W1-D1 Notes on Cardiopulmonary Conditions PDF

**[Topic- W1 D1]** ------------------------------ ### [AOTA: Cardiopulmonary Conditions] **[Heart Conditions]** - Heart disease risk factors include non-controllable (age, family history, gender) or controllable (smoking, hypertension, hyperlipidemia \[high concentration of fats in the...

**[Topic- W1 D1]** ------------------------------ ### [AOTA: Cardiopulmonary Conditions] **[Heart Conditions]** - Heart disease risk factors include non-controllable (age, family history, gender) or controllable (smoking, hypertension, hyperlipidemia \[high concentration of fats in the blood\], obesity, diabetes, stress) - Asthma can cause a barrel chest for children. People with asthma have hyperinflated lungs, which can partially expand the rib cage overtime. - To improve breathing = lean forward, place forearms on the thighs and practice pursed-lip breathing - For those obese, side-lying position + entire upper trunk elevated assist with breathing - Heart diagnosis: - **Myocardial infarction (MI) or heart attack**: blood/oxygen to the heart muscle is reduced and treatment focuses on limiting damage to the heart muscle, relieving pain and preventing clot formation. - Early activity after acute MI should not exceed 1-2 METs; it should stay in the 2-4 MET range for a recommended home exercise program - Healing of heart after myocardial infarction takes 4-8 weeks - MET levels 2-4 (light housekeeping, knitting, dressing. undressing) - Elevation in troponin levels \[protein released when heart is damaged\]\-- diagnostic marker for acute myocardial infarction - **Coronary artery disease (CAD):** ischemic disease \[blood flow to part of body is reduced or blocked\] commonly due to atherosclerosis which can narrow vessels over time and occlude blood supply to the heart - **Angina pectoris**: complication of CAD which the heart muscle constricts with increase activity demands, due to decreased blood supply. [Results in pain in the chest & left side of jaw-shoulders or shortness of breath, nausea, fast heartbeat and diaphoresis (sweating). ] - **Stable angina:** occurs due to physical exertion/stress and is relieved by rest or medication (nitrogylcerian) - **Unstable angina:** more dangerous form of chest pain and doesn't go away with rest of medication. Can be a warning sign of a heart attack - **Congestive heart failure**: results from impaired structure or function of ventricles - Pts with left ventricular dysfunction =present with increased fatigue, shortness of breath and pulmonary edema \[fluid build-up in the lungs\] - Pts with right ventricular dysfunction = present with peripheral \[away from center of body aka swelling in the legs/feet\] or abdominal edema - May have an acute onset or progress slowly and become chronic - **Cardiomyopathies**: group of heart muscle diseases that can affect how the heart pumps or its electrical signals. - **Peripheral artery disease**: condition when the arteries that supply blood to the limbs and pelvis become narrowed, but it doesn\'t affect the heart. - Common symptoms: pain and cramping while walking (called intermittent claudication), cold limbs, numbness or tingling in the legs, lack of hair growth, painful ulcers, and difficulty walking. - If left untreated, it can lead to gangrene (dead tissues) and amputation. - Wound care like vacuum-assisted closure (VAC) is used for managing serious wounds (should not be turned off w/o nurse knowledge; can only be turned off for 2 hrs within 24 hr period). Movement Is not usually restricted when a client is wearing a wound VAC. - Inflammatory diseases: - **Endocarditis**: A bacterial infection in the inner lining of the heart (endocardium) and heart valves. - Symptoms: fever, tiredness, trouble breathing, weight loss, night sweats, joint pain, numbness in the arms or legs, heart murmurs, and blockages in organs - Those with history, generally take antibiotics before dental procedures to prevent infection from migrating to the heart - **Myocarditis**: Inflammation of the heart muscle, usually caused by viral, bacterial, or fungal infections. - **Pericarditis**: Inflammation of the pericardium, the protective sac around the heart.\ It can happen after a heart attack, open-heart surgery, or due to immune system issues, kidney failure, or infections - **Cardiac tamponade**: A condition caused by an excess of fluid building up in the pericardium, leading to pressure on the heart and preventing it from working properly. *[Treatment for Heart Conditions ]* - **Open heart surgery (CABG) and valve replacement.** - Sternotomy \[cut breastbone to reach heart during surgery\] can be performed, precautions = WBR, no excessive twisting/turning and lifting limit. - Sternal precautions (6-12 weeks) = don't lift \>8lbs, no push/pull with arms, don't raise elbows above shoulders, do not twist/bend, hug a pillow when coughing/sneezing and do not drive until cleared (think BLT) - However, an OTR should consider for a pt who had a heart attack/open-heart surgery: perform ADLs using both hands to avoid placing pressure on sternal scar, sternal precautions and pacing/energy conservation techniques - **Angioplasty** \[minimally invasion to open blocked arteries to treat CAD; think balloon\], **atherectomy** \[minimally invasion to remove plaque from arteries and treat atherosclerosis- buildup of fat on the artery walls and improve blood flow; think catheter with blade inserted usually in the groin or upper thigh and the plaque is shaved\] - **Pacemakers and implantable defibrillator devices** precautions = no activity for first few weeks, no lifting \>10lbs, no shoulder flexion & abduction \>90 degrees of UE on side of pacemaker - **Ventricular assist device (VAD):** device that helps the heart pump blood to the body and is used at end stage heart failure for those who are not candidates for heart transplantation. - It is connected to a power source and Ots must avoid disconnecting the drive line to the power source during movement - **IABP:**  intra-aortic balloon pump used to augment low cardiac output *[Medical Considerations and Complications- Heart Conditions]* - **Deep vein thrombosis (DVT):** A blood clot forms in a deep vein, usually in the leg. - *Treatment*: Blood-thinning medications (heparin, warfarin, or aspirin); compression stockings or leg/foot compression; anticoagulation therapy [ ] - **Superficial thrombophlebitis**: Blood clots form in the veins just under the skin, often in the arm, leg, or groin - *Symptoms*: pain, swelling, redness, warmth, and tenderness. - *Treatment*: warm compresses, pain or anti-inflammatory meds, support stockings, or surgery to prevent deeper clots - **Pulmonary embolism (PE)**: Occurs when a blood clot ([usually from DVT]) travels to the lungs, blocking blood flow. - *Symptoms*: sudden shortness of breath, fast heartbeat, rapid breathing, chest pain, fainting, blue skin, sweating, and a mild fever. - *Treatment*: intravenous heparin and possibly a vena cava filter. - **Compartment syndrome**: Occurs when there is bleeding or swelling within a muscle compartment, causing pressure and pain. - *Treatment*: surgery (fasciotomy), rest, ice, and anti-inflammatory drugs. - **Gangrene:** Tissue death caused by a lack of blood supply. - *Symptoms*: blue or black skin, severe pain, numbness, and foul-smelling discharge. - *Treatment*: antibiotics, surgery, amputation, hyperbaric oxygen therapy, and pain medication. - **Raynaud's syndrome:** blood flow to the fingers and toes is reduced, usually due to cold or stress. - *Treatment*: vasodilators and calcium channel blockers to improve blood flow. *[Cardiac Rehabilitation]* **Phase 1 (Inpatient OT)** - Monitor heart rate, blood pressure, EKG, and symptoms before, during, and after activities. - **Orthostatic (postural) hypotension**: A sudden drop in blood pressure when moving from lying down to sitting or standing. - **Postprandial orthostatic hypotension**: Blood pressure drops after standing up, especially after eating (common in older adults, people with high blood pressure, or Parkinson's). - **Neutrally mediated hypotension**: Blood pressure drops after standing for a long time (affects children and young adults). - **Severe hypotension**: Caused by sudden blood loss. - Focus on low-level physical activities like self-care, education on heart and surgical precautions, energy conservation, and creating a home program for discharge. - Help patients gradually increase activity based on **Metabolic Equivalent (MET) levels**: - **Light activities (\6 METs)**: running, bicycling, shoveling, etc. - Monitor for symptoms or difficulty with activities. - Develop a home program that includes: - Guidelines for activities, pacing, and simplifying tasks; temperature precautions; social and sexual activity; risk factors and symptoms of activity intolerance. **Phase 2 (Outpatient OT)** - Exercise and activity tolerance with progression of MET levels. - Weight training at 2--4 weeks. - Educate on risk factors - Evaluate for psychosocial issues/ provide a referral if needed. **Phase 3 (Community)** - Phase 2 activities and progress are continued as tolerated - Less therapy supervision - Community settings **[Pulmonary Conditions]** Pulmonary Diagnosis: - **Chronic obstructive pulmonary disease (COPD):** lung condition that damages the alveolar walls and causes inflammation in the airways. - **Emphysema**: damaged air sacs/alveoli (damage/rupture); distal in the lungs - **SOB, pinkish skin due to increase rate of respiration** - **Chronic bronchitis:** long-term inflammation of the bronchioles (airways), leading to difficulty breathing (dyspnea); proximal in the lungs - **Severe coughing, SOB, poor oxygenation, blueish tint, and edema** - **Acute respiratory distress syndrome (ARDS)**: severe, life-threatening condition where inflammation from illness or trauma injures the lungs and causes fluid buildup. - **Interstitial lung disease (ILD)**: lung disorders that cause scarring in the tissue around the air sacs. The most common type of ILD is **sarcoidosis**. - **Cystic fibrosis**: - inherited disorder that causes severe damage to lungs, digestive system, and other organs - Mucus, SOB, **yellowing skin** - **Obstructive sleep apnea**: condition where breathing repeatedly stops for at least 10 seconds during sleep - **Pneumonia**: infection that causes inflammation of lung tissue. *Symptoms:* dyspnea (shortness of breath), fatigue, cough, anxiety, depression *Risk factors*: smoking, air pollution, chemical exposure and dust *Medical Management*: anti-inflammatory agents, oxygen therapy, meds to relax muscles around airway (bronchodilators) and meds to help clear mucus from airway by thinning mucus (iodides) *Goals of Rehab*: facilitate strength, endurance and mobility in the context of ADL/IADL retraining. Provide patient and caregiver education (energy conservation/stress management) **Classes of Heart Disease (1-4)** **Vital Signs:** Normal BP: \~ 120/80 Hypertension: \> 120/80 Hypotension: \< 90/60 Mean arterial pressure: 70-110 mmHg (well blood is flowing through the body) **Isotonic** exercises \[moving a muscle while applying a constant amount of weight for the muscles to lengthen/shorten; i.e, squats, lunges, pull ups\] - good for person with hypertension & heart disease **Isometric** \[static position while contracting a muscle; ie., plank, knee extension, wall sit\] - contract-relax exercise, muscle contraction and hold - contraindicated  R side of heart: body → (deoxygenated blood) heart → lungs; systemic flow - R sided congestive heart failure - blood flows back into venous system - *[Symptoms]***:** Cyanotic (blue**)** nail beds, jaundice, LE edema L side of heart: lungs → (oxygenated blood) heart → body; pulmonary flow - L sided congestive heart failure - blood flows back into lungs - *[Symptoms]*: difficulty breathing, anxiety, cerebral hypoxia - Aortic stenosis & aortic insufficiency have symptoms similar to L-sided ### [OT Miri: Cardiac Rehab/MET Level] **\*\*MET Level Definition: O₂ cost (energy level/compensation) to complete a task \[1= rest\]\*\*** **Phase I: acute inpatient rehab/hospitalization** - Pt is medically stabilized but priority is on close monitoring - Monitoring: Vital signs taken (4x) - Presentation of pt: tired & weak (Eval/Intervention = at bedside) - Focus on self-care ADLs - MET 1-2: bed & wheelchair mobility, bathing, grooming, feeding while sitting - MET 2-3: seated showers - Patient & family education: energy conservation, work simplification, cardiac & post-surgical precautions - Discharge to phase II at MET 3.5 **Phase II: Outpatient Rehab (3.5+ MET)** - Clinical status will allow for safe participation in an individualized program - Build up activity tolerance (beginning at activity 4-5 ranges with progression) - Improve IADLs & occupational roles/work activities **Phase III: Maintenance Community Exercise Programs** - Less intensive, monitored exercise program - Not covered by Medicare +-----------------------------------+-----------------------------------+ | 1.5-2\* | Transfers, seated self-care, | | | deskwork, knitted, etc. | +-----------------------------------+-----------------------------------+ | 2-3\* | Seated sponge bath/warm shower, | | | dressing/undressing, dusting | | | | | | - Heat makes heart work harder; | | | cold chills = requires more | | | energy | | | | | | - UE movement uses more energy | | | than LE, avoid overhead | +-----------------------------------+-----------------------------------+ | 3-4\* | Standing warm shower, most light | | | household chores (make the bed), | | | sweeping/mopping | +-----------------------------------+-----------------------------------+ | 4-5\* | Hot standing shower, changing bed | | | linens, golf, badminton, table | | | tennis, tennis doubles, dancing, | | | raking/wedding | +-----------------------------------+-----------------------------------+ | 5-6 | Sex (five-freaky), | | | shoveling/digging | +-----------------------------------+-----------------------------------+ | 6-7 | Brisk walking 5 mph | +-----------------------------------+-----------------------------------+ | 7-8 | Jogging 5 mph | +-----------------------------------+-----------------------------------+ | 8-9 | Running 5.5 mph | +-----------------------------------+-----------------------------------+ | 10+ | Fast running, recreational | | | activities independently | +-----------------------------------+-----------------------------------+ \*1-4 most likely seen in the exam\* **International normalized ratio (INR)** - how long it takes for blood to clot - \> 5 = at risk for bleeding, therefore on bedrest or activity restrictions - \< 2 = at risk of thromboembolism (blood clot) - associated with heart attack and stroke **Ventricular tachycardia** (abnormal heart rhythm, too fast, episodes can be life threatening) - HR \> 100 BPM can result in sudden cardiac death → defer OT until medically stable **Orthostatic hypotension** - - Lightheaded, blurred vision / **BP drop more than 20 mm HG systolic (top) and 10 mm HG diastolic (bottom)** - Trendelenburg, supine, lift lower extremities ### [OTEP 01: MET Levels] +-----------------+-----------------+-----------------+-----------------+ | **Stages** | **MET Level** | **Star Wars** | ADL | +-----------------+-----------------+-----------------+-----------------+ | I | 1.0 - 1.5 | Obi "One" | Light BUE | | | | Kenobi | tasks: [seated | | | | | for brief | | | | old man, slow, | amnt]{.underlin | | | | not very active | e} | | | | | of time such as | | | | | self-feeding, | | | | | reading, | | | | | washing face, | | | | | squat pivot | | | | | transfer | +-----------------+-----------------+-----------------+-----------------+ | II | 1.5 - 2.0 | | Slow | | | | | ambulation, | | | | | dressing, | | | | | grooming, | | | | | sponge bathing | | | | | (reaching to | | | | | entire body) | +-----------------+-----------------+-----------------+-----------------+ | III | 2.0 - 3.0 | R "2" D2 (think | [Seated]{.under | | | | robot) | line} | | | | | shower (warm | | | | R2D2 -- he's | water), seated | | | | short = seated | light IADLs, | | | | | piano, | | | | | computer, | | | | | extended | | | | | deskwork | +-----------------+-----------------+-----------------+-----------------+ | IV | 3.0 - 3.5 | C "3" PO (think | Ambulate as | | | | iron guy) | tolerated, | | | | | [standing]{.und | | | | Maid C3PO - | erline} | | | | dusting, making | shower (warm | | | | sandwich, | water), light | | | | dishes, | IADL (dusting, | | | | laundry, DIY | making | | | | | sandwich), | | | | | driving, slow | | | | | stairs | +-----------------+-----------------+-----------------+-----------------+ | V | 3.5 - 4.0 | | [Standing | | | | | medium]{.underl | | | | | ine} | | | | | IADL (dishes, | | | | | laundry, DIY | | | | | home repairs), | | | | | golf, slow | | | | | swimming/biking | +-----------------+-----------------+-----------------+-----------------+ | VI | 4.0+ | Harrison | **Heavy IADLs** | | | | "Four"-d | (mopping, | | | | | raking, | | | | Han Solo - | vacuuming), | | | | manly & | slow dancing, | | | | romantic man | light yoga | +-----------------+-----------------+-----------------+-----------------+ - **Self-care tasks - within MET 1.0-2.5** - **Only 6 stages**