Physical Dysfunction final

What are the most common cancers in men?

prostate, lung and bronchus, colon and rectum, urinary/bladder, melanoma of the skin

What are the most common cancers in women?

breast, lung and bronchus, colon and rectum, uterine corpus, and thyroid

Most common type of cancer treatment

-surgical removal of cancer cells

-radiation therapy (shrink or kill tumors)

-Chemo

-Immunotherapy

-Hormone therapy

-Stem cell transplants

Define Metastasis

spread of cancer to another part of the body

What should an OT do before evaluation and treatment for someone with cancer?

verify blood counts, vital signs, and images

Define cancer-related fatigue

distressing, persistent subjective sense of physical, emotional or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning

what are the 4 subcomponents of cancer related fatigue?

1. general fatigue

2. emotional fatigue

3. physical fatigue

4. mental fatigue

What are the two key measures of body functions during cancer treatment?

-vital signs (BP)

-Lab values (provide info regarding biochemistry)

What is affected in cancer-related cognitive impairment?

-memory

-executive function

-attention span

what is chemotherapy-induced peripheral neuropathy (CIPN)

-experienced by people who undergo treatment with neurotoxic chemotherapy agent causing damage to peripheral nerves

-can present as motor, sensory, autonomic, or mixed

-develops in symmetric stocking glove (toes and fingertips first)

What are the symptoms of CIPN?

tingling, numbness, paresthesia, temp sensitivity, pain, feeling of wearing gloves/stockings, weakness, impaired balance

How do you facilitate occupational performance when a person with cancer is in pain?

collaborative activity analysis with client, graded activities, identify pain triggers, posture assessment, visualization/mental strategies to overcome pain cycle

What is deconditioning?

-A loss of functional capacity due to lack of activity

-often associated with poor responses to treatment (poor survival)

How do OTs help combat deconditioning?

Through mobilizing activities (walking to bathroom rather than using bedside commode or sitting up in bed to eat)

Body image/self-efficacy is a common psychosocial issue in clients with cancer due to unavoidable changes to apperance T/F?

True

What is lymphedema?

-inadequate drainage of lymphatic fluid

-most commonly associated with breast cancer

-can begin soon after surgery/radiation or years later

Treatment for Lymphedema?

-gentle exercise and diaphragmatic breathing

-compression garments

-manual lymphatic drainage

-pneumatic compression

-complete decongsetive therapy (CDT)

How does Palliative care differ from hospice?

-Palliative care can be initiated at any point in time during course of illness and curative care can be used during palliative care. but curative care can not be used during hospice. and someone can move from palliative/curative to hospice when treatment is no longer appropriate

Left side of the heart pumps blood where? Right side of the heart pumps blood?

-Left side of the heart pumps blood from the lungs TO the body

-Right side of the heart pumps blood from the body to the lungs

What is an electrocardiogram? (ECG)

electrodes placed on the chest to pick up the hearts electrical impulses

What is Ischemic Heart Disease?

-occurs when a part of the heart is temporarily deprived oxygen to meet its demand.

**most common cause is CAD (coronary artery disease)

What is Congestive Heart Failure? and what leads to it?

-weakness of the heart that leads to a buildup of fluid in the lungs and surrounding tissue.

-CAD can lead to CHF

What is Angia?

-chest pain described as squeezing, tightness, fullness, sharp pain, pressure

*Warning sign of CAD

How long are restrictions prescribed for person who just had an MI (heart attack)

-6 weeks because the newly damaged heart muscle is easily injured

Why is OT frequently recommended for MI?

-to guide the patient toward a safe level of activity or participation in occupation, during the acute period of recovery

Define Valvular disease

-characterized by damage to or a defect in one of the four heart valves. resulting in two complications.

1. volume overload

2. pressure overload

What is volume overload?

-increases the potential for atrial fibrillation (irregular/ineffective contractions in both atria)

What is Cardiac rehab?

-medically supervised program designed to improve cardiovascular health

What are some cardiac risk factors?

*the more risk factors the higher chance of CAD

-Those that cant be changed: gender, age, hereditary

-Those that can be changed: high BP, smoking, cholesterol levels, inactivity

-contributing factors: diabetes, stress, obesity

How long do patients typically stay after an acute MI?

-hospital stay is about 5-10 days

-usually managed in a coronary care unit

before dx of MI what is it typically treated with?

-aspirin and O2

After MI OT can be called on to do what?

-monitor the patients response to activity and educate the patient about the disease process, risk factors, and lifestyle modifications

What are two surgical procedures for MI?

-Percutaneous transluminal coronary angioplasty (PTCA) (balloon angioplasty)

-Coronary Artery Bypass Grafting (CABG)

What is PTCA

-catheter is inserted into femoral artery and guided into the coronary arteries. Dye is injected and the site of the lesion is identified. A balloon inflated at the site of lesion to push plaque against the arterial wall

-Stent (wire mesh tube) may be implanted in coronary artery to keep it open

What is CABG?

-diseased section of the artery is bypassed with healthy blood vessels (taken from other parts of the body)t thus improving circulation

How do surgeons gain access to the heart?

Sternotomy- breaking the sternum and spreading the ribs

What are the typical sternal precautions

-no lifting more than 6-8pounds

-no pulling/pushing

-no stretching arms out wide

-don't put both arms over head for prolong periods

-no bending/twisting

*usually in place for 6-8weeks.

What is cardiac ablation?

-procedure used to destroy small areas of the heart that are emitting dangerous signals that cause the heart to contract abnormally

what is a pacemaker?

-used for arrhythmias that cannot be controlled by medication

-small device that delivers an electrical impulse to heart muscle to regulate HR

What is called the pacemaker of the heart?

sinoatrial node

When is a heart transplant or heart-lung transplant recommended?

-when the hearts pumping ability has become too comprised by CHF or cardiomyopathy

abnormally slow heartbeat (less than 60bpm) is called?

bradycardia

What does the cardiovascular system include?

-heart

-arteries

-veins

-blood

What are the 3 layers of the heart?

pericardium, endocardium, myocardium

What are the 3 primary pulse points

1. carotid (neck)

2. radial (wrist)

3. brachial (elbow)

Normal pulse rate for the heart?

60-90bpm

Abnormally high levels of lipids in the blood?

hyperlipidemia

What is a Ventricular Assistive Device (VAD)?

surgically implanted mechanical circulatory support devices that support the heart by pumping blood mechanically

What are some common cardiac medications?

-anticoagulants, antiplatelet agents, ACE inhibitors, beta blockers, calcium channel blockers, cholesterol lowering medications, diuretics, vasodilators

What are some psychosocial considerations for cardiac clients?

-depression, anxiety, anger, and social isolation is common

-evidence supports psychosocial counseling after MI that supports self-help appraisal, social support, and coping to improve QOL

What is cardiac rehab?

-medically supervised program designed to improve cardiovascular health

-3 phases

What are the 3 phases of cardiac rehab?

1: inpatient, monitored low level activity (self-care, precautions, energy conservation, graded activities)

2: outpatient, exercise can be advanced while client is monitored

3: community based exercise program

What tool is used to rate perceived exertion before and after activity?

Borg rate of perceived exertion scale

What is the respiratory system?

-supplies O2 to the blood and removed waste products primarily CO2 from the blood

What is a trachetomy

-occurs when the or pharynx becomes blocked, small incision may be made through the trachea to allow air to pass freely into the lungs

OT and chronic lung disease

-OT is commonly prescribed for clients with lung disease that impacts their ability to participate in daily life

-COPD, sarcoidosis, asthma, idiopathic pulmonary fibrosis, and cystic fibrosis will benefit from breathing techniques and energy conservation

What is COPD

*Chronic Obstructive Pulmonary Disease

-non curable and damage is irreversible

-air sacs (alveoli) of the lungs are damaged, lose elasticity and clogged with mucus

-includes Emphysema and chronic bronchitis

-difficult to breath

What is Emphysema and chronic bronchitis

Emphysema: medical condition where alveoli are damaged

Chronic Bronchitis: bronchial airways become inflamed increasing mucus production causing SOB (dyspena)

What are some pulmonary risk factors?

-Smokers are 12x more likely to die from COPD than nonsmokers

-smoking causes emphysema and chronic bronchitis

-environmental irritants such as dust, air pollution, and chemical exposure

What is pack year history?

-calculated by multiplying the number of packs of cigs consumed per day by the number of years smoking

What are ways to monitor response to activity?

HR, BP, rate pressure product (RPP), and ECG

HR: 60-90bpm

BP: 120/80 (sys/dys)

RPP: HR x Systolic BP

Medications for chronic lung disease

-anti-inflammatory, bronchodilators, expectorants, flu shots

-oxygen therapy

What is pulmonary rehabilitation (PR)?

-multidisciplinary, comprehensive program, tailored to the individual needs of each recipient

-psychological, emotional, and physical problems are addressed

What is the goal of PR?

What are the guidelines of PR?

Goal: stabilize or reverse the disease process and return the patients function and participation in activities

Guidelines: low and high intensity is beneficial, arm exercises should be unsupported against gravity and without resistance, leg exercises should be included, and supplemental oxygen is helpful

*improves dyspnea, reduce hospital days, and efficaciously utilizes medical services

Signs of respiratory distress

-Dyspnea

-extreme fatigue

-non-productive cough

-confusion

-impaired judgement

-cyanosis (blueish colored skin, insufficient O2)

Barriers preventing engagement in people with COPD

-uncertanity about progression of disease

-attributing the cause of disease to external factors

-progressing restriction in activity and isolation

-anxiety/depression

-passive acceptance

*OT encourage client to engage in activities that will develop their skills promoting resumption of occupations that bring value, meaning, and participation back into their life

What is dyspnea control postures?

-When sitting patient bends forward slightly at the waist while supporting UB by leaning forearms on table or things. While standing relief may be made by leaning forward and propping self on counter

What is pursed lip breathing?

-prevents tightness in airway by providing resistance to expiration

-should be used when bending, lifting, or stair climbing

-relax shoulder/neck, inhale through nose 2 counts, purse lips, exhale through lips 4 counts

Diaphragmatic breathing

calls for increase use of diaphragm to improve chest volume

Interventions for pulmonary disease?

-Progression and energy costs (METS-how hard lungs and heart are working) (1 the least, 7 the most)

-Energy conservation

-Life style modification (exercise, nutrition, cease smoking, drinking, support group)

-Education

What does HIV stand for? What does AIDS stand for?

-HIV: Human immunodeficiency Virus

-AIDS: acquired immunodeficiency Syndrome

Origin of HIV

-orinigated in africa, clinically identified in US in 1981

-Majority is HIV type-1

-leading cause of death for HIV is tuberculosis

-in low and middle class 52% accounts of HIV are women

-African Americans are mostly affected followed by hispanics/latinos

-male to male contact is the most common means of transmission

what is the infection process like for HIV?

-HIV is the virus that causes AIDS, belongs to a class of viruses known as retroviruses

-When the virus replicates through the reverse transcript process, it can have mutations which contribute to the resistance of the virus to the bodys immune system, which complicates medical treatment

How is HIV transmitted?

-bodily fluids, blood, semen, presiminal fluid, vaginal fluid, breast milk, rectal fluid

-most common is : sexual behavior and drug injection

-less common: breast feeding, mother to child pregnancy, accidental exposure to needles

-risk of infection to health care provider is low

What are the universal precautions the CDC recommends for HIV

-assume blood and bodily fluids are always potentially infectious

-use gloves

-wash hands and other skin surfaces after contact with body fluid

-practice safe handling of any sharp objects

Diagnosis of HIV

-Can be detected using antibody tests, combination tests, and nucleic acid tests

-range from asymptomatic to AIDS

-CD4-Primary receptor for HIV

What is seroconversion?

-immune response producing detectable antibodies

-during this process (up to 2 months after infection) the person may be infected but not have positive antibody test result

Categories of HIV?

-Category 1: counts of 500 or more of CD4 cells

-Category 2: 200-499 counts of CD4

-Category 3: below 200 CD4 cells

-Category A: mostly asymptomatic, initial onset of HIV

-Category B: never had AIDS defining illness but may have fever, herpes, diarrhea

-Category C:one or more AIDS defining illness

**Category 3 or C=AIDS

**Category 1,2,A,B=HIVpositive

Pharmacology for HIV

-No cure, but medications alter course of disease to promote healthier functioning

-medication restrict viral replication which increases CD4 count improving immune system

What is Antiretroviral Therapy? (ART)

-Antiretroviral medications most effective when used in combination because HIV quickly builds resistance to them

-increased survival rate

-extended life expectancy (increased prevalence rates of HIV while incidence rate has remained steady)

Predictors of poor adherence to ART?

-age related changes, low literacy levels, psychosocial issues, substance use, cognitive impairments, complex regimens, medication fatigue, and medication scheduling issues

What are side effects of ART?

-CNS disorders, peripheral neuropathy, gastrointestinal disorders, hepatotoxicity, Anemia, pancreatitis, osteopenia, osteoarthritis, lipodystrophy, hyperlipidemia, diabetes, hyperglycemia

*consistency with medication is crucial

Aging and HIV

-elderly people with HIV are more likely to have comorbidities

-HIV diagnosed at people older than 50 are at a more advanced stage

-physicians are more likely to attribute symptoms of HIV to something else in people older than 50

Neurological conditions relating to HIV

-neuro conditions are common and debilitating to ADL/IADL performance

-HIV is capable of passing the blood brain barrier and entering the CNS causing ADC

-OT should assess pain levels

What is the most common neurological complication in HIV?

Neuropathies =more specifically distal sensory neuropathy

-causes burning, painful sensation on distal end of LE, often with numbness, tingling, and decreased sensation

What is AIDS dementia complex (ADC)?

-commonly associated with HIV infection

-similar symptoms to Parkinsons and huntingtons (motor disturbance, imbalance, unsteady gait, tremor, weakness, behavior changes, cognitive changes)

What is positive prevention in HIV/AIDS

-link infected people to appropriate preventative services

-help with adhering to treatment regimens

-provide support to develop health habits for sustaining behavior that reduces risk

-health education and risk reduction programs

-emphasize establishing and maintaining habits and routines that support engagement in occupation

What are some assessments for HIV?

-Pizzi Assessment of Productive Living for Adults with HIV infection and AIDS

-Pizzi Health and Wellness Assessment (PHWA)

-Holistic assessments are useful to address multitude of issues

Interventions for prevention of disability relating to HIV?

-enhance occupational engagement and performance with an emphasis on maintaining performance patterns, habits, routines, etc.

Interventions for education and health promotion in HIV?

-energy conservation, address fatigue, weakness, deconditioning,

-educate about proper nutrition, work simplification, and medication management

Interventions for Maintaining and restoring performance in HIV

-allowing control and choices of daily living options

-adaptation of daily routines, finding alternative roles

-complementary medicines/therapies

Interventions for modifications, adaptations, and compensatory approaches in HIV?

-adaptive equipment and positioning

-changes in physical environment

interventions for Advocacy and psychosocial considerations in HIV?

-People with HIV often experience loss due to disease (friendship, work, family, and housing)

Define polytrauma

-multiple trauma, injuries to more than one physical region or organ system. one of which may be life threatening that can result in cognitive, physical, psychological impairments, and functional disability

What are common types of polytrauma injuries

-shrapnel injuries, amputations, severe wounds, loss of normal body functions, brain damage, sensory impairments, partial to full paralysis

What is a blast injury?

one of the most common causes of polytrauma. exposure from a blast such as from an improvised explosive or rocket propelled grenade

What is a primary blast injury?

-exposure to overpressurization wave or the complex pressure wave that is generated by the blast itself.

-air filled organs are typically susceptible (ears, lungs, GI tract, brain, and SC)

What is a secondary blast injury?

energized fragments flying through the air can cause penetrating injuries

What are tertiary blast injuries?

-individual is thrown from the blast into a solid object such as a wall or steering wheel.

-injuries are associated with acceleration/deceleration forces to the brain

What are quaternary blasts?

-significant blood loss associated with traumatic amputations or the inhalation of toxic gasses released by explosion