COMPS:Cardiopulmonary and Neurological Issues in Older Adults Flashcards
(86 cards)
1
Q
America’s leading health problem, AND leading cause of death
A
CVD
Cardiopulmonary disease
2
Q
Tobacco
A
- single largest preventable cause of death and disease in the US
- Kills > 480,000 Am’s ea. year
- >41,000 from secondhand smoke
*Higher nicotine addiction= harder to quit=more problems
3
Q
Smoking and PAD
A
smoking more closely related to getting PAD than any other risk factor
PAD INCs 4x if you smoke or have hx of smoking
*Among adults aged >65→ 12-20% may have PAD→ Risk inc’s w/ older age combined w/ smoking or DM
4
Q
WATCH YOUTUBE VIDEOS MENTIONED ON SLIDE 5!!!
A
*******
5
Q
Heart Sounds
S1
A
Closing of mitral & tricuspid
6
Q
Heart Sounds
S2
A
Closing of pulmonary & aortic
7
Q
Heart Sounds
*Development of an S3 heart sound w/ exercise
A
- S3 sound produced during passive LV filling
- LOWER in pitch and may indicate CHF
8
Q
Heart Sounds
What else are s/s of decompensated CHF?
A
- INC SOB,
- B/L pedal edema
- crackles
- JVD
- gain 2-3lb
- Cor Pulmonale → cond that causes R. side of heart to fail
- LT HTN in the arteries of the lung and R. Vent can lead to cor pulmonale
9
Q
R. Side vs. L. Side HF
A
- R. Side→
- periph swelling, congestion
- L. Side→
- SOB
10
Q
Heart Sounds
A
APT-M 2245
- Dr. Dieter’s
- Aortic area
- Pulmonic area
- Erb’s Point
- Tricuspid area
- Apex (Mitral)→ where S3 most commonly heard
11
Q
General Risk Stratification
Info gathered from PMH
A
- Ejection Fraction (EF)
- >/=60%→ NORMAL
- 50-59%→ LOW RISK
- 31-49%→ MOD RISK
- =30%→ HIGH RISK
- Hx of angina
- Hx of arrhythmia’s
- Hx of MI or CHF
12
Q
Cardiac Meds
Usually Stepwise approach
Looking @ HTN..
A
- Lifestyle mods
-
Progression of meds:
- Diuretics→ ACE inhibitors→ Beta-Blockers→ Ca Channel Blockers
- Will also use “Cocktails” of meds for Cardiac meds
13
Q
Cardiac Meds
Diuretics
A
- Lowers BP
- Diff types
- can cause electrolyte imbals
14
Q
Cardiac Meds
Beta Blockers
-olol
A
-Olol
- Blunt HR
- Need to use RPE, talk test
15
Q
Cardiac Meds
ACE Inhibitors
-pril
A
-pril
- SE’s
- Periph edema
- chronic cough
16
Q
Cardiac Meds
*Ca Channel Blockers
-ipine
A
-ipine
- Blunt HR
- Need to use RPE
17
Q
Cardiac Meds
*Nitroglycerin
“nitro”
A
“nitro”
- usually put under tongue for Angina
18
Q
Cardiac Meds
*Digoxin (Digitalis)
*think Toxicity!!!
A
- Used for A-Fib and/or CHF
- For CHF→ reduces force of heart→ works less hard
- *Toxicity→ more common in older adults
19
Q
Cardiac Monitoring
3 methods:
A
- Mean Arterial Pressure (MAP)
- HR Recovery
- Angina Presentation Pattern
20
Q
Cardiac Monitoring:
MAP
A
- Avg blood pressure during cardiac cycle
- “Perfusion pressure”
-
MAP= DBP + ⅓ (SBP-DBP
- HIGH= inc risk stroke, organ failure
- LOW= not enough blood to organs (ex. brain)
- NORMAL= 70-110 mmHg
21
Q
Cardiac Monitoring
*HR Recovery
A
- Quick/easy measure of cardiac health
-
NOTE***= 12 beat recovery in 1 min
- → higher mortality in next 6 yrs
22
Q
Cardiac Monitoring
*Angina presentation patterns
A
-
MALES
- L. shoulder
- Neck
- Jaw
- Teeth
- Upper back
-
FEMALES
- Fatigue
- Breathlessness
- Pain mid-back (often missed**)
23
Q
Pulmonary Monitoring
2 ways:
A
- Breath Sounds
- Looking for changes @ rest OR w/ exercise
- O2 Sats
- >/= 90% → NORMAL
- *Medicare will pay for O2 if =88%
24
Q
Breath Sounds
Normal vs. Abnormal
A
- Normal→ Bronchovesicular
- Abnormal→
- Crackles (rales)
- Wheezing (rhonchi)
- Stridor→ high pitched, foreign body (choking)
25
Breath Sounds
## Footnote
**Abnormal→ Crackles (rales)**
* bottom lungs
* Usually **Inspiration**
* **PNA, CHF**
26
Breath Sounds
## Footnote
**Abnormal→ Wheezing (rhonchi)**
* Usually **Expiration**
* **Asthma, COPD**
27
Breath Sounds
## Footnote
**Abnormal→ Stridor (think choking, kids)**
* HIGH pitched,
* foreign body
28
Breath Sounds
## Footnote
**Pitch**
Low
Med
High
29
Breath Sounds
**Intensity**
Soft, medium, loud
* **Diminished/Soft→** Emphysema, hypERinflation, atelectasis
* **Loud/ringing→** PNA
30
VO2max
* Point @ which 02 consumption **does not inc** w/ **inc'd intensity**
* **ml/kg/min OR L/min**
* **Avg= 30-40ml/kg/min**
* **3.5ml/kg/min= 1 MET @ rest**
31
VO2====
CO x (a-VO2)
* CO x diff bw arterial and oxygen concentrations
* **diff in O2 drop**
* V= ventilation= pulmonary component
* a= HgB carried in **arteries** (little “a” is arteries)
* CO= Cardiac Output (SVxHR)
* a-VO2== how much HgB “let go” in **peripheral arteries**
32
HR
#beats/min
33
Stroke Volume
SV= EDV-ESV
* Avg= 70mL
* EDV= mL blood @ **end of diastole (relaxation)**
* **110-130**
* ESV= mL blood @ **end of systole (contraction)→ 2nd systolic**
* **30**
34
Regulation of SV
* **Preload→** blood returning to heart or EDV
* **Frank-Starling Mech**
* Inc'ing preload== inc'ing SV until plateaus
* SV plateaus bc we all have MAX SV
* **Afterload→** same as TPR
* blood ejected OUT of heart influenced by **pressure gen'd in ventricle** compared to **pressure in systemic vasculature**
* **INC TPR== DEC SV**
* **Contractility/Inotropy→** contraction of heart muscles
* **INC + inotropic (caffeine)= INC SV**
35
Cardiac Output
CO= HR x SV
* Vol of blood ejected **out of L. ventricle into systemic vasculature per minute**
* blood ejected out of L. vent/minute
* Avg= 70mL x 70bpm = 5L/min
36
Cardiac Output
## Footnote
**Coronary Blood Flow**
* perfuse myocardium during **cardiac cycle**
* **Myoglobin** in the myocardium releases O2 during **systole**
* Reg'd by ANS
* \*NOTE: **SNS inc's vasodilation**
37
Blood Pressure
BP
\*measurement of **arterial blood flow** and **resistance to that flow**
* BP= CO x TPR
* \*CO= HR x SV
* **Components:**
* Systolic
* Diastolic
38
Blood Pressure
## Footnote
**MAP**
MAP= (SBP + 2DBP)/3 or ⅓SBP + ⅔DBP
* Ex. BP= 120/80
* (120+2)(80))/3= ~90 MAP
39
Blood Pressure
## Footnote
**Mean Venous Pressure**
MVP= CVP (Central Venous Pressure)
* 0-8mmHg
* Ohm's Law
* High resist to Low resist
40
Pulse Pressure
PP= Systolic - Diastolic
ex. 120/80→ 120-80= 40PP
41
a-VO2
how much HgB “let go” in peripheral arteries
42
PVR
Pulmonary Vascular Pressure
Resistance that must be overcome to push blood through the **circulatory system** and create flow
43
RR
Respiratory Rate
of breaths/min
NORM= 12-20
44
Dyspnea
Diff or labored breathing
SOB
45
Functional Outcome Measures
Be Familiar…
* 2 min Step Tests
* Walking Tests (6m or 2m)
* TM Tests
* Borg Scale
* Dyspnea Scale
* Angina Scale
46
6MWT for…
**Pulmonary and CV Dis. Pts**
* Stopwatch, hallway
* **HR _before_ administration, self-selected speed, resting permitted, HR AFTER test and distance recorded, RPE determined**
* **NO quantitative info on aerobic power**
47
Interventions:
**Significant benefits of exercise in older adults:**
* improved **max O2 uptake (VO2max)**
* reduction in **coronary risk factors** w/ program adherence
* marked improvement w/ **ex tolerance**
* adaptations in **Sk. mm**
* reduction in **symptoms**
* overall improvement in **functional capacity** and **mental status**
48
Interventions:
Keep in mind…
Pts willingness to adhere to regular training that has appropriate **intensity** w/out producing **limiting sx's**
49
Guidelines for Aerobic Activity
## Footnote
**What are we looking for?**
**_OPTION 1_**
_Option 1_
2 hours and 30 mins (150mins or 30min/day 5d/week) of **_moderate intensity_** aerobic activity ea. week
\***Muscle strengthening** exercise on 2 or more days a week working **all major muscle groups** (legs, back, abs, chest, shoulders, arms)
50
Guidelines for Aerobic Activity
## Footnote
**_Option 2_**
_OPTION 2_
1 hour and 15 mins (75mins) or **_vigorous intensity_** aerobic activity ea. week
\***Muscle strengthening exercise** on 2 ore more days a week working **all major muscle groups**
51
Guidelines for Aerobic Activity
## Footnote
**_OPTION 3_**
_OPTION 3_
An **Equivalent mix of _moderate- and vigorous-intensity_** aerobic activity
\***Muscle strengthening exercise** on 2 or more days a week working **all major muscle groups**
52
Aerobic Activities
## Footnote
**Intensity**
**MODERATE**
_MODERATE_
* 60% MHR
* 11-12 Borg
* 3-4 Mod Borg\*\*\*
* Perceived Workload Scale→ **fairly light/somewhat hard**
* Talk Test→ **steady pace, not breathless**
53
Aerobic Activities: Intensity
## Footnote
**Vigorous**
_Vigorous_
* 80%MHR
* 15-16 on Borg
* 5-6 Mod Borg\*\*\*
* Perceived Workload Scale→ **Hard**
* Talk Test→ **Very brisk walking, must take breath bw _4-5 words_**
54
Rehab Dosage
## Footnote
**Aerobic Capacity**
See pics
Be familiar w/ **zones**
* **50-60%→** Mod activity (maintenance/warm up)
* **60-70%→** Weight control (Fitness/fat burn)
* **70-80%→** Aerobic (cardio training/endurance)
* **80-90%→** Anaerobic (Hardcore training)
* **\>90%→** VO2max (Max Effort)
55
Interventions
A balanced fitness training program includes\_\_\_\_\_\_\_\_\_\_\_\_
includes activities to **inc flexibility, strength, and CV endurance**
56
Interventions:
The most effective exercise prescription begins w/ \_\_\_\_\_\_\_\_\_\_\_\_
a type of aerobic activity the patient enjoys. **A prescribed schedule of stepwise increments in _freq, duration, and intensity_ gradually leads to an optimum lvl of fitness**
57
Interventions
CV and Pulmonary dysfunctions
REVIEW EXERCISE GUIDELINES IN CPPT!!!!!!!!!!!!!!!
58
Interventions:
Many older adults w/ cardiopulmonary impairments require\_\_\_\_\_\_\_\_\_\_
supplemental O2 and it is considered a drug (\>21%) when breathed in higher conc's than that found in atm cond's (20.98%)
59
Intervention:
The most common reason for O2 use is \_\_\_\_\_\_\_\_\_\_\_\_\_
**arterial hypoxia. PTs working w/ pts who require supp O2 should have knowledge base of the pros and cons of O2 tx**
60
Interventions:
The pts exercise prescription may req \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
modification of O2 dosage and this change **should be discussed w/ pts physician**
61
MAJOR patho affecting older adults in US….
Parkinson's (PD)
\*majority of indiv's are \>50yo when dx w/ PD
62
PWP may have wide variety of s/s w/ diff rates of dis. progression
Ex's
* Tremor
* bradykinesia
* rigidity
* postural instab
* deficits in motor planning
* diff w/ dual-tasking
* loss of automaticity
* have to think about everything→ auto things no longer auto
* dystonia
* dec'd speed
* altered stride rate
* variable stride length
* GI sx's
* soft voice
* mumbled OR fast speech
* loss of facial express (masked face)
* trouble swallowing → dysphagia
* diff chewing and probs communicating
63
PWP
Ex and Rehab programs
must be tailored to the individual
\*PWP need to dev. **long-term exercise habits**
64
Data released from the National Parkinson's Foundation's *Parkinson's Outcome Project*
shows PWP who start **exercising earlier** experience a **significantly slower decline** in QOL vs those who start later
65
PD Eval
## Footnote
**Do you have a hx of falls and near falls?**
How many in last 2 yrs?
\***Indicator of fx risk and lvl of impair.**
66
PD Eval
## Footnote
**Do you see a neurologist regularly?**
**\*Regular neuro care could save the lives of 1000s ea yr**
* If no→ **refer to one!**
* If yes→ ASK:
* **Have you been staged using a formal scale?**
* Hoehn and Yahr Scale OR Unified PD Rating Scale
* UPDRS rates PD as **postural instability** and **gait disorder predominant (PIGD)** OR **Tremor Dominant**
* **PIGD→** faster disease progress, more diff w/ ADLs, greater disability, more intellectual impairment, higher depression rates, lack of motivation
67
**postural instability** and **gait disorder predominant (PIGD)**
**PIGD→** faster disease progress, more diff w/ ADLs, greater disability, more intellectual impairment, higher depression rates, lack of motivation
68
PD Eval
## Footnote
**What is your _current level_ of exercise participation?**
PWP NEED to dev. **long-term exercise habits**
69
PD Meds
## Footnote
**What meds are you taking?**
**\*name, dosage, timing and SEs→ “On/Off times”**
**\*is pt tolerating meds? Has another provider prescribed _additional_ meds? Did pt try a med and then stop?**
**Ex's of meds:**
* Cholinesterase Inhibitors
* Antipsychotics
* L-dopa
* SSRIs
* Clonazepam
70
PD Meds
## Footnote
**Cholinesterase Inhibitors**
\*used to tx **thinking changes in dementia**
**\***can help w/ **visual hallucinations, sleep disturbs, changes in thinking/behavior**
71
PD Meds:
## Footnote
**Antipsychotics**
* Used to tx **behavioral sx's**
* **MAY cause serious SEs in up to 50% of those w/ PD dementia**
* Can cause sudden changes in:
* impaired swallowing
* acute confusion
* eps of hallucinations
* appearance of worsening related to PD sx's
72
PD meds:
## Footnote
**L-dopa**
* **Chief tx for PD movement sx's**
* can aggravate hallucinations and confusion in those w/ **PD dementia**
73
PD meds:
## Footnote
**SSRIs**
* Selective Serotonin Reuptake Inhibitors→ tx depression
74
PD Meds:
## Footnote
**Clonazepam**
Can tx REM disorder
75
PD Assessment
## Footnote
**IPE Approach**
see pics
76
PD Tests and Measures
## Footnote
**APTA Clinical Summary**
**\*Evidenced Based approaches!!**
Tests & Measures to perform
77
PD Interventions:
## Footnote
**4 Key Elements:**
1. Promotion of **task specific phys activity** and **lifelong participation in ex. program**
2. **Strategy training→** impacted by cognition
3. Mgmt of **2\* Sequelae**
1. lack of consensus regarding rehab and fatigue lvls
4. **Fall prevention** and **risk reduction**
78
PD Strategies
See pics of chart
79
PD Strategies
## Footnote
**Mid/Early Stages**
* Vigorous activity→ high intensity
* Task specific practice of relevant skills
* Standardized tx→ LSVT BIG
* Cog decline begins to become apparent→ try to get ahead of this
* retains ability to relearn motor skills
* Maint of flex, strength, CV function
* LSVT BIG
80
PD Strategies
## Footnote
**Mod/Middle Stage**
* Strategies similar to those used in Early stage, but w/ progress. LESS emphasis on impairs
* Cog ability becomes an issue
81
PD Strategies
## Footnote
**Severe/Late Stage SAFETY**
* Focus on compensatory strategies and safety
* Cog ability becomes issue
82
PD Strategies
**Types of activities**
* Resistance ex
* aerobic cond (neuro protective)
* balance re-ed
* dancing, boxing
* flexibility
83
PD Strategies
## Footnote
**Mgmt of 2\* Sequelae**
Lack of consensus regarding rehab and fatigue lvls
84
PD Strategies
**Dosage→ No consensus**
* Lack Larger scale studies report:
* **@ least 6 sessions of 45-60mins over 8 wks**
* **@ least 2.5 hours/week slows decline in QOL**
85
PD Take Homes:
#1
* Tx demos significnt **short-term benefits→ ESP early/mid-stage dis.**
* Need to teach **long-term strategies and skills** to maintain and slow progression
* **education on HEP**
* Clinicians should consider role of client cognition/non-motor sx's and progress to **compensatory strategies/education in LATER stage dis.**
* Utilize client preferences to **maximize long term adherence** and determine specificity of task
* **Specificity of task** is shown to be HIGHLY IMPORTANT when selecting **intervention strategies**
86
PD Take Homes
#2
* **Task specific** better than **non-specific training**
* **Dual task** activity performance show better carryover
* **Auditory, rhythmic (music) cues** help regulate walking (compared to visual or tactile)
* No matter the intervention, **intensity** appears to be the **KEY COMPONENT**
