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Coronary Artery disease

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process or narrowing the lumen of coronary artery disease process

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atherosclerosis

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plaques and fatty material clogging up large size arteries --good with early detection and treatment

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angina pectoris

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ischemia characterized by mild to mod chest pain/ pressure or dull ache in chest and left arm. felt anywhere in upper body

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myocardial infarct

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porlonged ishcemia of myocardium occlusion of coronary arteries

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heart failure

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heeart is unable to maintain adequate circulation of the blood to meet the metabolic needs

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CHF

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left sided heart failure. not adequately pumped into systemic circulation pulmonary congestion, edema, low cardiac output due to back up of blood from LV to LA and lungs

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classifications of heart failure

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class 1: cardiac disease without limitation in physical activity- no symptoms for normal activity class II: slight limimtation of physical activity- Class III: less than ordinary activity causes fatigue, palpitation, dyspnea, or angina pain Class IV: patients with cardiac disease resulting in inability to carry on any phys activity without discomfort

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COPD

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poor expiratory flow rates essentially... the carbon is stuck inside of an individuals lungs, during the respiratory process it is not ejected quickly enough DO NOT UP THE o2 level of a client in a hospital who has COPD. You will only further cause carbon to sit in their lungs. ---if their o2 is below standards, medical nurse of Physician for the correct response to the problem

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HR parameters

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normal HR is 70. range is 60-100

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tachycardia

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greater than 100 bpm

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bradycardia

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less than 60 bpm

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o2

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80-100 ? i was told anything below 90 should be reviewed

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Diaphoresis

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excessive sweating associated with decreased cardiac outpu

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pulses

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decreased or absent pulses associated with PVD

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skin color and vascular status

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bluish color related to decreased cardiac output or cold; especially lips, fingertips, nail bed.

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grading scale for edema

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1+ mild, barely perceptible indentation 30 seconds and > 1 inch pitting

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Pallor

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absence of rosy color in light skined individuals, associated with decreased peripheral blood flow

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rubor

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dependent redness with PVD

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skin changes

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clubbing of fingernails; pale, shiny, dry, abnormal pigmentation; ulceration, dermitis; gangrene

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intermittent claudication:

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pain, cramping, fatigue occuring during exercise and relieved by rest, associated with PVD, pain is typically in calf

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activity tolerance

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6MWT vital monitors dyspnea, angina, claudication exertion borg scale, MET scale

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1.5- 2 met

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eating seated transfers: bed to chair washing face and hand. brushing hair IADL- hand sewing machine sewing, SWEEPING FLOORS, (light housework) desk work, auto driving typing electrical calculating machine walking 1mph

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2-3 MET

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Seated sponge bath, standing sponge bath dressing undressing, wheelchair propulsion walking 2-3 mph IADL- dusting, kneading fough, vacuum, handw ashing small items preparing a meal (really? so like a sandwich or a legit dinner?) golfing

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3-4 met

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Standing WARM shofwer, bowel movement on toilet (the pushing and valsalva) IADL- making abed, sweeping, mopping, gardening

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4-5 MET

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HOT shower, bowel movement on bed pan (apparently increased valsalva because of positioning) boring regular sex with your long term partner (i disagree with this statement.) changing bed linen, gardening, raking, weeding ... aka a lot of the very demanding forms of gardening and housekeeping are attained around 4-5 METS.

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5-6 MET

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Hot sex with a stranger!!! scandalous wakjub =g yo staurs biking 10mph on level ground

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6-7

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shoveling splitting wood snow shoveling the competitive sports walking with braces and crutches... aka "little johnny just got out of the cardiac unit and wants to wear a brace so he can run and play with the other children. knowing that he can't tolerate a MET level beyond 4-5. What is your education to little johnny about the brace and how he can play with his friends?" --the answer would be explain to him that he cannot resume the demanding playing but something functional he really likes that is not so intense instead.

question

deep vein thrombosis

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inflammation of a vein in association with the formation of a thrombus, usually occurs in LE

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lymphedema

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excessive fluid due to obsturction of lymphatics, swelling if soft tissues in arms and legs --primary lymph- congenital secondary- acquired, due to injury the book didn't mention this, but standard retrograde massage is not functional for treating lymphedema- you need to take a class and be a lymphedema certified person. in addition, lymphedema is often associated with cancer. mastectomies or any removal of a lymph node will result in swelling --

question

bacterial penuomonia

answer

intra-alveolar bascterial infection --streptococcal is most common type gram negative is typically from people with underlying hronic condition

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viral pneumonia

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inflammatoory process, caused by viral agents

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aspiration neumonia

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caused by aspirated material- (if someone cant eat or swallow correctly)

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SARS

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severe acute respiratory syndrome atypical- respiratory illness caused by a coronavirus---

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TB is spread how...

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airborn sneezing and coughing is how its caught weakened immune system are at greater risk for rapid onset of TB disease, such as people with HIV/AIDS substance abuse Diabetes scoliosis cnacer of head or neck

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does TB only stay in the lungs?

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if it preogresses, it can spread to kidneys, spine, Rood's disease- vertebral collaps caused by TB resulting in compression of spine

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chronic obstructive diseases

answer

....

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emphysema

answer

abnormal enlargement and destruction of air spaces distal to terminal bronchioles, may result in destruction of acini, the functiona units for gas exchange in the lungs dyspnea on exertion, diminish breath sounds, wheezing prolonged expiratory phase pursed lip breathing physical presentation: enlarged anterior/posterior dimensions of the chest wall

question

asthma

answer

increased reacitivty of the trach and bronchi to various stimuli etio is unknown- wheezing, dypsnea, chest pain, facial distress, non productive cough with acute exacerbation

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pulmonary edema

answer

excesive seepage of fluid from pulomnary vasc system

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ways to monitor and look at Pulse, HR

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rhythmical throbbing arterial wall.. force of contraction volume and viscosity of blood 30 secodns for normal beats, 1 minute for irregular

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most common site to read HR

answer

radial wrist at base of thumb

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bruit

answer

abnormal sound or murmur, associated with atherosclerosis

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cyanosis

answer

bluish color related to decreased cardiac output or cold. especially lips, fingernail beds

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grading scale for peripheral pulses

answer

0-absent pulse 1+ pulse diminished, barely perceptible 2+ easily palbale, normal 3+full pulse, increased strength 4+ bounding pulse

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pallor

answer

absence of rosy color in light skinned individuals, associated with decreased perispheral blood flow

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OT CARIO PUL Rehab phase 1

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determined client is medically stable all kinds of conditions in the hospital MI< CABG< ANGIOPLASTY< VALVE repai/replacement/ CHF main focus - pt family education energy conservation metabolic cost of acitivities risk factor mod discharge to proper facility eval the basic bed mobility while monitoring vitals ---transfers, AROM, etc breathing techniques

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how can you detect OH in vitals

answer

BP Systolic drop over 20 in sit to stand

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ways to raise BP when in bed position, when client is feelign dizzy

answer

isometric hand contractions

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MAX HR for < 6 weeks MI

answer

120

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Max HR CHF, cardiomyopathy

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130

question

Target HR is what percentage or patient's max HR

answer

60-80%

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things to avoid

answer

avoid the isometric muscle work (if the HR is high) avoid overhead exeristes. (holding UEs over head for time) avoid lateral arm movements that can stretch and pull on incision sites

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when is a client ready for phase 2?

answer

when they are able to carry out activities at a MET level 3-5

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why use the METS?

answer

quantify amount of energy required for each task -a way to grade activities -find a baseline for the client

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phase 2 in the cardiac treatment is what?

answer

rehab/subacute/acute rehab build up activity tolerance greate Ind with all of the necessary stuff

question

what met level are you beginning acitivites at in phase 2??

answer

MET level 4-5 (if they can tolerate it, this really is person dependent) (but don't follow your instincts on the test questions, follow the textbook material) increase as it goes get all of the functional activities completed before discharge the whole home education piece

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when can a client have sex again, what MET level is this graded at?

answer

5-6 MET levels

question

Phase 3 Maintenance/Trianing stage

answer

once a week, completing stage 2 individual exercise programs weights cardiovasc

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rehab guidelines for lymphatic disease

answer

edema 2nd to lymph dysfunction short-stretch compression bandages, worn 24 hours a day manual lymph drainage (MLD) with complete decongestive therapy Massage, PROM to assist lymph flow decongest proximal segments, then extremities have to be certified

question

phase 2 lymph disease

answer

skin care compression bandages exercise lymphadema bandaging at night MLD as needed compression pumps, use with caution, limited benefits

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curret CPR guidelines

answer

30 compressions, then breathing CAB only exception is newborn babies push 2 inches into chest for adults

question

what happens if a person on NSAIDS or anti clotting meds has a wound open up?

answer

may take longer for the wound to clot

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things to do when you see a bad wound

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elevate the leg pressure with bandage over the wound

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internal bleeding

answer

fall, blunt force trauama can be swelling can be life threatening alll of the vitals will shoot up

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ecchymosis

answer

black and blue in the injured area

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RICE procedure

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rest, ice, compression, elevation

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major internal bleeding

answer

MD pesonnel supplemental o2 monitor vitals and be ready to report them to a doc

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Shock

answer

failure of circulatory system to perfuse vital organs may lose consciousness heart rate increases organs failure

question

types of shock

answer

hemorrhagic--severe bleeding psychogenic-emotional metabolic- loss of fluids anaphylactic- allergy cardiogenic- MI or cardiac arrest respiratory- illness or arrest septic- infection neurogenic- TBI pale, gray, blue, cool skin increased, weak pulse increased respiratory decreased BP irritability or resltessness diminishing LOC nausea or vomiting

question

Cystic fibrosis

answer

genetically inherited 30,000 children total lung disease characterized by production of abnormal mucous.

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CF effect on function

answer

exercise intolerance poor nutrition due to malabsorption

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respiratory distress syndrome RDS

answer

lungs collapse after each breath

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mild case

answer

supplemental o2 CPAP

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severe case

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intubation and a mixture of o2 and air provided

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effect on function

answer

intellectual development

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Bronchopulmonary displasia

answer

disorder often as a result of barotrauma high inflating pressures infection the walls of the lungs thicken, making the exchange of o2 and carbon more difficult

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