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How to approach a cardio & pulmonary patient (evaluation & treatment)
- Carefully review chart, precautions (HR, BP, METS)
- Be aware of procedures & precautions
- Check with the NURSE!
- Constantly observe symptoms, complaints and monitor vital signs.
What are the symptoms (reported by client) & signs (observed by us) of Cardio/Pulmonary issues in response to exercise/activities?
- Symptoms: chest pain, fatigue, dizziness, nausea/vomiting, SOB (dyspnea), muscle bone joint pain
- Signs: Pallor (ashy skin), staggering gait, confusion, resting HR >130 or <40, Palpitations >6hr, BP abnormalities
Myocardial Infarction (MI)
Coronary Artery Disease (CAD)
Congestive Heart Failure (CHF)
- MI: lack of blood flow to heart (ischemic-part of hear is derived of oxygen and dies)
- CAD: buildup of platelets in coronary artery, clogging passage way, narrowing, low volume of blood allowed to pass through
- CHF: heart can not pump enough blood to the rest of the body..fluid backs up to lungs, heart enlarged, SOB
Signs & Symptoms of CHF exacerbation:
- Weight gain
- SOB with normal activity
- Edema in ankles & feet
When pressure is applied to swollen area, the indentation persists
Treatment of Edema
- Elevation (not good=dependent position)
- Pressure garnmets (TED hose, compression)
- Retrograde massage-distal->proximal, circumfrential
- Ankle pumps
- Low sodium diet
- Diuretic meds
Treatment post MI
- Restrictions for 6 WEEKS
- Allow healing, but maintain strength of healthy part of the heart!
- OT ROLE:
- safe activities, recognize signs/symptoms, pacing & energy conservation, grading activities (METS) first 4-8wks only activities rated 2-4METS
Phase I: Inpatient
- MAR P.D.
- Prevent muscle loss from bedrest (get them to move, even in supine!)
- ADLs..instruct in appropriate adls and activities, energy conservation, grading
- Risk factors: educate about these and how to reduce them (diet, see PT ST, smoking, hypertension, weight)
- Precautions: reinforce these! METS (sternal precautions=no pushing/pulling)
- Discharge Plan
Phase II: Outpatient
- Continued surveillance of cardiovascular response to exercise!
- Limit psychological stress
- Determine appropriate exercise and activity intensity
- Maximize vocational status
- Remind of risk factors & how to reduce them
Phase III: Community-Based Rehab
- Group setting! not covered by insurance, requires physician referral
- MONITOR the following
- BP, HR, EKG (1x per month), goal setting for risk management
Phase IV: Long Term Management
- For physical & psychosocial support
- Cardiac groups
- Educational workshops
- Social outings
- Encourage recreation & leisure!
- Encourage change in behaviors & risks!
Controllable risk factors for Cardiac !
- OT must direct considerable energy twd EDUCATING about controllable risk factors
- Smoking, Hypertension, Sedentary lifestyle, Obesity, Psychological stress, Diet (diabetes (DM), hyperlipidemia (HLD)
COPD & ASTHMA
Signs/Symptoms of Respiratory Distress:
- Risk Factors: SMOKING
- Signs/Symptoms of Respiratory Distress:
- Dyspnea (SOB)
- Extreme fatigue/confusion
- Nonproductive, dry cough
- Cyanosis (lack of O2 in blood-blueish color in lips and nail beds)
Pulmonary (COPD & Asthma) management
Hospital & OT
- anti-inflammatory, bronchodilators, Pulmonary fx tests (incentive spirometer, pulse oximeter) expectorands, steroids
- O2 therapy
- Ventilator (mechanical assist)
- Pursed lip breathing
- Diaphragmic breathing
- Energy conservation
- Adaptive approach
OT GOALS in pulmonary rehab
- Endurance: increase (ADL training)
- Breathing Techniques: improve!
- Activity tolerance: improve!
- Stress mgmt & relaxation: improve!
- Awareness & monitoring of vital signs!
Dyspnea Control Postures
- NO SUPINE!!
- Upright positions are best
- Fwd-leaning, sideways, decrease reliance on accessory muscles in breathing
- Postural Drainage: positions that make it easy for mucus to drain
Therapeutic Breathing Techniques
- Pursed Lip Breathing!
- relieves SOB, maximize O2 uptake, promotes relaxation, 1:2 ratio, inhale nose 1-2, exhale mouth 1-2-3-4
Therapeutic Breathing Techniques
- Diaphragmatic Breathing
- strengthen diaphragm---> decrease breathing rate and oxygen demand! -->less effort to breathe!
- Progressive muscle relaxation + breathing
- Decrease anxiety
- Control SOB
- Biofeedback (auditory response to muscles)
Psychosocial issues of pulmonary:
- Sensory deprivation (afraid to go outside and do things)
- Boredom, depression
- Sense of loss of control
- Emotional libility/irritability - can be from drugs
- Perceived as uncooperative (told to work harder when they simply can not)
- High anxiety "COPD personality"
- Deliver air during inspiration and allow passive expiration (no muscle contraction)
- Endotracheal tube inserted through nose or mouth into trachea
- Intubation (can't talk) Extubation (patient must breathe on his/her own-will not see them when they are extubated)
Reasons to Intubate
- Upper airway obstruction
- Unable to protect airways from aspiration
- unable to clear pulmonary secretions
- Short term airway mgmt needed 1-7days
What are the 4 P's in energy conservation
- PLAN: highest demand activities during time that you have the most energy
- PACE: take breaks!
- PRIORITIZE: do what is critical to get done
- POSITION: no supine, better to stand or sit!