Conditions in OT Exam #1 - Healthcare Disparities, Cardiopulmonary, Deconditioning, & Acute Care

Pleura

Membrane surrounding the lungs separating them from the chest wall and protecting them to allow smooth breathing

Systole & Diastole

Systole: ventricles contract and pump blood into the aorta and pulmonary artery

Diastole: when the ventricles fill with blood

One complete heartbeat is composed of these two phases

Normal Pulse Rate

60-100 beats per minute

Arrythmia

A problem with the rate or rhythm of the heartbeat

Tachycardia: heartbeat is too fast; higher than 100 bpm

Bradycardia: heartbeat is too slow; lower than 60 bpm

AFib

Arterial Fibrillation

A problem in the hearts electrical system which stimulates the heart to squeeze and relax; when blood flow slows it has potential to pool which increases risk of stroke, blood clots, or other heart complications

Normal Respiratory Rate

12-20 breaths per minute

Systolic & Diastolic Pressure

Systolic: blood being pushed out of the heart and into the arteries of the circulatory system

Diastolic: when the heart rests in between heart beats

systolic / diastolic

Sphygmomanometer

Inflatable blood pressure cuff; used to measure blood pressure manually

Hypertension & Hypotension

Hypertension: high blood pressure

Hypotension: low blood pressure

Normal Oxygen Saturation

96%-100%

Hypoxemia: low blood oxygen

Primary Hypertension vs. Secondary Hypertension

Primary: when there is no specific identifiable etiology, but it may be attributed to age, obesity, family history, or lifestyle factors

• typically develops gradually over many years

Secondary: often triggered by an underlying condition which tends to have a sudden onset and causes high BP

CAD - Coronary Artery Disease

Develops when coronary arteries become damaged over time

• narrowing; reduces blood flow

Atherosclerosis

A buildup of fatty, fibrous plaque that can progressively narrow the vessels and occlude blood supply to the heart, increasing the risk of significant health-related issues

Angioplasty

Percutaneous coronary intervention: with or without stent placement, is a common procedure used to open an artery (inflated balloon)

Stent: a small, mesh tube used to keep the artery open

CABG - Coronary Artery Bypass Graft

Procedure used to manage severe cases of CAD;

surgery involves circumventing the blocked artery by using a harvested vessel from another part of the body, most commonly the saphenous vein in the leg

CHF - Congestive Heart Failure

A chronic, progressive condition that impacts the heart’s ability to pump blood to the body and provide organs & tissues with oxygen and nutrients

Results from impaired ventricle structure and/or function and affects both sides of the heart

Dyspnea

Shortness of breath; a common symptom of heart failure

Symptoms of Left-sided vs. Right-sided Heart Failure

Left: typically presents with increased fatigue, shortness of breath, and pulmonary edema

Right: specifically noted for peripheral edema (swelling)

ECG - Electrocardiogram

Determines heart rhythm irregularities, presence of structural changes, valve function issues, and thickness of the heart wall

EF: ejection fraction - the thickness and stiffness of the heart wall and the amount of blood the left ventricle pumps out with each contraction

Diagnostic Procedures

CT: Computerized Tomography Scan

MRI: Magnetic Resonance Imaging

COPD - Chronic Obstructive Pulmonary Disease

An umbrella term used to describe a group of progressive lung disorders; characterized by irreversible airflow obstruction causing dyspnea and limited reserve lung capacity that increases the risk of developing hypoxemia

PFT: pulmonary function test

ABG: arterial blood gas analysis

MI - Myocardial Infarction

Heart Attack

Occurs when the blood flow bringing oxygen to the heart muscle is severely reduced or completely occluded

Medication Treatment:

Aspirin – reduces blood clotting

Thrombolytics – Clot busters

Heparin – Blood thinner

Nitroglycerin – Widens blood vessels to improve blood flow

Beta blockers – Slow the heartbeat to decrease blood pressure (BP)

ACE inhibitors – Lower BP and stress on heart

Statins – Lower unhealthy cholesterol levels

Signs & Symptoms of a Heart Attack

chest pain

arm or back discomfort

neck or jaw discomfort

trouble breathing with or without chest discomfort

feeling lightheaded

breaking into a cold sweat

feeling sick

nausea & vomiting

General Deconditioning

A process of physiological change caused by a decline in activity that results in decreased functional participation and independence due to weakness and other related factors

Gravitational Deconditioning

The effect that spending prolonged periods of time in a lying position has an organ system function

Hospital-associated Deconditioning

A functional decline caused or worsened by hospitalization, unrelated to a neurological or orthopedic condition

PICS - Post-intensive Care Syndrome

Disability that affects ICU survivors, including impairment in cognition, psychiatric health, and physical function

Deconditioning vs. Sarcopenia, Frailty, and Fatigue

Deconditioning: not fatigue caused by a medical condition rather than immobility

Sarcopenia: loss of muscle mass related to aging, not immobility

Frailty: appears slowly; a state of vulnerability - weakness, fatigue, chronic pain, anxiety

Fatigue: decreased endurance due to medical condition that can’t be remediated with rest

Immobility Effects on Body Systems

Urinary: reduced kidney function, incontinence UTIs

Musculoskeletal: brittle bones, contractures, muscle weakness

Nervous: lack of stimulation, anxiety, isolation

Digestive: decreased appetite, constipation, incontinence

Integumentary: decreased blood flow, pressure ulcers

Cardiovascular: blood clots, reduced blood flow

Respiratory: pneumonia, decreased respiratory effort, decreased oxygenation of blood

Symptoms of Deconditioning

pain

disrupted sleep patterns

nutritional deficits

altered cognition and disorientation + confusion

joint contractures

immobilization osteoporosis

impaired balance and fall risk

deep vein thrombosis

UTIs

incontinence

pressure ulcers

depression & anxiety

PT vs. OT in Deconditioning

PT:

mobility

transfers

ambulation

muscle strength

ROM and flexibility

OT:

ADL and IADL training

cognitive function

safety

ROM and strength related to task completion

Factors Contributing to Health Disparities

policy decisions

environment

stress

health education

insurance and access to healthcare

access to healthy foods

Difference Between BMP & CMP

CMP includes more liver and kidney function tests than BMP

BMP: measures essential metabolic components of blood

BUN – Blood urea nitrogen – Measures kidney function

Creatinine – Another indicator of kidney function

Glucose – Blood sugar

Carbon dioxide – Indicates issues with kidneys or lungs

Calcium – Can indicate bone, kidney, or thyroid issues

Sodium & potassium – Minerals that indicate body’s fluid balance

Chloride – Electrolyte that indicates body’s fluid balance

CMP: everything from BMP, plus:

Albumin – Protein that indicates liver or kidney disease

Total protein – Accounts for overall blood protein levels

ALP – A liver enzyme that can indicate liver or bone conditions

SGPT – Enzyme in kidneys & liver that can indicate liver damage

SGOT – Enzyme in liver and heart cells that can indicate liver damage

Bilirubin – Created when liver breaks down red blood cells

CBC - Complete Blood Count

Hemoglobin Levels (oxygen carrying protein in RBCs):

Normal Adult Women:11.6 – 15 g/dl (grams per deciliter)

Normal Adult Men:13.2 – 16.6 g/dl

Typically get blood transfusion if below 7 or 8 g/dl

• Jehovah’s Witnesses do not believe in receiving any blood products

Ventriculostomy

Drains excess cerebrospinal fluid (CSF) from a ventricle in your brain

Sternal Precautions After CABG

Varies based on surgeon / facility, but in general:

• Do not push or pull forcefully with arms

• Avoid pushing up from a chair

• Do not reach backwards

• Limit arm movement to 90 degrees flexion – don’t reach overhead

• Do not let people pull on your arms if they are helping you move

• Do not lift anything over 8-10 lbs (this varies; typically, a gallon of milk)

• Keep arms close to your body (“move within the tube”)

• Use a pillow when coughing and transferring in/out of bed

• Try to do everything with both arms rather than just one