pathos

telehealth

"Emerging model of health care delivery . . . which involves health care services, health information, and health education" and "a mechanism to provide services at a location that is physically distant from the client, thereby allowing for services to occur where the client lives, works, and plays

telerehabilitation

•Term used to identify the use of ICTs for the delivery of rehabilitative and rehabilitative services (ATA, 2010).

synchronous telehealth delivery

•Real-time delivery

Example: Occupational profile performed through telehealth

•Client education

•Example exercise program or techniques.

asynchronous delivery

•Not in real time

•Example: Video recording of a walkthrough of the client's home that is uploaded for the therapist

•The therapist can then make recommendations for the client to make.

•The therapist may send documents for the client and caregiver to review at their earliest convenience.

telehealth is a

delivery method

NOT A DISTINCT SERVICE

COPD encompassess

emphysema and chronic bronchitis

Stage 1 COPD

mild

80%

Stage 2 COPD

moderate

50-80%

Stage 3 COPD

severe

30-50%

Stage 4 COPD

very severe

less than 30%

hypercapnia

excessive carbon dioxide in the blood

emphysema

•The walls of the alveoli are destroyed

•Causing lungs to lose some of its elasticity

•Causes air trapping

•Reduces ability for the lungs to shrink during exhalation

•The lung then inhales less air on the next breath.

chronic bronchitis

•Excessive sputum production and cough lasting at least 3 months occurring 2 years in a row.

Decreased oxygen to the brain caused by decreased oxygen in the blood (hypoxemia)

•Impaired judgment, confusion, and motor incoordination

Buildup of carbon dioxide (hypercapnia) due to inadequate gas exchange in the lungs

•Drowsiness and/or apathy

diaphragmatic breathing

•Sit in a relaxed position preferably with feet elevated

•Place your hand on your abdomen

•As you inhale through your nose, try to feel your stomach push out as your lungs fill with oxygen

•Next, fill your stomach go down as you exhale with pursed lips

•Stop if you get light headed or fatigued.

asthma

•Asthma is a lung disease that makes it harder to move air in and out of your lungs.

•Airways in your lungs are often swollen or inflamed which makes them extra sensitive to things in the environment like cold weather, dust, smoke, chemicals, pet dander, etc.

•When you breathe in a "trigger" the airways become even more swollen.

•Most triggers cause an allergic reaction.

status asthmaticus

a prolonged, exacerbated, extremely severe, life-threatening asthma attack

Basal Metabolic Equivalent (MET) levels

cardiac

input valves

bicuspid, tricuspid

DIASTOLIC

output valves

aortic and pulmonary

SYSTOLIC

electrical conduction pattern of the heart

sinoatrial (SA) node in right atrium

atrioventricular (AV) node

bundle of His

L & R bundle branches

Purkinje fibers

SA node function

responds to vagal and sympathetic nervous system input

Ischemic heart disease

occurs when part of the heart is temporarily deprived of O2

coronary artery disease

atherosclerosis (build up of plaque) of the coronary arteries

narrowed blood vessels lead to reduced blood flow and O2 and nutrients

precursor to all cardiac events

can lead to CHF and MI

STEMI MI

involves all 3 layers of the heart-transmural

ST segment of ekg is elevated

classic heart attack

moderate to large MI= poor prognosis

anterior STEMI

most serious because of large muscle mass that is lost in the heart

Q wave indicates

size of MI

Non-STEMI MI

when thrombus in the coronary artery is incomplete, less damage

better prognosis but there is a higher risk for death or other cardiac events, due to hx of previous cardiac events

valvular disease

volume and pressure overload

volume overload

valve fails to close properly, blood backflows

increases risk for AFIB

aortic stenosis

pressure overload

Fromingham heart study identified...

risk factors for heart disease

cardiac ablation

destroy small areas that emit dangerous signals

Cardiac Rehab Phase 1

monitored low-level ax, 24-48hrs for medical status

self care

energy conservation

graded ax, monitor vitals

NSTEMI hospital stay

1 day

STEMI hospital stay

2-3 days

CABG hospital stay

3-7 days

Cardiac Rehab Phase 2

outpatient

cardiac rehabilitation is education about proper exercise procedures, and about how to self-monitor heart rate and exertion levels during exercise. This phase centers around your safe return to functional mobility while monitoring your heart rate.

•Begins upon discharge from hospital

•~3 days a week for 4-8 weeks (everyone is not the same)

•Around 5.0 - 6.0 METS for exercise goal if they have good heart function and physical condition

•Continuous versus discontinuous exercise

MAHR (maximum age adjusted heart rate)

•take 220, subtract pt's age

The difference is the pt's max age-adjusted heart rate

•To get the range of 50-70%, multiply that number by .50 and .70.

Cardiac Rehab Phase 3

Phase three of cardiac rehabilitation involves more independent and group exercise. You should be able to monitor your own heart rate, your symptomatic response to exercise, and your rating of perceived exertion (RPE).

community based

not covered by insurance

trained personnel will monitor BP response adn assist patient with monitoring HR

goal setting for risk management continues

patients gain support from others who have common goals

shock related respiratory failure

pulmonary edema, sepsis, cardiac events lead to difficulty keeping O2 in blood

hypoxemic respiratory failure

too little O2

hypercapnic respiratory failure

too much CO2 in blood

acute on chronic respiratory failure

longstanding lung conditions that worsens

pneumonia

infection that inflames air sac in one or both lungs

healthcare associated pneumonia

client lives in SNF and are sent to hospital and acquire pneumonia

healthcare acquired pneumonia

develops pneumonia after they have been hospitalized

hypostatic pneumonia

due to inactivity/ immobility

cystic fibrosis

electrolyte movement across cell membrane is altered and causes organs to retain increased sodium fluoride

leaves a mucous that obstructs the passage way

affects lungs, pancreas, intestines, liver, sweat glands, reproductive system

hyponatremia

excessive loss of salt, sodium

nausea, vomiting, muscle weakness, confusion

hemothroax

blood in the pleural cavity

pneumothorax

A pneumothorax can be caused by a blunt or penetrating chest injury

a collapsed lung. A pneumothorax occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse.

normal BP

Less than 120 AND Less than 80

elevated BP

120-129 AND Less than 80

stage 1 hypertension

130-139 OR 80-89

stage 2 hypertension

140 or higher OR 90 or higher

stage 3 hypertension

Higher than 180 And/or Higher than 120

sternal px

do not lift more than 5-10lbs

avoid pushing/pulling with both arms

void driving/riding in front seat

avoid straining

last 8 weeks

left heart failure

left ventricle is enlarged= hypertrophy

most common

result of atherosclerosis that causes vessels to narrow

blood backs up into left atria and pulmonary veins=pulmonary edema

right heart failure

dysfunction in right ventricle due to sustained increased work of right ventricle

results from right ventricle damage, lung conditions, valvular dysfunction

typically occurs after left heart failure

most common cause is pulmonary HTN

left heat failure symptoms

dyspnea, orthopena

right heart failure symptoms

ascites, peripheral edema, anorexia, nausea, cognitive deficits

a-fib is linked to

CVA

Stage A CHF

•High risk for heart failure

•No structural heart disease or symptoms of heart failure

•Example: patients with HTN, atherosclerosis, diabetes

Stage B CHF

•Structural heart disease but no symptoms of heart failure

•Example: patients with previous MI, asymptomatic valvular disease, left ventricular dysfunction

Stage C CHF

•Structural heart disease with prior or current symptoms of heart failure

•Symptoms include SOB, fatigue, and exercise intolerance

Stage D CHF

•Refractory heart failure requiring specialized interventions

•Patients with marked symptoms at rest despite medical management

focus on symptom relief

pacemaker precautions

•No shoulder flexion/abduction past 90 degrees

no pushing or pulling

no lifting anything greater than 5-10lbs

Endocarditis

is inflammation of the membrane that covers the inner layer of the heart.

Digoxin

Treatment of heart failure, arrhythmias, and atrial fibrillation

1-2.5 METs

walking at a slow pace

dish washing

watching tv

2.6-4.0 METS

walking downstairs

carrying load of 15lbs

raking the lawn

stretching

4.0-6.0 METS

•Major house cleaning

moving furniture

weeding

slow wood chopping

roofing

softball

continuous exercise

20-40 minutes of exercise is the goal

then gradually increase intensity

Advantage:Less equipment and space and it mimics what the patient will be doing at home.

disadvantage: Only certain muscle groups are targeted on one piece of equipment. just one form of aerobic exercise

discontinuous exercise

Time of exercise remains the same but intensity increases

Patient then switches to another and repeated several times

advantage:Exposed to a variety of equipment, boredom is minimized, multiple muscle groups

disadvantage:lots of space needed, and to coordinate with patients shifting equipment

6.0-10 METS

•Walking or standing with objects weighing 50 - 74 lbs

firefighter carrying hose

high impact aerobics

running 10-12 minute mile

RPE (rate of perceived exertion)

6 = no exertion; 20 = maximal exertion;

13 is somewhat hard, 15 is hard, 17 very hard

what does RPE measure

effort, strain, discomfort and fatigue during aerobic and resistance training

RPE category scale

0- nothing at all

1- very weak

2- weak

3- moderate

5- strong

7- very strong

Modified Borg Dyspnea Scale

0- nothing at all

0.5- very, very slight

1- very slight

2- slight

3- moderate

4- somewhat severe

5- severe

6- more severe

7-very severe

8-very severe

9- very, very severe

10- maximal

10- maximal