Principles of OT in Physical Health: Cardiac Dysfunction and COPD

Chapter 32: Cardiac Dysfunction and Chronic Obstructive Pulmonary Disease (COPD)

Introduction

  • Significant public health issues:

    • CDC reports heart disease as the leading cause of death in the US, claiming over 630,000 lives annually.

    • COPD affects almost 15.7 million individuals, leading to limitations in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) due to poor endurance.

Cardiovascular Disease (CVD)

  • Definition: Refers to diseases affecting the heart or blood vessels.

Anatomy and Circulation

  • Overview of the cardiovascular system and mechanisms involved in heart contraction.

Pathology of Cardiac Disease

  • Ischemic Heart Disease:

    • Atherosclerosis:

    • A chronic process where arterial walls become injured over time, often due to smoking or high blood pressure.

    • Resulting damage leads to irregular artery walls prone to plaque accumulation.

    • Coronary Artery Disease (CAD):

    • A specific form of atherosclerosis affecting arteries supplying the heart muscle.

    • Ischemia:

    • Occurs when a coronary artery is obstructed, leading to insufficient oxygen supply to the heart.

    • Angina: Chest pain that arises during activities such as eating, exercise, exertion, or exposure to cold.

    • Unrelieved chest pain may indicate a Myocardial Infarction (MI).

    • Myocardial Infarction (MI):

    • Commonly known as a heart attack.

    • Urgent evaluation required as part of the heart muscle could die, influencing survival based on the extent of damage.

    • 90% of MI patients develop arrhythmias as a consequence.

    • Congestive Heart Failure (CHF):

    • Occurs when the heart cannot pump effectively, resulting in fluid accumulation in the lungs or body.

  • Valvular Disease:

    • Damage to heart valves due to disease or infection can result in CHF.

    • Potential for blood clots in the ventricles, leading to cerebrovascular accidents (CVAs).

Cardiac Risk Factors

  • Categorized into three groups:

    • Unchangeable Factors:

    • Heredity, male gender, age.

    • Changeable Factors:

    • Cholesterol levels, smoking, high blood pressure, inactivity.

    • Contributing Factors:

    • Diabetes, stress, obesity.

    • Four risk factors associated with left ventricular enlargement contributing to CHF include smoking, diabetes, hypertension (HTN), and excessive weight.

Medical Management

  • Initial management includes administering aspirin in the emergency room if not previously taken.

  • Percutaneous Transluminal Coronary Angioplasty (PTCA):

    • A procedure wherein a balloon catheter is guided to the lesion site, inflated to displace plaque, improving blood flow upon deflation.

  • Coronary Artery Bypass Grafts (CABG):

    • Surgical intervention involving a sternotomy.

    • Healthy blood vessels from areas such as the saphenous veins, internal thoracic artery, or radial artery are used to bypass diseased coronary arteries, enhancing circulation.

    • Patients must adhere to sternal precautions for 4-6 weeks post-surgery.

  • Endoscopic Atraumatic Coronary Bypass (endo-ACAB):

    • An alternative approach that does not necessitate a sternotomy, allowing for quicker recovery without strict sternal precautions.

  • Cardiac Medications:

    • Refer to Table 32.1 for complete list and descriptions (see page 597).

Psychosocial Considerations

  • Many patients experience feelings of sadness, anxiety, and a decreased quality of life.

  • Occupational Therapy Practitioners (OTPs) should assist in developing new habits and routines for engaging in meaningful activities.

Cardiac Rehabilitation

  • Phases of Rehabilitation:

    • Phase 1: Inpatient Rehabilitation

    • Focus on monitored low-level physical activities, including self-care.

    • Emphasis on reinforcing precautions, energy conservation, and graded activities.

    • Phase 2: Outpatient Rehabilitation

    • More advanced, closely monitored exercise regimen.

    • Phase 3: Community-Based Exercise

    • Further integration into community activities.

  • Signs of Cardiac Distress:

    • Refer to Table 32.2 for indications (page 599).

  • Tools for Measuring Patient Response to Activity:

    • Heart Rate (HR), Blood Pressure (BP), Rate Pressure Product (RPP):

    • A measurement providing a more accurate assessment of cardiac output and performance.

    • Formula for RPP can be found on page 599.

Anatomy and Physiology of Respiration

  • Function of the respiratory system is to supply oxygen to the blood and eliminate waste products such as carbon dioxide.

  • Anatomical structure and innervation details:

    • Two main bronchi branch from the trachea, entering left and right lungs.

    • Breathing is primarily involuntary through the autonomic nervous system (ANS), with some voluntary control during activities like swimming or playing a musical instrument.

Chronic Obstructive Pulmonary Disease (COPD)

  • Characterized by:

    • Damage to the alveolar wall and inflammation of conducting airways.

    • Encompasses conditions such as emphysema, peripheral airway disease, and chronic bronchitis.

    • A progressive and chronic condition.

  • Asthma:

    • A respiratory condition marked by bronchial irritability with episodic onset, often presenting with wheezing and dyspnea.

    • Genetic predisposition can influence asthma development in certain individuals.

  • Common Signs of COPD:

    • Daily cough, shortness of breath, increasing fatigue during exercise.

  • Risk Factors:

    • Smoking and exposure to environmental irritants, such as pollution and chemicals.

Medical Management of COPD

  • Medications include:

    • Anti-inflammatory Drugs:

    • Steroids to reduce inflammation.

    • Bronchodilators:

    • Example: Albuterol, used to open airways.

    • Expectorants:

    • Example: Guaifenesin, assist in loosening and clearing mucus.

    • Oxygen Therapy:

    • Administered at a specific liter flow, depending on individual patient needs.

    • Ventilators:

    • Used for patients experiencing respiratory distress.

  • Signs and Symptoms of COPD:

    • Dyspnea, fatigue, nonproductive cough, confusion, impaired judgment, cyanosis.

Psychosocial Considerations for COPD

  • Depression and anxiety are common due to functional decline, particularly with breathing difficulties during exertion.

Pulmonary Rehabilitation

  • Goals: Stabilization or potential reversal of the disease process, optimizing patient function.

  • Interdisciplinary team involves:

    • Medical Doctors, Nursing staff, Respiratory therapists, Dietitians, Occupational and Physical Therapists, Social Workers, and Psychologists.

Treatment Techniques for COPD (Pages 601-602)

  • Dyspnea Control Postures: Techniques to alleviate dyspnea.

  • Pursed Lip Breathing: Facilitates prolonged exhalation to reduce breathing difficulty.

  • Diaphragmatic Breathing: Enhances lung capacity and efficiency.

  • Desensitization: Reduces sensitivity to discomfort.

  • Relaxation Techniques: Manages anxiety and stress.

  • Biofeedback: Improves awareness and control over physiological functions.

  • Chest Expansion Exercises: Aims to increase lung volume.

Evaluation and Treatment of Persons with Cardiopulmonary Dysfunction

  • Evaluation Process:

    • Review of medical records, patient interviews, and assessment of performance skills.

  • Intervention:

    • OTPs must assess cardiovascular responses to activity (see Table 32.2 on page 603) and account for Basal Metabolic Equivalents (METs - see Table 32.4 on page 604).

    • Education on energy conservation techniques and providing family education.

O2 Saturation and Titrating

  • Oxygen Measurement:

    • Measured in liters (e.g., 2L).

  • Understanding Oxygen Use:

    • Difference between room air and supplemental oxygen.

    • Oxygen orders can be direct or titrate for specific parameters.

  • Nasal Cannulas:

    • Direction on usage and signs of discomfort.

  • Wall O2 vs. Portable O2:

    • Discusses flow movement, special tools or keys for operation, and tank storage requirements.

    • Importance of competency/site training for administering O2.

  • Titration:

    • Adjusting the oxygen flow rate depending on activity level, aiming for an O2 saturation of 88-92%, though specific physician parameters may vary.