Cardiac and pulmonary and acute care safety

140, 90

Hypertension is a systolic blood pressure of _____ mmhg or more, and .or a diastolic pressure of ____ mmhg or more

ST Elevation MI

STEMI stands for....

Anterior STEMI

Most serious MI, life-threatening; known as the "widow maker"

Anterior MI

Blockage in the left main or left anterior descending artery (LAD) of the heart will cause damage to the front of the left ventricle

Inferior MI

blockage in the right coronary artery

Diaphoresis

CLassic symptom of heart attack; excessive sweating

Coronary Artery Disease (CAD)

Common term for the buildup of plaque in the heart's arteries that could lead to heart attack

Angina

•Heart pain caused by a temporary inadequate supply of blood to the heart muscle; ot should rest patinet with angina

Angioplasty

•Procedure to improve blood flow through an occluded artery

atherectomy

When lesions are too calcified for angiopalsty, proceudre involves a rotating blade to cut the plaque

stop

Sternal precautions= If you feel sternal shifting of clicking, ________any UE exercises

backwards with both arms

When someone has sternal precautions, they may move their arms within a pain free range but must avoid reaching...

No pushing through arms

what changes about a transfer with someone with sternal precautions?

sternal precautions

A heart hugger is one option to maintain...

Heart Hugger

name this device

Congestive Heart Failure (symptoms)

SOB, increase in weight, dry cough, inability to sleep laying flay, swelling in LEs, lack of appetite, difficulty focusing attentino

Cardiomyopathy

disease of the heart muscle

Atrial fibrillation

•Irregular and ineffective contractions in both atria

•Blood flow through the heart slows

•Blood clots (emboli) may develop

heart damage

A troponin blood test is looking for....

Stress echocardiogram

an ulstrasound taking with either exercise or a pharmacologic agent to increase heart rate in order to assess how the heart functions with exertion

ejection fraction

measurement of how much blood ejects the heart with each beat

60

A normal EF is greater than _____%

50-60

A mild EF impairment is ____ to _____%

40-50

A moderate EF impairment is ____ to _____%

40

A significant EF impairment is less than_______%

Coronary Angiography

Most definitive cardiovascular tests involving:

•Catheter inserted into a blood vessel in the groin or radial artery and threaded back into the heart

•Dye is injected through it

•Extent of the obstruction in any coronary blood vessel is visualized

Coronary Angiography

_________ often have movement restrictions day of procedure and lifeting restrictions for atleast a week

pace maker

An electrical device for stimulating or steadying the heartbeat or reestablishing the rhythm of an arrested heart.

Left Ventricular Assist Device

Booster pump implanted in the abdomen with a tube inserted into the left ventricle. A "bridge to transplant" or destination therapy when heart transplantation is impossible.

Angina, fatigue, dyspynea, dizziness, vomiting, diaohoresis

List as many signs and symptoms of excercises intolerance and cardiac distress

Rate of Perceived Extertion

RPE stands for

METs

metabolic equivalents; units of measure used to describe the amount of O2 the body needs for a given activity

6-20, 1-10

RPE scores range from __ to ____ where as METs range from _____ to ______

Phase one (inpatient cardiac rehabilitation

What phase of cardiac rehabilitation does OT primarily play a role in

COPD (chronic obstructive pulmonary disease)

Combiniation of emphysema and chronic bronchitis

ARDS (acute respiratory distress syndrome)

respiratory failure in an adult; typically an inflammatory reaction to illness or trauma

Pursed Breathing

OT intervention for pulmonary disorders that prevent stightness in the airway by providing resistance to expiration

Diaphragmatic Breathing

OT intervention for pulmonary disorders that increases the use of the diaphragm to improve chest volume

20

When working with someone with a cardiovascular condition, you should stop or even discontinue if HR increases more than ______ beats/min

220

When working with someone with a cardiovascular condition, you should stop or even discontinue if systolic BP rises above ______ mmhg

15

When working with someone with a cardiovascular condition, you should stop or even discontinue if RPE goes above

160/100, 80/40

Unstable vitals for early mobilization would include if Bp is greateer than _______ or lower than _________

130, 40

Unstable vitals for early mobilization would include if HR is greater than ____ or less than _____

90

Unstable vitals for early mobilization would include if OT Sat is less than _______

30

Unstable vitals for early mobilization would include if respiration rate is greater than ______

7

IF hemogllobin is less than_______ therapy would most likely be bedside only

Femoral

OT can only perform supine activites if a patient has a ______ line

Side

When someone has a seizure and convlusions subside, have the client rest on their _____ to maintain an open airway

Hyperglycemia

Hyperglycemia or Hypoglycemia:

Ketoacidosis

180

Hyperglecemia is a blood sugar level over ________ mg/dl

70

Hypoglycemia is a blood sugar below _______ mg/dl

hyperglycemia

Hyperglycemia or Hypoglycemia:

Excessive thirst and increased urination

Hyperglycemia

Hyperglycemia or Hypoglycemia:

Fruity breath odor

Hyperglycemia

Hyperglycemia or Hypoglycemia:

Dry skin, flushed

Hyperglycemia

Hyperglycemia or Hypoglycemia:

frequent infections and slow healing cuts/wounds

Hyperglycemia

Hyperglycemia or Hypoglycemia:

Blurred vision and nausea

Hypoglycemia

Hyperglycemia or Hypoglycemia:

Hunger and shakiness

Hypoglycemia

Hyperglycemia or Hypoglycemia:

Sweating and pale skin tone

Hypoglycemia

Hyperglycemia or Hypoglycemia:

Rapid heart rate, dizziness, headache

Hypoglycemia

Hyperglycemia or Hypoglycemia:

Confusion, trouble speaking

High-Fowler's position

A semi-sitting position; the head of the bed is raised 60 to 90 degrees; facilitates lung expansion

Orthopneic position

client bends forward and leans forearms on table or counter; helps someone in respiratory distress

what are the sternal precautions?

can move arms in a pain free range, but don’t reach back with both arms at the same time, do not lift push or pull more than 10 pounds, do not let others push or pull on your arms when helping you move, avoid one sided pulling, if you feel sternal shifting or clicking stop activity

CPK MB diagnostic study

enzyme in blood within 6 hours after a heart attack, peaks at 24 hours

troponin tests

rises after 3-6 hours and cn stay high for 14 days

• if levels are higher or haven’t leveled off, therapy may be delayed

pacemaker precautions

no lifting affected arm over head on the side of the pacemaker for 2 weeks, no lifting or pushing more than 10 pounds for 6 weeks, no driving for 2 weeks, keep area dry for 48 hours, then shower but no scrubing, may need a sling for 2 weeks

what to think about if your patient has a newly implanted pacemaker?

how will this affect ADLs? Balance? what if they use a device? what if they live alone?

risk factors for heart disease

NC: age, gender, family history

Controllable: smoking, NTH< sendentary lifestyle, obesity, diabetes, stress

What are OTs goals within Phase I of inpatient cardiac rehabilitation?

prevent muscle loss from bed rest, monitor and assess patient’s ability to function, instruct in appropriate home activities, educate about risk factors and methods to reduce them

What is the OTs goal during the intervention phase of inpatient cardiac rehabilitation?

evaluate, analyze, and modffy patients activities of daily living (can they tolerate ADLs)

During exercise, OTs monitor heart rate, BP, and EKG responses

what are the 7 symptoms fo cardiac distress/exercise intolerance?

angina, extreme fatigue (RPE > 15), dyspena (excessive SOB with activity), light-headed, nausea, cerebral symptoms, excessive sweating

• have chair behind them in case symptoms begin

OT intervention of Functional Skill Deficits Secondary to Pulmonary Disease

ADL eval and train on increasing endurance, instruction and training in appropriate breathing techniques, UE function, energy conservation, promote roles, need for AT, educate on stress management

What are the 4 appropriate responses to cardiovascular activity? `

HR - increases with activity to no more than 20 bpm above resting (if it doesn’t drop or rise that is a concern)

BP: systolic BP rises with activity (>220 mmHG is BAD)

Absence of adverse symptoms (SOB, angina, nausea, extreme fatigue *RPE>15

Pulse Ox - above 90 is good!

what are some psychosocial consideration?

uncertainty, depression, anxiety, isolation

what are the symptoms of MI?

angina, pressure readiating down the teeth, jaw, ear, and arm

diaphoresis (sweating), SOB

gender differenes in heart attack

women: dizziness, cold sweat, SOB, indigestion, unusual fatigue, sleeping issues

men: SOB, chest pain, UE discomfort

clinic safety recommendations

Remember appropriate hand-washing techniques -Wash hands for 30-40+ seconds before and after each treatment, Make sure space is adequate, Do not transfer clients in congested areas or where your view or movement is blocked, Use gait belt and nonskid footwear, Routinely check equipment to be sure it is working properly, Make sure furniture and equipment in the area are stable, Keep floor free from cords, scatter rugs, litter, and spills, Do not leave clients unattended, Have the treatment area and supplies ready before the client arrives.

Follow procedures for handling and storing potentially hazardous material

when leaving a patient consider…

Call light in reach, Bed/chair alarms, Phone and other desired items in reach, Is patient in a safe position? Brakes set on bed/wheelchair, Bed rail position, Ask if they are comfortable, Ask if they have any questions or needs

complications of bedrest

decrease activity tolerance, muscle atrophy, delirium, sores, DVT

what to think about before getting them out of bed?

sitting and standing balance, cognition, safety awareness/insight, activity tolerance

symptoms of decreased functional endurance

excessive heart rate elevation, increase respiratory rate, O2 decline, breathlessness

what are some causes of delirium?

isolation, deep sedation, prolongded immobility, use of drugs, anxiety, stress

ways to manage delirium

regulate sensory input, sleep hygiene, environmental modification, communication, caregiver training

the two types of infection control are…

universal precautions'

• preventing transmission of pathogens through contact with blood and body fluids

body substance isolation

• isolation of all most and infectious substances

  • ALWAYS CLEAN TOOLS THAT WERE BROUGHT INTO ROOMS

protective isolation is…

occurs if a condition makes them more likely to get an infection

people who enter the room may have to wear PPE

nosocomial infection

hospital-acquired infections (happens within 24 hrs of being admitted)

signs of a seizure

Place the person in a safe location, and position away from anything that might cause injury. Do not attempt to restrict or restrain, Loose clothing around the person’s neck to assist in keeping the client’s airway open, Do not insert any objects into the client’s mouth, When convulsions subside have the client rest on his or her side to maintain an open airway, The client may experience confusion, be incontinent, or be lethargic

Obtain medical assistance

hyperglycemia is

severly low insulin levels but high blood glucose levels

• called ketoacidosis and can lead to a diabetic coma

occur because: missed medication, overeating, lack of exericse

symptoms of hyperglycemia

increased thirst, dry skin, fatigue, fruity breath, increased urination, nausea, slow healing cuts, weight loss

what is hypoglycemia

excessive insulin but low blood glucose

• insulin reaction or shock

symptoms of hypoglyemia

hunger, shakiness, pale skin, increased HR, dizzy or light-headed, sleepy, trouble speaking, mood changes