Cardio & Pulmonary

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Cardio & Pulmonary
2014-09-24 21:15:22
Cardio Pulmonary

Cardio & Pulmonary
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  1. 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.
  2. 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
  3. 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
  4. Signs & Symptoms of CHF exacerbation:
    • Weight gain
    • Confusion/Fatigue
    • SOB with normal activity
    • Edema in ankles & feet
  5. Pitting Edema
    When pressure is applied to swollen area, the indentation persists
  6. 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
  7. 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!
  12. 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)
    Risk Factors:
    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)
  14. Pulmonary (COPD & Asthma) management
    Hospital & OT
    • Hospital:
    • anti-inflammatory, bronchodilators, Pulmonary fx tests (incentive spirometer, pulse oximeter) expectorands, steroids
    • O2 therapy
    • Ventilator (mechanical assist)
    • OT:
    • Posture
    • Pursed lip breathing
    • Diaphragmic breathing
    • Relaxation
    • Energy conservation
    • Adaptive approach
  15. OT GOALS in pulmonary rehab
    • Endurance: increase (ADL training)
    • Breathing Techniques: improve!
    • Activity tolerance: improve!
    • Stress mgmt & relaxation: improve!
    • Awareness & monitoring of vital signs!
  16. 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
  17. 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
  18. Therapeutic Breathing Techniques
    • Diaphragmatic Breathing
    • strengthen diaphragm---> decrease breathing rate and oxygen demand! -->less effort to breathe!
  19. Relaxation Techniques
    • Progressive muscle relaxation + breathing
    • Decrease anxiety
    • Control SOB
    • Biofeedback (auditory response to muscles)
  20. 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"
  21. Ventilators
    • 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)
  22. Reasons to Intubate
    • Upper airway obstruction
    • Unable to protect airways from aspiration
    • unable to clear pulmonary secretions
    • Short term airway mgmt needed 1-7days
    • ICU
  23. 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!