chp 45 week

Main function of the cardiovascular system

Maintains blood flow throughout the body so tissues receive oxygen and nutrients and metabolic wastes can be removed.

Function of the right side of the heart

Pumps deoxygenated blood from the body to the lungs for oxygenation.

Function of the left side of the heart

Pumps oxygenated blood from the lungs out to the rest of the body.

Primary function of the left ventricle

Pumps oxygenated blood into the aorta for systemic circulation.

Ischemia

Inadequate blood flow and oxygen delivery to body tissue.

Angina

Chest discomfort or pain associated with myocardial ischemia.

Reason for clarifying a patient's typical angina symptoms prior to OT treatment

Allows the therapist to recognize whether symptoms occurring during activity are baseline for that individual and respond appropriately.

Key evaluation questions for an OT to ask a patient with angina

What the chest discomfort feels like, what activities trigger it, what relieves it, and how it impacts meaningful occupations.

Myocardial infarction (MI)

Damage or death of heart muscle tissue resulting from prolonged interruption of its blood supply.

Most common underlying cause of myocardial infarction (MI)

Atherosclerosis.

Primary mechanism of beta blockers in cardiac care

Reduces heart rate and decreases overall workload placed on the heart.

Importance of baseline vital signs prior to OT activity

Establishes resting physiological status and provides a benchmark comparison for the body's response to activity.

Vital signs to monitor during OT with cardiopulmonary patients

Heart rate, blood pressure, respiratory rate, oxygen saturation ($\text{SpO}_2$) when indicated, and subjective symptom response.

Rate-Pressure Product (RPP)

A clinical estimate of myocardial workload and oxygen demand.

Rate-Pressure Product (RPP) calculation formula

$$\text{RPP} = \text{Heart Rate} \times \text{Systolic Blood Pressure}$$

Clinical indication of an increasing Rate-Pressure Product (RPP)

Indicates increased workload and higher oxygen demand placed on the myocardium.

Purpose of monitoring patient physiological response during ADLs

ADLs impose physical demands on the cardiopulmonary system; monitoring determines whether activity intensity is safe and tolerated.

Primary purpose of sternal precautions

Protects the healing sternum and prevents structural instability following a median sternotomy.

OT ADL modifications for sternal precautions

Modifies pushing, pulling, heavy lifting, transfers, and dressing to minimize excessive physical stress on the healing sternum.

Cardiac rehabilitation

A comprehensive interprofessional approach designed to improve physiological function, activity tolerance, health behaviors, and occupational participation following cardiac events.

Primary function of the respiratory system

Gas exchange—bringing oxygen into the body and removing carbon dioxide.

Anatomical site of gas exchange in the lungs

Alveoli.

Chronic Obstructive Pulmonary Disease (COPD)

A chronic progressive respiratory condition characterized by airflow limitation that causes dyspnea and impacts daily activities.

Impact of COPD on occupational performance

Dyspnea, fatigue, and reduced endurance limit engagement in ADLs, IADLs, mobility, work, and leisure occupations.

Dyspnea

The subjective sensation of difficult, labored, or uncomfortable breathing (shortness of breath).

Clinical signs of respiratory distress during OT

Increasing dyspnea, abnormal respiratory rate/pattern, breathlessness limiting speech, cyanosis, altered mental status, and rapidly declining activity tolerance.

Dyspnea-control posture

A positioning technique used to decrease breathing difficulty and optimize respiratory muscle efficiency.

Seated dyspnea-control posture

Leaning slightly forward while supporting the upper body with forearms resting on a table or thighs.

Standing dyspnea-control posture

Leaning forward while supporting the upper body on a stable surface such as a counter or shopping cart.

Biomechanical rationale for forward-leaning dyspnea postures

Reduces accessory muscle recruitment, optimizes diaphragm participation, improves inspiratory muscle function, and decreases perceived breathlessness.

Pursed-lip breathing

A breathing technique involving inhalation followed by a slow, controlled exhalation through partially closed lips.

Clinical benefit of pursed-lip breathing

Maintains positive airway pressure, prevents small airway collapse, and enables control over breathing rate and dyspnea.

Diaphragmatic breathing

A breathing technique emphasizing deep abdominal expansion via the diaphragm rather than upper chest accessory muscle use.

Primary goal of energy conservation in OT

Enables patients to perform necessary and meaningful occupations while minimizing fatigue, unnecessary energy expenditure, and symptoms.

Core principles of energy conservation

Plan, prioritize, pace, position, and simplify activities.

Pacing (energy conservation principle)

Balancing physical activity with scheduled rest breaks rather than continuing until exhaustion or severe symptoms occur.

Purpose of activity planning in energy conservation

Reduces unnecessary repetitive movement and allows demanding tasks to be distributed evenly throughout the day or week.

Ergonomic benefit of sitting vs. standing during occupations

Sitting decreases postural muscle effort and overall metabolic and physical demands of an activity.

Rationale for storing items within easy reach

Reduces excessive reaching, bending, walking, and overall energy expenditure.

Metabolic Equivalent of Task (MET)

A standardized unit used to estimate the energy cost and oxygen demand of physical activities relative to rest.

Utility of MET levels in OT practice

Helps OTs quantify activity demands and structure safe, progressive grading of ADLs and IADLs.

Primary determinant for activity progression in cardiopulmonary OT

The patient's physiological response, subjective symptoms, tolerance, and safety—not solely task completion.

Key focus areas during a cardiopulmonary occupational profile interview

Daily routine, symptom triggers (angina/dyspnea), condition understanding, and specific occupational performance limitations.

Rationale for occupation-based intervention in cardiopulmonary OT

Ensures the ultimate outcome is safe, meaningful participation in real-life ADLs and IADLs rather than solely improving physiological metrics.

Overarching OT principle in cardiopulmonary rehabilitation

Grade activity while monitoring physiological response, teach symptom management and energy conservation, and progressively restore participation in meaningful occupations.

Main function of the cardiovascular system

Maintains blood flow throughout the body so tissues receive oxygen and nutrients and metabolic wastes can be removed.

Function of the right side of the heart

Pumps deoxygenated blood from the body to the lungs for oxygenation.

Function of the left side of the heart

Pumps oxygenated blood from the lungs out to the rest of the body.

Primary function of the left ventricle

Pumps oxygenated blood into the aorta for systemic circulation.

Ischemia

Inadequate blood flow and oxygen delivery to body tissue.

Angina

Chest discomfort or pain associated with myocardial ischemia.

Chest pain characteristics suggestive of angina

Squeezing, tightness, aching, burning, or choking pain that is usually substernal and may radiate to the arms, jaw, neck, or back.

Clinical significance of increased intensity or duration of angina

Indicates worsening myocardial ischemia.

Reason for clarifying a patient's typical angina symptoms prior to OT treatment

Allows the therapist to recognize whether symptoms occurring during activity are baseline for that individual and respond appropriately.

Key evaluation questions for an OT to ask a patient with angina

What the chest discomfort feels like, what activities trigger it, what relieves it, and how it impacts meaningful occupations.

Myocardial infarction (MI)

Damage or death of heart muscle tissue resulting from prolonged interruption of its blood supply.

Most common underlying cause of myocardial infarction (MI)

Atherosclerosis.

Importance of baseline vital signs prior to OT activity

Establishes resting physiological status and provides a benchmark comparison for the body's response to activity.

Vital signs to monitor during OT with cardiopulmonary patients

Heart rate, blood pressure, respiratory rate, oxygen saturation ($\text{SpO}_2$) when indicated, and subjective symptom response.

Rate-Pressure Product (RPP)

A clinical estimate of myocardial workload and oxygen demand.

Rate-Pressure Product (RPP) calculation formula

$$\text{RPP} = \text{Heart Rate} \times \text{Systolic Blood Pressure}$$

Clinical indication of an increasing Rate-Pressure Product (RPP)

Indicates increased workload and higher oxygen demand placed on the myocardium.

Purpose of monitoring patient physiological response during ADLs

ADLs impose physical demands on the cardiopulmonary system; monitoring determines whether activity intensity is safe and tolerated.

Borg Rate of Perceived Exertion (RPE) Scale measurement

Measures the patient's subjective perception of physical exertion and fatigue during activity.

Range of the Borg RPE Scale

$$6\text{ to }20$$

Borg RPE Scale rating of 6

No exertion at all (resting state).

Borg RPE Scale rating of 9

Very light exertion, such as a short walk at the person's own pace.

Borg RPE Scale rating of 13

Somewhat hard exertion, but the person still feels okay continuing.

Borg RPE Scale rating of 15

Hard and tiring exertion, although continuing is not excessively difficult.

Borg RPE Scale rating of 17

Very hard exertion; the activity is very strenuous and requires pushing to continue.

Borg RPE Scale rating of 19

Extremely strenuous exertion, representing near-maximal effort.

Borg RPE Scale rating of 20

Maximal exertion.

Key documentation elements for OT when a patient experiences dyspnea

The specific activity that triggered dyspnea and how long it takes for symptoms to resolve.

Resting respiratory indicators of acute congestive heart failure (CHF)

Dyspnea at rest accompanied by a resting respiratory rate of $>30\,\text{breaths/min}$.

Orthopnea

Dyspnea (shortness of breath) caused or aggravated by lying supine.

Clinical assessment method for orthopnea severity

Asking how many pillows the patient requires to breathe comfortably while sleeping.

Diaphoresis

Cold, clammy sweating often associated with autonomic response or cardiac distress.

Cerebral symptoms indicating inadequate oxygen delivery to the brain

Ataxia, dizziness, confusion, and syncope (fainting).

Orthostatic blood pressure change indicating potential cardiac distress

A drop in systolic blood pressure or hypotension of $>10\,\text{mmHg}$ when transitioning from supine to sitting or sitting to standing.

Primary mechanism and examples of anticoagulants

Decreases blood clotting ability (e.g., warfarin, heparin) to prevent clot formation, enlargement, and stroke.

Primary mechanism and examples of antiplatelet agents

Prevents platelets from sticking together (e.g., aspirin, clopidogrel) to prevent clot formation after MI or in unstable angina.

Primary mechanism and purpose of ACE inhibitors

Expands blood vessels and lowers angiotensin II (e.g., fosinopril, captopril) to reduce cardiac workload in hypertension and heart failure.

Primary mechanism and purpose of Angiotensin II Receptor Blockers (ARBs)

Blocks angiotensin II action to prevent blood pressure elevation (e.g., losartan, irbesartan) in hypertension and heart failure.

Primary mechanism and purpose of ARNI medications (e.g., sacubitril/valsartan)

Improves blood flow, reduces sodium retention, opens narrow arteries, and decreases cardiac workload in heart failure.

Primary mechanism of beta blockers in cardiac care

Decreases heart rate, cardiac output, and blood pressure (e.g., atenolol, propranolol), causing the heart to beat slower and with less force.

Primary mechanism and indications for calcium channel blockers

Blocks calcium movement into heart and vessel cells (e.g., amlodipine, diltiazem) to treat hypertension, angina, and arrhythmias.

Primary mechanism and indications for digoxin (Lanoxin)

Increases the force of myocardial contractions to manage heart failure, atrial fibrillation, and other arrhythmias.

Primary mechanism and indications for diuretics

Increases water and sodium excretion through urination (e.g., furosemide, hydrochlorothiazide) to lower blood pressure and decrease edema.

Primary mechanism and indication for vasodilators like nitroglycerin

Relaxes blood vessels, increases myocardial oxygen supply, and decreases cardiac workload to ease angina chest pain.

New York Heart Association (NYHA) Class I cardiac disease

Cardiac disease is present, but with no limitation of ordinary physical activity; ordinary activity does not cause undue fatigue, dyspnea, palpitations, or angina.

Specific Activity Scale Class I MET threshold

Ability to complete physical activities requiring $\le 7\,\text{METs}$.

New York Heart Association (NYHA) Class II cardiac disease

Slight limitation of physical activity; comfortable at rest, but ordinary activity produces fatigue, dyspnea, palpitations, or angina.

Specific Activity Scale Class II MET threshold

Ability to complete activities requiring $\le 5\,\text{METs}$, but not activities requiring $\ge 7\,\text{METs}$.

New York Heart Association (NYHA) Class III cardiac disease

Marked limitation of physical activity; comfortable at rest, but less than ordinary activity causes symptoms.

Specific Activity Scale Class III MET threshold

Ability to complete activities requiring $\le 2\,\text{METs}$, but not activities requiring $\ge 5\,\text{METs}$ (e.g., showering without stopping, dressing without stopping).

New York Heart Association (NYHA) Class IV cardiac disease

Inability to perform any physical activity without discomfort; cardiac symptoms may occur even at rest.

Specific Activity Scale Class IV MET restriction

Inability to complete physical activities requiring $\ge 2\,\text{METs}$.

Primary purpose of sternal precautions

Protects the healing sternum and prevents structural instability following a median sternotomy.

OT ADL modifications for sternal precautions

Modifies pushing, pulling, heavy lifting, transfers, and dressing to minimize excessive physical stress on the healing sternum.

Cardiac rehabilitation

A comprehensive interprofessional approach designed to improve physiological function, activity tolerance, health behaviors, and occupational participation following cardiac events.