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NBCOT > Cardiovascular & pulmonary system disorders (ch 8) > Flashcards

Cardiovascular & pulmonary system disorders (ch 8) Flashcards

1
Q

what is cardiac output?

A

amount of blood ejected from the heart per minute; dependent upon heart rate and stroke volume

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2
Q

what is stroke volume?

A

average amount of blood ejected per heart beat.

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3
Q

what is ejection fraction?

A

percentage of blood emptied from the ventricle during systole; a clinically useful measure of left ventricle function.

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4
Q

what do capillaries do?

A

connect arteries to veins. have thin, permeable walls.

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5
Q

what is hyperkalemia?

A

increased potassium ions, decreases the rate and force of heart contraction and produces EKG changes.

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6
Q

what is hypokalemia?

A

decreased potassium ions, produces EKG changes; arrhythmias, may progress to v-fib

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7
Q

what is hypercalcemia?

A

increased calcium concentration; increases heart rate.

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8
Q

what is hypocalcemia?

A

decreased calcium concentration; depresses heart action.

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9
Q

increased peripheral resistance….

A

increases arterial blood volume and pressure

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10
Q

decreased peripheral resistance….

A

decreases arterial blood volume and pressure

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11
Q

peripheral resistance is influenced by…

A

arterial blood volume: viscosity of blood and diameter of arterioles and capillaries.

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12
Q

definition of coronary artery disease (CAD)

A

atherosclerotic disease process that narrows the lumen of coronary arteries resulting in ischemia to the myocardium. Lipid-laden plaques affect moderate and large-size arteries; characterized by thickening of the intimal layer of the blood vessel wall from the focal accumulation of lipids, platelets, monocytes, plaque, and other debris.

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13
Q

what is angina?

A

chest pain due to poor blood flow through bv’s in heart. usually lasts less than 20 minutes due to transient ischemia.

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14
Q

angina is caused by…

A

imbalance in myocardial oxygen supply and demand; brought on by increased demands on heart (exercise, emotional upsets, smoking, extreme temps esp cold, overeating, tachyarrhythmias) and vasospasms.

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15
Q

Stable angina vs unstable angina vs variant angina?!

A
  • Stable: classic exertional angina occurring during exercise or activity; relieved with rest and/or sublingual nitroglycerin.
  • Unstable: coronary insufficiency at rest without any precipitating factors or exertion. increases risk for MI or death; pain is difficult to control.
  • Variant: caused by vasospasm of coronary arteries in absence of occlusive disease. responds well to nitroglycerin or calcium channel blocker long term.
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16
Q

Myocardial infarction (MI)

A

prolonged ischemia, injury, and death of an area of they myocardium caused by occlusion of one or more coronary arteries; results in necrosis of heart tissue.

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17
Q

3 types of heart failure are…

A
  1. left-sided heart failure (CHF): blood not adequately pumped into system circulation.
  2. right heart failure: blood not adequately returned from systemic circulation to the heart.
  3. biventricular failure: severe LV pathology producing backup into the lungs, increased PA pressure, and RV signs of HF.
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18
Q

New York heart Association (NYHA) Functional Classification is the most commonly used system to assess the stage of heart failure. Relates symptoms to everyday activities and the patients QoL. Places patients into categories based on limitations during physical activity. Functional capacity is…

A

how a patient with cardiac disease feels during physical activity.

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19
Q

NYHA Functional Classification Class I

A

cardiac disease, but not limitation of physical activity. (no fatigue, dyspnea, or angina pain.)

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20
Q

NYHA Functional Classification Class II

A

cardiac disease resulting in slight limitation of physical activity. Comfortable at rest. Ordinary activity results in fatigue, palpitation, dyspnea, or angina.

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21
Q

NYHA Functional Classification Class III

A

cardiac disease resulting in marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or angina.

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22
Q

NYHA Functional Classification Class IV

A

cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or angina may be present even at rest. If any physical activity occurs, discomfort increases.

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23
Q

Occlusive peripheral arterial disease (PAD)

A

chronic, occlusive arterial disease of medium and large-sized vessel. Diminished blood supply to affected extremities with pulses decreased or absent. Early stages: intermittent claudication; burning/searing/aching/tight pain; pain with walking, relieved by rest. Late stages: rest pain, muscle atrophy, trophic changes (trophic= related to feeding/nutrition); affects primarily LE.

Associated with HTN and hyperlipidemia; patients may also have CAD, diabetes, cerebrovasuclar disease, metabolic syndrome, hx of smoking.

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24
Q

What is claudication?

A

pain during exercise caused by too little blood flow

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25
Q

Thromboangiitis obliterans (aka Buerger’s disease)

A

chronic inflammatory vascular occlusive disease of small arteries and veins. Most common in young male smokers. Begins distally and progresses proximally in both LE and UE. Symptoms: pain, paresthesias, cold extremities, diminished temp sensation, fatigue, risk of ulceration and gangrene.

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26
Q

Diabetic angiopathy

A

inappropriate elevation of blood glucose levels and accelerated atherosclerosis; neuropathies a major problem; ulcers may lead to gangrene and amputation.

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27
Q

Raynaud’s phenomenon

A

episodic spasm of small arteries and arterioles abnormal vasconstriction reflex exacerbated by exposure to cold or emotional stress; tips of fingers develop pallor, cyanosis, numbness, and tingling; affects mostly females.

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28
Q

Varicose veins

A

distended, swollen superficial veins; tortuous in appearance; may lead to varicose ulcers.

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29
Q

Superficial vein throbophlebitis

A

clot formation and acute inflammation in a superficial vein; localized pain usually in saphenous vein

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30
Q

Deep vein thrombosis

A

inflammation of a vein in association with formation of a thrombus; usually occurs in LE. Associated with venous stasis (bed rest; lack of leg exercise), hyperactivity of blood coagulation, and vascular trauma; may be contributing factor to CVA.
Symptoms: progressive inflammation w/ tenderness to palpation; change in LE temperature/color/circumference/tenderness.

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31
Q

chronic venous insufficiency

A

chronic leg edema; skin pigmentation changes, scaly appearance, itchy.

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32
Q

lymphedema

A

chronic disorder with excessive accumulation of fluid due to obstruction of lymphatics; causes swelling of the soft tissues in arms/legs. Results from mechanical insufficiency of lymphatic system.

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33
Q

Primary lymphedema

A

congenital condition with abnormal lymph node or lymph vessel formation (hypoplasia or hyperplasia).

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34
Q

Secondary lymphedema

A

acquired, due to injury of one or more parts of lymphatic system. Possible causes: surgery (mastectomy, femoropopliteal bypass, lymph node removal); tumors, trauma, or infection of lymph nodes; radiation; chronic venous insufficiency.

35
Q

what is perfusion?

A

blood flow to the lungs (a good thing!)

36
Q

what is pneumocystis pneumonia (PCP)?

A

pulmonary infection caused by a fungus in immunocompromised hosts; most often found in patients following transplantation, neonates, and those with HIV

37
Q

what is SARS?

A

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

38
Q

tuberculosis is caused by?

A

airborne bacteria.

39
Q

what is Rood’s disease?

A

vertebral collapse caused by TB resulting in compression of the spinal cord. Cervical spinal lesions can result in hand functional impairment, sensory impairment, postural changes. Thoracic spinal lesions can result in paraparesis, neurogenic bowel/bladder, altered mobility, and altered ADLs.

40
Q

What are the three sequelae of TB?

A
  1. kidney dysfunction can occur
  2. Rood’s disease
  3. space-occupying lesions in the brain produce stroke-like symptoms.
41
Q

COPD is characterized by what?

A

poor expiratory flow rates

42
Q

what is peripheral airways disease?

A

inflammation of the distal conducting airways; association with smoking.

43
Q

what is chronic bronchitis?

A

chronic inflammation of the tracheobronchial tree with cough and sputum production lasting at least 3 months for 2 years.

44
Q

what is emphysema?

A

permanent abnormal enlargement and destruction of air spaces distal to terminal bronchioles; may result in destruction of acini, the functional units for gas exchange in the lungs.

45
Q

signs/symptoms of emphysema…

A

-dyspnea and exertion
-diminished breath sounds, wheezing
-prolonged expiratory phase
-pursed lip breathing
physical presentation of enlarged anterior/posterior dimensions of chest wall, hypertrophied accessory muscle from overuse, use of accessory muscles for breathing, forward leaning posture
-chronic cough and sputum maybe
- eventual cachexia and signs of R heart failure

46
Q

what is cachexia? (cachectic)

A

physical wasting and loss of muscle mass due to disease

47
Q

what is asthma?

A

increased reactivity of trachea and bronchi to various stimuli (allergens, exercise, cold).

48
Q

what is pleural effusion?

A

excessive fluid between the visceral and parietal pleura, caused mainly by increased pleural permeability to proteins from inflammatory diseases, neoplastic disease, increased hydrostatic pressure within pleural space (CHF!), decrease in osmotic pressure, peritoneal fluid within the pleural space, or interference of pleural reabsorption from a tumor invading pleural lymphatics.

49
Q

what is atelectasis?

A

collapsed or airless alveolar unit, caused by hypoventilation secondary to pain during the ventilator cycle, internal bronchial; obstruction, external bronchial compression, low tidal volumes, or neurologic insult.

50
Q

what is claudication?

A

pain caused by too little blood flow during exercise.

51
Q

Intermittent Claudication Rating Scale

same exists for dyspnea and angina

A 
0- no claudication pain
1- initial, minimal pain
2- moderate, bothersome pain
3- intense pain
4- max pain, cannot continue
52
Q

normal heart rate is ?? bpm?

A

60-100 (70 is normal).

53
Q

newborn heart rate is ?? bpm?

A

120 (70-170).

54
Q

tachycardia is ____ than ____ bpm

A

greater than 100bpm

55
Q

bradycardia is ____ than ____ bpm

A

less than 60bpm

56
Q

what is normal BP range (systolic and diastolic)?

A

systolic 110-140; diastolic 60-80.

57
Q

what is normal infant BP?

A

75/50

58
Q

what is normal infant respiration rate?

A

40 breaths/minute

59
Q

what is diaphoresis?

A

excessive sweating associated with decreased cardiac output

60
Q

Phase 1 OT Cardiopulmonary Rehab (focus, eval and tx)

A

Inpatient rehab/ acute hospitalization.

  • Focus on patient education (energy conservation, metabolic cost of activities), improve self care abilities, decrease anxiety, promote risk factor reduction, discharge to home
  • Eval and tx: if pain free, no arrhythmia, and pulse 100 or less, do an activity program! Begin with activities at MET level 1-2 (bed mobility, static standing, transfers, bed bath, AROM, wc mobility); breathing exercises. As activity tolerance improves, increase MET levels.
61
Q

Monitor during tx in Phase 1 cardiopulmonary rehab…

A

-Observe: SOB, pain, nausea, dizziness, decrease/increase in BP, facial expression, heart rate; o2 saturation (problems below 86 for pulmonary, below 90 for cardiac); monitor ECG.

62
Q

signs/symptoms or diagnoses that contraindicate tx during cardiopulmonary rehab

A
  • uncontrolled atrial/ventricular arrhythmias
  • recent embolism/thrombophlebitis (clot in vein)
  • dissecting aneurysm
  • severe aortic stenosis
  • acute systemic illness
  • acute MI (within 2 days)
  • digoxin toxicity (digoxin is a heart medication)
  • acute hypoglycemia
  • third degree heart block
  • unstable angina
63
Q

Phase 2 OT Cardiopulmonary Rehab (focus, eval and tx)

A

Outpatient/ Convalescence (subacute)

  • Focus: educate patient on importance of exercise; build up activity tolerance; improve IADL ability; support smoking cessation/lifestyle changes.
  • Eval and tx: home eval; education; graded exercise program; begin at MET level 4-5; resumption of sex at MET 5-6; practice functional activity; energy conservation
64
Q

Phase 3 OT Cardiopulmonary Rehab (focus, eval and tx)

A

Maintenance/Training Stage (Community Exercise Programs)

  • Focus: patients attend maintenance/training sessions once a week following completion of phase 2. Groups may be integrated into individual exercise programs.
  • OT tx: PRN for IADL, leisure pursuits, and work.
65
Q

What is MET?

A

Metabolic equivalent levels. MET levels are used to quantify the amount of energy required to perform an activity and to provide the therapist with a guideline for grading activities.

66
Q

Rehab guidelines for lymphatic disease- phase 1

A
  • short-stretch compression bandages, worn 24 hours/day
  • manual lymph drainage with complete decongestive therapy (massage and PROM to assist lymphatic flow; emphasis on decongesting proximal segments first (trunk) then extremities; compression using multi-layered padding; certified lymphedema specialists).
  • functional activities (ADL, adapted IADL, energy conservation; skin care/compression garments; address psychosocial issues
67
Q

Rehab guidelines for lymphatic disease- phase 2

A
  • skin care
  • compression bandages
  • exercise
  • lymphedema
  • manual lymph drainage as needed
  • compression pumps (use with caution; limited benefits)
68
Q

what is ecchymosis?

A

black and blue area- bruise (although not necessarily caused by blunt trauma)

69
Q

hypoperfusion is aka?

A

shock

70
Q

what is shock?

A

failure of the circulatory system to get blood to vital organs. may lose consciousness. heart rate increases, therefore increased oxygen demand. organs fail when deprived of oxygen. heart rhythm affected causing cardiac arrest/death.

71
Q

signs/symptoms of shock

A
  • pale, gray, or blue, cool skin
  • increased, weak pulse
  • increased respiratory rate
  • decreased blood pressure
  • irritability or restlessness
  • diminishing level of consciousness
  • nausea or vomiting
72
Q

care for shock

A
  • obtain hx if possible
  • examine victim for airway, breathing, circulation, and bleeding
  • assess level of consciousness
  • determine skin characteristics and perform capillary refill test of fingertips (squeeze and look for healthy blanch then pink. If no pink in 2 seconds, shock!)
  • keep victim from getting too hot/cold
  • elevate legs 12 inches unless there is suspected spinal injury or painful deformities of LE
  • administer supplemental oxygen PRN
  • do not give any food or drink.
73
Q

what is cystic fibrosis (CF)?

A

genetic (autosomal recessive trait gene mutation); chronic, progressive lung disease characterized by production of abnormal mucous; salt concentration in sweat; decreased release of certain enzymes by pancreas; abnormalities on x-rays; failure to grow properly.

74
Q

complications of CF?

A
  • reduced life expectancy (mucous clogs lungs and lead to life-threatening infections; mucous obstructs pancreas and stomps enzymes from helping body absorb food)
  • cardiac symptoms a possible complication
  • diabetes, cirrhosis, and rectal prolapse are rare complications
  • 5-10% of children with CF have intestinal blockage
75
Q

OT eval for CF

A
  • assess for developmental delays related to decreased strength and endurance and decreased attention (due to pain)
  • assess enviro to determine adaptation for energy conservation and possible equipment
  • assess psychosocial status (stress related to hospitalizations and absenteeism; fatigue related to care needed; emotional stress from pain and prognosis).
76
Q

OT intervention for CF

A
  • energy conservation
  • enviro adaptations
  • positioning to promote postural drainage
  • neurodevelopmental treatment to improve endurance and postural stability
  • facilitation of fine, gross, visual motor, cognitive, and psychosocial development
  • parent education/ teacher education
77
Q

Respiratory Distress Syndrome (RDS); etiology, and what is it?

A

Etiology= premature birth; insufficient production of surfactant to keep alveoli open
Lungs collapse after each breath

78
Q

RDS medical tx

A

Mild case: supplemental oxygen alone or in combo with CPAP

Severe case: intubation and oxygen

79
Q

RDS effect on function

A
  • good future intellectual development of premature infant who had RDS and was treated
  • impairments for those who incur a severe intracranial hemorrhage, including motor, sensory, cognitive, and/or language impairments.
  • premature infants with RDS may have visual defects, hypotonia, and other health issues that impact development
80
Q

OT tx for RDS

A
  • monitor development
  • facilitate sensori-motor and cognitive development
  • address psychosocial issues that arise
  • provide parent education regarding handling, positioning, energy conservation, and methods to facilitate normal development.
  • adapt enviro PRN
  • observe medical precautions
  • refer PRN to ophthalmologist and other services.
81
Q

Bronchopulmonary Dysplasia (BPD) etiology and what is it?

A

Etiology: respiratory disorder often as a result of barotrauma. High inflating pressures; infection; meconium aspiration; asphyxia. A complication of prematurity.
Walls of the immature lungs thicken, making exchange of oxygen and CO2 more difficult; mucous lining of lung reduced along with airway diameter. Infant must work harder than normal to obtain sufficient oxygen to survive.

82
Q

Complications of bronchopulmonary dysplasia

A
  • greater risk for hypotonia and gross motor delays
  • feeding problems (poor nutrition, leading to fragile bones)
  • CNS problems like brain damage can lead to impairments in motor, sensory, speech, and cognitive function.
  • recurrent otitis media (middle ear inflammation) leading to conductive hearing loss and speech problems.
83
Q

Effect of bronchopulmonary dysplasia on function

A
  • poor autonomic and sensory regulation; can impact alertness needed for feeding.
  • poor exercise/activity tolerance due to illness and compromised respiration
  • reduced socialization due to long periods of poor health and susceptibility to infection.
  • isolation/stress on child and family… psych problems then.
  • greater risk for attachment disorder
84
Q

OT tx for bronchopulmonary dysplasia

A
  • facilitate sensori-motor and cognitive development
  • address psychosocial issues that arise
  • provide parent education regarding handling, positioning, feeding, EC, and enviro adaptations
  • parent advocacy related to acquiring needed equipment/services
  • observe all medical precautions

NBCOT (20 decks)

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