Pharmacology; cardiovascular and pulmonary considerations; home health

polypharmacy

-excessive/inappropriate use of meds

2 factors that affect adverse drug rxn

-pattern of drug use that occurs in geriatrics

-altered response to drug tx

pharmacokinetic changes

-way the body handles the drug

pharmacodynamic changes

-way the drug affects the body

aspects of pharmacodynamics changes

-drug absorption

-drug distribution

-drug metabolism

-drug excretion

aspects of pharmacodynamic changes

-change in affinity

-change in way drug is linked to cells internal biochemistry

-change in biochemical response

Beers Criteria

-A list of medications that are generally considered inappropriate when given to elderly people

HTN essential

-no etiologic cause

HTN secondary

-occurs in presence of known causes

classification of hypertension

what might be impacted by HTN

-impaired exercise tolerance (need longer warm up and cool down)

how will education or HEP change for pt w/ HTN

-longer warm up and cool down

-regulate activity level

-adherence ot meds

-stress mgmt

-dietary modification

coronary artery disease

-progressive disease where a combination of atherosis and sclerosis of coronary aa creates myocardial ischemia

CAD effect on physiology

-angina pectoris (stable and unstable)

-imbalance btwn myocardial O2 supply and demand

CAD meds

-beta-blockers

-blood thinners

-nitroglycerin

what may be impacted by CAD

-HR

-VO2 max

-exercise tolerance

-endurance

stable angina

-predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin

unstable angina

-chest pain at rest or chest pain of increasing frequency

what can be used to assess exercise tolerance w/ CAD

-vital signs

-subjective reporting

-s/s

Overall tx w/ CAD should emphasize

-risk factor reduction

-exercise training

-self-management

how will education or HEP change with CAD

-resistance training should be used in addition to aerobic training

-safe dosages

-30-69% 1RM

A-fib

-most common arrhythmia

-conduction issue

-related to increased atrial pressures and enlargement

effect of A-fib on physiology

-decreased cardiac output

-clot formation

-decreased exercise tolerance

Can people with A-fib exercise safely

-yes but consideration needs to be paid to comorbidities

what can be used to assess

-ECG

-RPE

-pulse (60s)

how will education or HEP change w/ A-fib

-signs of DVT

-rest as needed

-graded exercise

-how to properly take pulse

congestive heart failure (CHF)

-complex clinical syndrome that results in a heart that is unable to provide sufficient output to meet perfusion and oxygenation needs of the body

CHF meds

-diurectics

effect on physiology

-pain

-orthopnea

-paroxysmal nocturnal dyspnea

-fluid retention

-activity intolerance

what can we do

-know where bathroom is

-exercise mild/mod HF

-check dyspnea

-check BP

-check wt

-check fatigue

when exercising pt w/ CHF

-check dyspnea

-check RPE

-low intensity, long duration

-more rest

-volume should increase overtime based on observable adaptations

pt ed for CHF

-volume monitoring

-med adherence

-dietary restrictions

-monitoring for s/s of decompensation

valvular disease

-valve defect that restricts or causes backflow

effect of valvular disease on physiology

-increased afterload-->concentric hypertrophy of ventricle

-HF

-decreased CO

exercise considerations with valvular disease

-decreased exercise tolerance

-dyspnea

-fatigue

pt ed or HEP changes with valvular disease

-check RPE

-energy conservation techniques

peripheral vascular disease

-atherosclerosis in peripheral arteries

ABI

-> 1.4 abnormal, incompressible tib aa

-1-1.4 normal

-0.9-0.99 borderline, acceptable

-0.80-0.89 mild disease

-0.5-0.79 moderate disease, specialist referral

-<0.3 severe limb disease

exercise considerations with PVD/PAD

-overcome fear of claudication pain and falling

-exercise only to mild or no sxs

-interval training better tolerated initially

-non-wt bearing activity is not as effective as wt bearing but can be used to supplement warm-ups

-longer warms ups

-sensory considerations and foot care emphasis

-exercise should be progressed in volume first THEN intensity

-evidence for unsupervised exercise training is mounting

-shifting culture toward tech driven tele coaching and tele monitoring

HR max calculation

-208 - (0.7 x age)

Cardiac output

-HRxSV

-5L/min at rest

-20-40 L/min during exercise

SV

-EDV-ESV

Ejection fraction

-% EDV

primary HTN

-no cause

secondary HTN

-Elevated BP with a specific cause

COPD

-Airway obstruction associated with emphysema and chronic bronchitis

effect on physiology (COPD)

-effortful inhalation-->hypertrophy of accy muscles

-air trapping

-increased effort on exhalation d/t

-decreased skeletal muscle endurance d/t

-shift from type I to type II muscle fibers

-reduced mitochondrial density

-reduced capillary density

-decreased exercise capacity

ed and HEP considerations in COPD

-tripod

-barrel chest

-inspiratory muscle training

-resistance training

-rib joint mobilizations

-stress management

pneumonia

-acute inflammation of the lungs caused by bacterial, viral, or fungal pathogen

-collection of edema, RBC, WBC leave lung tissue unable to perform ventilation or perfusion

effect on physiology pneumonia

-decreased cilia

-decreased oropharyngeal clearance-->aspiration

-decreased immune response

clincial presentation of pneumonia

-productive cough

-yellow, green, rust colored sputum

-dyspnea

-tachycardia

-tachypnesa

-hypoxemia

presentation of pneumonia in older adults

-change in mental status

-anorexia

-decrease in function and activity tolerance

-falls

-incontinence

-elevated HR

-changes in sleep cycle

how will ed and HEP change s/p pneumonia

-more rest breaks

-work on endurance

-refer for swallowing

Rehab for pulmonary conditions

-breathing control

-chest PT

-conditioning exercise

-pt ed

-helping ribcage mobilization

Rehab for cardiac conditions

-Pt ed

-appropriately dosed exercise

-breathing techniques and relaxation

-monitor vitals

-stress mgmt

-nutritional considerations