of lung), removal of damaged or diseased alveoli
Occupational Therapy Evaluations for Lung Disease
- Focuses on what client needs, wants or is expected to do
- Analyzes what factors affect occupational performance
Occupation-focused assessments for Lung Disease
- Role checklist
- Occupational Performance History Interview
- Occupational self-assessment version 2.2
- Performance Assessment of Self-Care skills
- Canadian Occupational Performance Measure
- Short Form-36
- Activity Card Sort
Client Factor assessments for Lung Disease
- Chronic Respiratory Disease Questionnaire Self-Administered Standardized
- Beck Depression Inventory-II
- Borg Rating of Perceived Exertion scale
- Range of Motion
- Measures of pain
- Measures of muscle strength
- Monitoring of vital signs
Occupational Therapy Interventions for Lung Disease
- Energy conservation techniques, may include environmental adaptations or breathing techniques
- ADL retraining: grading activities , assistive devices
- UE strength and ROM training: some pulmonary medications weaken muscles. Need to preserve muscles which assist with inhalation.
- Educate client and family on risk factors and measures to take for prevention
- Lifestyle modification: new/alternate occupations without exacerbating condition
- Environmental assessment
- Medication management
- Support group and resource recommendations
Occupational Therapy and the Evidence for Lung Disease
- Qualitative study showed that COPD patients often have to change their occupations and feel this as a loss, but OT helped them maintain or return to occupational satisfaction
- OT shown to increase physical function, quality of life, independence and ADL/IADL efficiency and decrease dyspnea
- OT can also improve social functioning and physical & psychological health
Caregiver Concerns for Lung Disease
- As COPD increases, reliance on family/friends increases
- Often caregivers experience: decreased quality of life, depression, feeling burdened
- Can become patient’s only emotional and social outlet
- Caregivers need support and education on how to care for themselves physically and emotionally too
