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That one thing you need > Burns & Cardiopulmonary Diseases > Flashcards

Burns & Cardiopulmonary Diseases Flashcards

1
Q

What does medical management involve in the emergent phase of burns (0-72 hours after injury)?

A

Sustaining life, controlling infection, and managing pain

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2
Q

What sustaining life involve in the emergent phase of burns?

A
  • risk of dehydration
  • hypo or hyperthermia: temperature regulation
  • fluid resuscitation
  • cardiopulmonary stability
  • escharotomy, fasciotomy - circulation, burn tissue
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3
Q

What does medical management involve in the acute phase of burns (72 hours after until wound is closed)?

A
  • infection control
  • grafts
  • pain management
  • proper nutrition and hydration
  • cardiopulmonary stability
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4
Q

What is OT’s evaluation in the emergent phase of burns?

A

-observe joints affected by burns, gather information on prior functional status

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5
Q

What is OT’s intervention in the emergent phase of burns?

A

-splinting in ANTIDEFORMITY
(intrinsic plus, opposite posture, extension neck, elbow, knees, abduction shoulder, extension hip, anti-frog leg and foot drop)

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6
Q

What is OT’s evaluation in the acute phase of burns?

A
  • ADLs
  • psychosocial
  • communication
  • cognition
  • ROM
  • muscle strength
  • pain
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7
Q

What is OT’s intervention in the acute phase of burns?

A
  • splinting and positioning in antideformity and anticontracture positions,
  • edema management (elevation, AROM exercises, elastic bandage)
  • early participation in ADLs (implement ROM, when standing, apply compression wrapping to provide adequate vascular support)
  • education
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8
Q

What is the thing to remember about ROM when working with a patient who has a burn?

A

-do NOT do passive or active ROM with exposed tendons or recent grafts (wait 5-7 days)

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9
Q

What does the surgical and postoperative phase of burns include?

A
  • postoperative immobilization period (usually about 3-10 days), walking not resumed until 5-7 days after grafting in lower extremities
  • positioning- anticontracture, promote greatest SA for graft placement
  • exercise (of uninvolved extremities)
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10
Q

What does the rehab phase include for patients with burns?

A
  • skin conditioning (lubricate it, massage it, and protect it… with sunblock)
  • scar management (compression therapy for edema and scar)
  • custom-made compression garments
  • therapeutic exercise and activity
  • splinting (dynamic or serial to reverse disabling contracture formation)
  • ADLs
  • client education
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11
Q

What does the outpatient and community reintegration phase include for patients with burns?

A
  • scar management
  • community re-entry
  • psychosocial adjustment
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12
Q

What are some burn-related complications to consider?

A
  • contracture (position and splint)
  • hypertrophic scar (compression)
  • heterotrophic ossification (ROM AROM, maybe surgery)
  • pain (coordinate w nurse, pain management techniques)
  • heat intolerance (AC accommodations)
  • Sun exposure (sunscreen)
  • pruritis (compression garment, cold packs)
  • psychosocial adjustment
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13
Q

What does phase 1 of OT intervention in cardiac rehabilitation include? (inpatient)

A
  • MET levels 1 - 3.5
  • monitoring of electrocardiogram, blood pressure, and pulse
  • clinical pathway
  • progression of ADLs according to MET levels
  • monitor symptoms
  • Patient and family education (precautions, energy conservation)
  • develop home program describing activity guidelines, pacing, and simplification of activities, etc
  • DC to phase 2 at MET 3.5
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14
Q

What does phase 2 of OT intervention in cardiac rehabilitation include? (outpatient)

A
  • MET levels 3.5+
  • OT 3 days a week for 4-8 weeks
  • Safe participation in exercise and tolerance to progress MET levels
  • Improve IADLs, improve ability to return to occupational roles
  • AVOID isometric work/holding breath –increases O2 demands
  • weight training after 2 weeks
  • education
  • evaluation of psychosocial issues
  • work hardening maybe
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15
Q

What does phase 3 of OT intervention in cardiac rehabilitation include? (community)

A
  • Sessions about 1x/week OR home tx if can’t make it to OP
  • Maintenance: monitored community exercise program
  • physical referral
  • stress test
  • continuation of phase 2 and progress
  • more in community settings
  • NOT covered by Medicare
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16
Q

What is the OT evaluation for respiratory conditions?

A
  • ADL assessment
  • monitor heart rate, blood pressure, oxygen saturation
  • daily activity interview
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17
Q

What is the OT intervention for respiratory conditions?

A
  • ADL training, admin of oxygen if saturation goes below 90%; frequent rest breaks
  • education to use pursed lip and diaphragmatic breathing, lean forward
  • upper extremity strengthening
  • adapt community activities
  • stress management training
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18
Q

Activities for OT interventions at Phase I of Cardiac Rehab (Acute Inpatient)

A
  • MET levels 1.3.5
  • MET 1-2: begin at bedside; WC mobility; transfers; bathing, grooming, eating SEATED
  • MET 2-3: Seated showers, dressing, washing dishing
  • Improve self care!
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19
Q

Before working with a patient in an acute inpatient rehab setting, what do you need to make sure to do?

A

Check vitals! Make sure NO pain or irregular pulse before any activity! Check yo self FIRST

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20
Q

Activities for OT interventions at Phase II of Cardiac Rehab (Outpatient)

A
  • Graded exercise program
  • Improve IADLs
  • Standing shower, ind. bowels, climb stairs, home care, ride back
  • Back to normal routine!
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21
Q

What should you make sure to avoid when working with client in outpatient cardiac rehab setting (phase II)?

A

Avoid isometric work/holding breathe, as this increases O2 demands

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22
Q

Heart Disease risk factors

A

Non controllable: age, sex, family history

Controllable: smoking, high lipids, high cholesterol, hypertension, obesity, diabetes, mental stress, lack of exercise

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23
Q

Spectrum of clinical entities ranging from angina to infarction to sudden cardiac death

A

Coronary Artery disease. Arteries that supply blood to heart harden and narrow, causing decrease in blood flow
Angina: chest pain
Myocardial Infarction (MI): prolonged ischemia (decreased blood supply), injury and death to myocardium
Heart failure: heart unable to maintain adequate circulation to meet metabolic needs of body. Leads to increase pressure, fluid build up of legs, ankles, feet

24
Q

How patient with cardiac disease feels during physical activity

A

Functional capacity

25
Q

Condition with diminished blood supply to affected extremities with pulses decreased or absent.

A

Peripheral Vascular Disease (PVD).

26
Q

Condition relating to Peripheral Vascular Disease that is defined as chronic inflammatory vascular occlusive disease of small arteries and veins

A

Buerger’s disease. Begins distally and progresses proximally in both LEs and UEs. Symptoms: pain, parasthesias, cold extremities, diminished temperature sensation, fatigue, risk of ulcers and gangrene

27
Q

Condition of Peripheral Vascular Disease which involves inappropriate elevation of blood glucose levels and accelerated altherosclerosis (build-up of plaque)

A

Diabetic angiopathy (disease of blood vessels). Ulcers may lead to gangrene and amputation

28
Q

With a patient with Raynaud’s phenomenon, what must you remember regarding the external environment?

A

Raynaud’s phenomenon is an episodic spasm of small arteries and arterioles abnormal vasoconstriction reflex. It is exacerbated by exposure to cold or emotional stress. Tips of fingers are especially sensitive. They develop pallor, cyanosis, numbness, tingling. Largely affects females.

29
Q

What precautions are most important for a client after heart surgery?

A 
Sternal precautions. 
Don’t reach both arms overhead.
Don’t reach both arms out to the side.
Don’t reach behind your back.
Don’t lift more than 5 to 8 pounds.
Don’t push with your arms. For example, don’t push yourself up from a chair.
Don’t pull with your arms. For example, don’t pull open a heavy door.
Don’t drive.
30
Q

T/F: With a patient with a Deep vein thrombosis (DVT), it is crucial that the patient remain in bed for at least 48 hours post-surgery

A

False! Early mobility after surgery helps to eliminate venous stasis

31
Q

You enter the room of a 53 female post CVA who is laying in bed. You notice that she has a lot of inflammation of both LEs, which is very painful and hot to the touch. This situation requires IMMEDIATE medical attention. What condition is she probably experiencing?

A

Deep Vein thrombosis (DVT).

  • Possible complication of CVA involving inflammation of a vein with the formation of a thrombosis (blood clot). Usually occurs in LEs
  • May be asymptomatic early
  • Changes in LE temp, color, circumference, appearance or tenderness/pain
32
Q

OT interventions after treatments of Coronary artery disease e.g., open-heart surgery, coronary artery bypass graft, valve replacement or repair

A
  • Sternal precautions

- Home program guidelines

33
Q

Chronic progressive condition that affects the pumping power of your heart muscles. Fluid builds up around the heart and causes it to pump inefficiently

A

Heart Failure.

34
Q

New York Heart Association (NYHA) Functional Classification System

A
  • Most commonly used classification system to assess the stage of heart failure.
  • Relates symptoms to everyday activities and patients’ QOL
  • Class 1: No limitation of physical activity
  • Class 2: Slight limitation of physical activity. Comfortable at rest
  • Class 3: Marked limitation of physical activity. Still comfortable at rest
  • Class 4: Discomfort during physical activity. Symptoms of heart failure present even at rest
35
Q

Which of the following is NOT an acute pulmonary disease?
A. Bacterial pneumonia
B. Bronchitis
C. Viral pneumonia
D. TB
E. SARS (Severe acute respiratory syndrome)

A

B. Bronchitis is a COPD

36
Q

How is TB spread?

A

TB is an airborne infection caused by a bacterium (Mycobacterium tuberculosis). If TB is of the throat or chest, it can be passed by sneezing or coughing. Most at risk when you live around or are in close contact with those infected and with weakened immune systems

37
Q

Disorder characterized by poor expiratory flow rates

A

Chronic Obstructive Pulmonary Diseases (COPD). Includes Peripheral airways disease, Chronic bronchitis, Emphysema

38
Q

Which type of COPD is associated with smoking?

A

Peripheral airways disease. Inflammation of the distal conducting airways

39
Q

A patient with COPD is excessively coughing at producing a great amount of sputum (saliva and mucus). Which type of COPD does he probably have?

A

Chronic bronchitis. Chronic inflammation of the tracheobronchial tree with couch and sputum production lasting at least 3 months for 2 consecutive years

40
Q

You see a patient with COPD who complains of constant dyspnea (shortness of breath,) especially when engaging in physical activity. You notice he is breathing with pursed lips and has a barrel chest. What type of COPD does he probably have?

A

Emphysema: permanent abnormal enlargement and destruction of air spaces distal to terminal bronchioles. Results in airway dilation, premature airway closure, air trapping

41
Q 
You see a patient who complains of the following symptoms: primary complaint of dyspnea on exertion, wheezing, pursed lip breathing, barrel chest, chronic cough and sputum. Which Pulmonary dysfunction do you think of FIRST? (lol no reason to caps or even put in "first" at all... just trying to make it look like NBCOT)
A. TB
B. COPD
C. Pneumonia
D. Asthma
A

B. COPD is a disorder characterized by poor expiratory flow rates.

  • TB: airborne infection caused by bacterium Mycyobacterium tuberculosis
  • Asthma: increased reactivity of trachea and bronchi to various stimuli e.g., allergens, exercise, cold
42
Q

Group of diseases all characterized by difficulty expanding the lungs, causing a reduction in lung volumes

A

Chronic Restrictive Diseases

43
Q

What medical status and history is important when assessing a cardiopulmonary patient initially?

A
  • Review medical record
  • Interview patient and/or family/caregiver
  • Presenting symptoms: pain, dyspnea (SOB), fatigue/perceived exertion, palpitations, dizziness, edema
  • Past medical history: onset of incident, premorbid status, current meds
  • Diagnostic tests to determine activity restrictions, vital sign parameters, prognosis
  • Social history
  • Discharge environment and anticipated level of activity
44
Q

What should you assess when first seeing a patient with a cardiopulmonary patient?

A
  • Vital signs: HR 60-100 bpm; BP 120/80; respiration 12-18 breaths per minute
  • Condition of extremities: sweating, pulse, skin color
  • Mobility Assessment
  • Cognition: ability to understand, process, retain, apply info taught in rehab
  • ADLs
  • Activity Tolerance
  • Psychosocial assessment: depression, anxiety, stress
  • Environmental assessment
45
Q

Which of the following is abnormal for an adult middle aged male?
A. Heart rate of 75 BPM
B. Blood pressure of 115/75
C. Respiration of 20 breaths/min

A

C. Normal respiration rate is 12-18

46
Q

Pediatric pulmonary disorder that is a chronic progressive lung disease characterized by production of abnormal mucus and affects the ability to grow properly. Also reduces life expectancy

A 
Cystic Fibrosis (CF) 
-Affects exercise tolerance and nutritional intake
47
Q

OT eval with Cystic Fibrosis

A
  • Assess for developmental delays related to decreased strength and endurance and decreased attention due to pain
  • Assess environment to determine adaptations for energy conservation and possible equipment needs
  • Assess psychosocial status: child and family stress from frequent hospitalizations, social isolation, home tx
  • Fatigue
  • Emotional stress
48
Q

OT intervention with Cystic Fibrosis

A
  • Energy conservation
  • Environmental adaptations
  • Positioning to promote postural drainage
  • Neurodevelopmental tx to improve endurance and postural stability
  • Facilitation of fine, gross, visual motor, cognition, psychosocial development
  • Parent education, including advocacy for child
  • Teacher education: precautions for playground play and participation in healthful physical activities
  • Observe medical precautions: respiratory/cardiac
49
Q

Pediatric pulmonary disorder in which lungs collapse after each breathe

A

Respiratory Distress Syndrome (RDS). With tx, intellectual development appears good

50
Q

OT Eval for Respiration Distress Syndrome (RDS)

A
  • Assess for developmental delays
  • Assess environment
  • Effects may include visual defects, hypotonia
51
Q

OT intervention for Respiration Distress Syndrome (RDS)

A
  • Monitor development
  • Facilitate sensorimotor and cognitive development
  • Address psychosocial issues
  • Parent education: handling, positioning, energy conservation, methods to facilitate normal development
  • Adapt environment
  • Observe medical precautions
  • Refer to opthalmologist and other relevant services
52
Q

Pediatric Respiratory disorder that is a complication of prematurity and affects the walls of the immature lungs to thicken, making the exchange of oxygen and CO2 more difficult

A

Bronchopulmonary Dysplasia (BPD). Infant must work harder than normal to obtain sufficient O2 for survival.

  • Poor autonomic and sensory state regulation, affecting proper feeding
  • Poor exercise/activity tolerance due to compromised respiration
  • Reduced ability to socialize due to poor health and susceptibility to infection
53
Q

Occupational Therapy Eval for Bronchopulmonary Dysplasia (BPD)

A

BPD is a respiratory disorder that results as a complication of prematurity. The infant must work harder than normal to obtain sufficient O2 for survival

  • Assess for developmental delays/deficits
  • Assess environment to determine adaptations related to energy conservation, positioning, and enhanced occupational performance
54
Q

Occupational therapy intervention for infant with Bronchopulmonary Dysplasia (BPD)

A
  • Facilitate sensorimotor and cognitive development
  • Address psychosocial issues that arise
  • Adapt environment
  • Provide parent education regarding handling, positioning, feeding, energy conservation, appropriate environmental adaptations
  • Parent advocacy related to acquiring necessary services and equipment
  • Observe all medical precautions
55
Q

Functional effects of respiratory distress syndrome (RDS) on infant

A
  • Visual defects

- Hypotonia and other effects that can effect development

56
Q

What is important to remember regarding feeding when treating an infant with Bronchopulmonary Dysplasia (BPD)

A

-With BPD, infants have poor autonomic and sensory state regulation, which can impact the state of alert which is necessary for proper feeding

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