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Questions and Answers
Which assessment tool is used for evaluating cognition in patients?
Which assessment tool is used for evaluating cognition in patients?
What is essential to monitor during a rehabilitation session for a patient recovering from Long COVID?
What is essential to monitor during a rehabilitation session for a patient recovering from Long COVID?
Which intervention is appropriate for patients experiencing POTS symptoms?
Which intervention is appropriate for patients experiencing POTS symptoms?
What should be assessed to determine the impairments in a Long COVID patient?
What should be assessed to determine the impairments in a Long COVID patient?
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Which of the following is NOT a component of the progressive activity/exercise program for Long COVID patients?
Which of the following is NOT a component of the progressive activity/exercise program for Long COVID patients?
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What is a common physical symptom experienced by individuals with POTS?
What is a common physical symptom experienced by individuals with POTS?
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Which of the following medications may be used to alleviate symptoms of POTS?
Which of the following medications may be used to alleviate symptoms of POTS?
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What is the initial exercise recommendation for individuals with POTS?
What is the initial exercise recommendation for individuals with POTS?
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What is one common lifestyle adaptation recommended for managing POTS?
What is one common lifestyle adaptation recommended for managing POTS?
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How long should strength training be performed per session for individuals with POTS?
How long should strength training be performed per session for individuals with POTS?
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Which intervention may help reduce symptoms during upright activity in POTS patients?
Which intervention may help reduce symptoms during upright activity in POTS patients?
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What is an initial goal for aerobic training frequency in POTS management?
What is an initial goal for aerobic training frequency in POTS management?
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How much fluid intake is typically recommended for POTS patients daily?
How much fluid intake is typically recommended for POTS patients daily?
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What is considered a decrease in blood pressure to diagnose orthostatic hypotension?
What is considered a decrease in blood pressure to diagnose orthostatic hypotension?
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Which factor is NOT listed as a cause of orthostatic hypotension?
Which factor is NOT listed as a cause of orthostatic hypotension?
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Which of the following symptoms is classified as common for orthostatic hypotension?
Which of the following symptoms is classified as common for orthostatic hypotension?
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What is a recommended non-pharmacological treatment for orthostatic hypotension?
What is a recommended non-pharmacological treatment for orthostatic hypotension?
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Which medication is NOT typically used in the treatment of orthostatic hypotension?
Which medication is NOT typically used in the treatment of orthostatic hypotension?
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What type of lifestyle modification may help manage orthostatic hypotension symptoms?
What type of lifestyle modification may help manage orthostatic hypotension symptoms?
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Which maneuver could help reduce symptoms of orthostatic hypotension?
Which maneuver could help reduce symptoms of orthostatic hypotension?
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What consideration should be taken when monitoring a patient with orthostatic hypotension?
What consideration should be taken when monitoring a patient with orthostatic hypotension?
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Which of the following symptoms is classified as mild COVID-19?
Which of the following symptoms is classified as mild COVID-19?
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What is a significant factor in determining early mobility for patients with critical illness due to COVID-19?
What is a significant factor in determining early mobility for patients with critical illness due to COVID-19?
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What is the recommended SpO2 level to maintain during rehabilitation of patients with COVID-19?
What is the recommended SpO2 level to maintain during rehabilitation of patients with COVID-19?
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What role did personal protective equipment (PPE) shortages play during initial COVID-19 rehab interventions?
What role did personal protective equipment (PPE) shortages play during initial COVID-19 rehab interventions?
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According to the WHO, when do Post-COVID-19 conditions typically begin to manifest?
According to the WHO, when do Post-COVID-19 conditions typically begin to manifest?
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Which group of individuals is at higher risk for developing Long COVID?
Which group of individuals is at higher risk for developing Long COVID?
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What type of physical therapy intervention is NOT typically utilized in the early stages of COVID-19 rehabilitation?
What type of physical therapy intervention is NOT typically utilized in the early stages of COVID-19 rehabilitation?
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Which of the following conditions is often associated with Long COVID?
Which of the following conditions is often associated with Long COVID?
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What symptom is NOT commonly associated with endocarditis?
What symptom is NOT commonly associated with endocarditis?
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Which of the following treatments is typically recommended for pericarditis?
Which of the following treatments is typically recommended for pericarditis?
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What is the primary risk factor associated with cardiotoxicity from cancer treatments?
What is the primary risk factor associated with cardiotoxicity from cancer treatments?
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Which cardiovascular disorder is least likely to be associated with cancer treatment?
Which cardiovascular disorder is least likely to be associated with cancer treatment?
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What is a common symptom of POTS?
What is a common symptom of POTS?
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What is NOT a typical treatment strategy for myocarditis?
What is NOT a typical treatment strategy for myocarditis?
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Which diagnostic method is used for assessing heart function post-cancer treatment?
Which diagnostic method is used for assessing heart function post-cancer treatment?
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Which condition is characterized by inflammation of the pericardial sac?
Which condition is characterized by inflammation of the pericardial sac?
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What is considered essential for diagnosing POTS?
What is considered essential for diagnosing POTS?
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In which age group and gender is POTS primarily diagnosed?
In which age group and gender is POTS primarily diagnosed?
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What condition could result from chemotherapy and radiation treatment?
What condition could result from chemotherapy and radiation treatment?
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Which cardiovascular test is NOT typically used during cancer treatment evaluation?
Which cardiovascular test is NOT typically used during cancer treatment evaluation?
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What is a significant consequence of autonomic dysfunction?
What is a significant consequence of autonomic dysfunction?
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What is a characteristic symptom of myocarditis?
What is a characteristic symptom of myocarditis?
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What is the recommended initial frequency for aerobic training in POTS management?
What is the recommended initial frequency for aerobic training in POTS management?
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Which treatment is suggested to help reduce heart rate and symptoms during upright activity for POTS patients?
Which treatment is suggested to help reduce heart rate and symptoms during upright activity for POTS patients?
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Which of the following exercises should be avoided initially for POTS patients?
Which of the following exercises should be avoided initially for POTS patients?
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How long should strength training sessions last for POTS patients?
How long should strength training sessions last for POTS patients?
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What dietary change is recommended for individuals with POTS?
What dietary change is recommended for individuals with POTS?
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Which lifestyle adaptation is NOT recommended for managing POTS symptoms?
Which lifestyle adaptation is NOT recommended for managing POTS symptoms?
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What effect does short-term exercise have on patients with POTS after three months?
What effect does short-term exercise have on patients with POTS after three months?
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What type of training is emphasized as fundamental in the treatment of POTS?
What type of training is emphasized as fundamental in the treatment of POTS?
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What aspect of patient assessment is crucial when monitoring for Long COVID symptoms during a rehabilitation session?
What aspect of patient assessment is crucial when monitoring for Long COVID symptoms during a rehabilitation session?
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Which component should be individualized in a progressive activity/exercise program for patients recovering from Long COVID?
Which component should be individualized in a progressive activity/exercise program for patients recovering from Long COVID?
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Which rehabilitation strategy helps manage fatigue for patients recovering from Long COVID?
Which rehabilitation strategy helps manage fatigue for patients recovering from Long COVID?
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What is an important intervention for patients experiencing an exacerbation of symptoms following exertion?
What is an important intervention for patients experiencing an exacerbation of symptoms following exertion?
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Which assessment tool is specifically designed to evaluate endurance in patients recovering from COVID-related illness?
Which assessment tool is specifically designed to evaluate endurance in patients recovering from COVID-related illness?
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What was a primary reason for the delay in rehabilitation services during the initial COVID period?
What was a primary reason for the delay in rehabilitation services during the initial COVID period?
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Which symptom is considered part of the mild category of COVID-19?
Which symptom is considered part of the mild category of COVID-19?
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What is the recommended oxygen saturation level to maintain during rehabilitation for COVID-19 patients?
What is the recommended oxygen saturation level to maintain during rehabilitation for COVID-19 patients?
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What is a common long-term effect experienced by individuals recovering from COVID-19?
What is a common long-term effect experienced by individuals recovering from COVID-19?
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Which group is more likely to develop Long COVID?
Which group is more likely to develop Long COVID?
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What factor might influence early mobility interventions for critically ill COVID-19 patients?
What factor might influence early mobility interventions for critically ill COVID-19 patients?
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What is NOT a recommended physical therapy intervention for COVID-19 recovery?
What is NOT a recommended physical therapy intervention for COVID-19 recovery?
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What percentage of Americans reportedly experience Long COVID symptoms?
What percentage of Americans reportedly experience Long COVID symptoms?
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What is a common symptom of orthostatic hypotension?
What is a common symptom of orthostatic hypotension?
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Which of the following is NOT considered a potential cause of orthostatic hypotension?
Which of the following is NOT considered a potential cause of orthostatic hypotension?
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What lifestyle modification is recommended for managing orthostatic hypotension symptoms?
What lifestyle modification is recommended for managing orthostatic hypotension symptoms?
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Which treatment option is advised to monitor for adverse effects in patients with orthostatic hypotension?
Which treatment option is advised to monitor for adverse effects in patients with orthostatic hypotension?
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When experiencing symptoms of orthostatic hypotension, what position change is advisable to minimize symptoms?
When experiencing symptoms of orthostatic hypotension, what position change is advisable to minimize symptoms?
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What is a critical consideration when treating a patient with orthostatic hypotension?
What is a critical consideration when treating a patient with orthostatic hypotension?
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Which of the following patients is most at risk for developing orthostatic hypotension?
Which of the following patients is most at risk for developing orthostatic hypotension?
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Which statement accurately describes the treatment approach for orthostatic hypotension?
Which statement accurately describes the treatment approach for orthostatic hypotension?
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Which symptom is commonly associated with endocarditis?
Which symptom is commonly associated with endocarditis?
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What is a common treatment for pericarditis?
What is a common treatment for pericarditis?
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Which of the following is a recognized risk factor for cardiotoxicity from cancer treatments?
Which of the following is a recognized risk factor for cardiotoxicity from cancer treatments?
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How long should physical activity be avoided in cases of myocarditis?
How long should physical activity be avoided in cases of myocarditis?
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Which diagnostic test is NOT typically used during or after cancer treatments?
Which diagnostic test is NOT typically used during or after cancer treatments?
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What is a symptom of postural orthostatic tachycardic syndrome (POTS)?
What is a symptom of postural orthostatic tachycardic syndrome (POTS)?
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Which of the following can be a consequence of cancer treatments?
Which of the following can be a consequence of cancer treatments?
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What is the main treatment for symptomatic pericarditis?
What is the main treatment for symptomatic pericarditis?
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What intervention may help in managing symptoms of autonomic dysfunction?
What intervention may help in managing symptoms of autonomic dysfunction?
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Which condition is least likely to result from chemotherapeutic agents?
Which condition is least likely to result from chemotherapeutic agents?
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What is a typical symptom of pericarditis?
What is a typical symptom of pericarditis?
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Which autoimmune disease is known to contribute to autonomic dysfunction?
Which autoimmune disease is known to contribute to autonomic dysfunction?
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Which aspect is crucial for diagnosing POTS?
Which aspect is crucial for diagnosing POTS?
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Study Notes
Cardiac Pathophysiology & Intervention
- Cardiac pathophysiology and intervention, presented by Heidi Tymkew PT, DPT, MHS, CCS
- Topics covered include inflammatory disorders of the heart, endocarditis, pericarditis, myocarditis, oncology-related heart disorders, autonomic dysfunction, orthostatic hypotension, COVID-19 and rehab, and long COVID
Inflammatory Disorders of the Heart
- Focuses on conditions affecting the heart's lining and surrounding membranes
- Includes endocarditis (inflammation of inner lining) and pericarditis (inflammation of the pericardium)
- Myocarditis (inflammation of the heart muscle) is discussed as well.
Endocarditis
- Symptoms: Chills, fever, joint and muscle pain, red spots/nodes on hands/feet, shortness of breath, fatigue, swelling
- Treatment: IV antibiotics, surgery if heart valves are damaged, exercise limitation during acute phase
Pericarditis
- Description: Inflammation of the pericardial sac around the heart.
- Causes: Often idiopathic but can also result from injury (e.g., post-CABG surgery), heart attack, autoimmune diseases, or viral infections
- Symptoms: Chest pain (sharp/stabbing, worse with coughing, swallowing, deep breaths, and lying flat, better when sitting and leaning forward), pericardial rub
- Treatment: Anti-inflammatory medications, steroids, pain medication, antibiotics (if bacterial infection), surgery (rarely) - pericardial window to drain inflamed lining, limited physical activity for 1-3 months
Myocarditis
- Causes: Infections (viruses, bacteria, parasites), drugs/vaccines (cancer therapies, immune checkpoint inhibitors, clozapine, COVID-19 vaccine, smallpox vaccine), and autoimmune diseases (Lupus, Sarcoidosis)
- Symptoms: Irregular heart rhythm, chest pain, heart failure, shortness of breath, fatigue, palpitations, leg swelling
- Treatment: No standard treatment, treat heart failure and arrhythmias, avoid physical activity for 3-6 months, cardiologist clearance needed
Oncology-Related Heart Disorders
- Some cancer treatments can injure the heart muscle and blood vessels, increasing the risk of cardiovascular disease.
- Cardiotoxicity is damage to the cardiovascular system from cancer treatments.
- Examples of Chemotherapy Treatments: Anthracyclines (doxorubicin, daunorubicin), Cisplatin
- Examples of Oncology Heart Issues: Cardiomyopathy, coronary artery disease/MI, valvular heart disease, arrhythmias, pericarditis, myocarditis, hypertension, stroke, blood clots (DVT or PE), peripheral artery disease.
- Risk of heart attack/stroke is 2-6 times higher in cancer patients than those without cancer.
Cardiac Tests Used In/After Cancer Treatments
- BNP, NT-proBNP, Troponin I or T, Lipid profile, EKG, Echocardiogram, Cardiac MRI
- Cardioprotective strategies to reduce impact of cancer treatments: Dexrazoxane, ACE Inhibitors, Beta-blockers
Autonomic Dysfunction
- The autonomic nervous system (ANS) controls involuntary physiologic processes.
- Includes the sympathetic (SNS) and parasympathetic (PNS) nervous systems.
- The SNS and PNS work together to maintain homeostasis.
Causes of Autonomic Dysfunction
- Hereditary causes: Familial dysautonomia, Hereditary sensory neuropathy Type 3
- Acquired/idiopathic causes: Neurocardiogenic syncope, POTS, Multisystem Atrophy, Pure autonomic failure.
- Result of a pre-existing condition: DM, autoimmune diseases (e.g., RA, lupus), neurogenic orthostatic hypotension, Parkinson's disease, Dementia with Lewy Bodies, Medications, Trauma
Normal Response to Position Change
- In a healthy individual, the body regulates blood volume redistribution when changing posture from supine to standing.
- Blood shifts from the lower body to the upper body
- Heart rate and peripheral vasoconstriction increase to maintain cardiac output.
Postural Orthostatic Tachycardia Syndrome (POTS)
- An autonomic disorder characterized by excessive tachycardia upon standing, in the absence of orthostatic hypotension and other medical conditions.
- Primary affects females 15-50 years old.
- Symptoms: Lightheadedness/dizziness, headaches, visual problems, anxiety, shortness of breath, GI problems (nausea, vomiting, diarrhea), shakiness, hypoglycemia, fast heartbeat, acrocyanosis (red-blue discoloration of legs in standing).
- Diagnosed by 10-minute standing test/tilt-table test; sustained heart rate increase >30 bpm with no blood pressure change. Symptoms should also be present for 6 months.
Long COVID (Post-Acute Sequelae of COVID-19)
- Long Covid is a post-infection condition, usually 3 months after viral infection.
- Symptoms continue for 2+ months.
- Long COVID symptoms often include fatigue, brain fog, headache, difficulty concentrating, sleep problems, breathing problems, chest pain, muscle pain, gastrointestinal problems (e.g., bloating, nausea, diarrhea), and/or low back pain, physical exertion and stress are common triggers for symptom exacerbation.
COVID-19 and Rehab
- Rehab services were often delayed during the early COVID-19 pandemic due to PPE shortages.
- Usage of rehab services increased after the pandemic.
- Early mobility needs to be based on the patient's response to mobility.
- Close monitoring of vital signs, including oxygenation levels (SpO2).
- May need to titrate oxygen to maintain the patient's SpO2 above 88%-90%.
- PT intervention should include proning, airway clearance, early mobility, and strengthening activities.
Orthostatic Hypotension (OH)
- A decrease in systolic blood pressure by 20 mmHg or more, and a decrease in diastolic blood pressure by 10 mmHg or more, within 3 minutes of standing from supine position.
- Increases in older adults.
- Causes: Dehydration, blood loss, certain medications, neurological disorders, cardiovascular disorders, endocrine disorders (e.g., diabetes), prolonged bed rest, volume depletion, antihypertensive meds.
- Symptoms: Dizziness, lightheadedness, visual symptoms, weakness, fatigue, headache, nausea, cognitive slowing, syncope, chest pain, neck/shoulder pain, dyspnea, seizure-like movements
- Treatment: Correct any reversible conditions (drug side effects, hypovolemia), pharmacological therapy (Midodrine, Fludrocortisone, Pyridostigmine).
- Monitor for supine hypertension.
- Other interventions: Diet (exercise prior to meals, avoid alcohol and large meals, adequate hydration, limit exposure to hot showers/baths and weather), using compression stockings and/or abdominal binders with head-of-bed elevated 15-20 degrees.
- Physical Counter Maneuvers: Help reduce venous pooling, help to reduce symptoms, avoid straining and static standing and change positions slowly.
- Tips when treating a patient with OH: monitor vital signs, be aware of medications used, teach physical maneuvers, make the patient safe to go home (modify ADLs).
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Description
This quiz focuses on assessment tools and interventions for patients recovering from Long COVID and experiencing POTS symptoms. Test your knowledge on essential monitoring practices and appropriate rehabilitation strategies. Ideal for healthcare professionals and students in the medical field.