Willard and Spackman - Cardiac and Pulmonary Conditions

Question 1

Cardiac Conditions

Answer 1

Any condition that originates in and/or affects the heart

Conditions are often diagnosed following a cardiac event

Question 2

If condition is identified before event

Answer 2

General practitioner conducts first stages of diagnosis via a physical exam. Checks: blood pressure, cholesterol, blood glucose, family medical history

To further evaluate condition, diagnosis and develop treatment plan, cardiologist may use: electrocardiogram, ultrasound, chest X-ray, stress test, angiogram, cardiac enzyme blood test, cardiac catheterization

Question 3

Coronary Heart Disease (CHD)

Answer 3

• Most common heart disease
• plaque buildup which narrows blood vessels that supply heart
• Can lead to heart attack, angina (chest pain, discomfort or tightness) or other complications

Question 4

Myocardial Infarction (MI) aka Heart Attack

Answer 4

Insufficient oxygenated blood flow causes damage or death to portion of cardiac muscle

During MI, person may enter cardiac arrest

Question 5

Congestive Heart Failure

Answer 5

Different types:

1. left-sided systolic heart failure
2. left-sided diastolic heart failure
3. right-sided heart failure

• chronic and progressive condition
• heart does not sufficiently pump blood to maintain body’s need for oxygenated blood
• Different from cardiac arrest

Question 6

Congenital Heart Defects

Answer 6

• present from birth, caused by abnormalities in prenatal development in of the structures or blood vessels of heart
• defects vary and can include abnormal heart valves or holes in the walls of the heart
• diagnosis often made at birth or in early infancy after presentation of symptoms, diagnosis sometimes made during pregnancy

Question 7

Arrhythmia

Answer 7

• a change in the normal electrical impulses that generate heartbeat
• most are harmless, but could result in cardiac arrest

Question 8

Cardiac Arrest

Answer 8

• sudden loss of heart function, death within minutes

- May be reversed and life saved if CPR is performed OR a defibrillator is used immediately

Question 9

Incidence and Prevalence

Answer 9

One in 3 US adults (approx. 82.6 million) have at least one cardiovascular disease (cardiac condition, as well as stroke and hypertension)

16.3 million have CHD, 5.7 have heart failure, and 650K have heart defects

Question 10

CHD Cause

Answer 10

CHD caused by atherosclerosis

Atherosclerosis - narrowing of vessels from a buildup of plaque in the artery walls that supply the heart

Risk factors: high cholesterol, hypertension, diabetes, smoking, obesity/overweight, diet, inactivity, alcohol use

Genetics likely plays a role, but unclear if cause is actually shared environment/lifestyle choices

Question 11

MI Cause

Answer 11

MI caused by blood flow being stopped or impeded to the coronary artery (often by blood clots in arteries after piece of plaque breaks)

Question 12

CHF Cause

Answer 12

CHF caused by several compounding conditions (hypertension, CHD, MI, congenital heart defects & diabetes)

Question 13

Congenital Heart Defects

Answer 13

Congenital heart defects develop due to genetics, environmental factors or behavior/lifestyle choices on behalf of mother (uses drugs, smokes, drinks during pregnancy)

Question 14

Arrhythmia Cause

Answer 14

Arrhythmia caused by HD, MI or conditions where cells responsible for electrical conduction are affected

a. Could be result of congenital conditions, side effects to medications or use of addictive substances
b. Can cause MI, cardiac arrest or stroke

Question 15

Signs of cardiac event

Answer 15

• change in pattern of angina or shortness of breath
• heart palpitations/”fluttering”
• lightheadedness, dizziness, confusion, fainting or near-fainting
• more fatigue than expected
• unusual pain in joints/muscles after exercise
• sweating
• drop in BP of 20mm Hg or more or HR 20 BPM or more over resting rate

Question 16

Interdisciplinary Interventions - Surgery

Answer 16

• Angioplasty (AKA percutaneous coronary intervention PCI) - balloon inserted into artery and inflated to widen blockage and increase blood flow (or a laser on tip of catheter to vaporize plaque). Often used with stenting
• Stenting - wire mesh tube props coronary artery open
• Atherectomy - catheter with rotating shaver trims away plaque
• Coronary Artery Bypass Graft (CABG, “Cabbage”, AKA open heart surgery) - rerouted blood flow by grafting vessels from other parts of the body to the blocked artery
• Minimally invasive bypass - bypass performed via video monitors and scopes through small ports in the chest
• Transmyocardial revascularization (TMR) - lasers drill ~1mm holes into heart walls to relieve severe angina
• Valve replacement - artificial valve replaces abnormal/diseased valve
• Radiofrequency (or catheter) ablation - corrects arrhythmias by destroying small amount of cardio cells which cause the abnormal heartbeat
• Insertion of Left ventricular assist device (LVAD) - assists with pumping chamber
• Defibrillator or pacemaker implantation - maintains normal heartbeat
• Cardiomyoplasty - assists in pumping heart by wrapping skeletal muscle around heart and stimulated via pacemaker-like device
• Heart transplant - when heart is irreversibly damaged

Question 17

Cardiac Rehabilitation

Answer 17

• Education and counseling to manage condition
• increased physical fitness
• reducing symptoms
• finding support
• smoking cessation
• dietary and nutrition counseling
• psychological and emotional effects counseling

Question 18

Occupational Therapy Evaluations for Cardiac Conditions

Answer 18

Focuses on what client needs, wants or is expected to do and any factors that may impact performance

Begins with assessments followed by specific evaluation of the potential impact of cardiac condition on occupational performance

Question 19

Occupation-focused Assessments for Cardiac Conditions

Answer 19

• Role checklist
• Occupational performance history interview
• Occupational self-assessment, version 2.2
• Performance Assessment of self-care skills
• Canadian occupational performance measure
• Short form-36
• Activity card sort
• Reintegration to normal living scale

Question 20

Client factor assessments for Cardiac Conditions

Answer 20

• Beck Depression Inventory II
• Borg rating of perceived exertion scale
• measures of pain
• measures of muscle strength
• vital signs monitoring

Question 21

Occupational Therapy Interventions for Cardiac Conditions

Answer 21

OTs are frequent members of cardiac rehab teams

Precautions should be taken to prevent overexertion

HR and BP monitored regularly, alert team of changes

Common interventions:

• energy conservation techniques to reduce stress on heart
• ADL retraining (grading to reduce strain, assistive devices, suggestions for sexual activity w/o overexertion)
• environmental adaptations
• education on risk factors and how to remain healthy/functional
• lifestyle modification - new/alternate occupations w/o cardiac stress
• medication management
• support group recommendations

Question 22

Occupational Therapy and the Evidence for Cardiac Conditions

Answer 22

• greater need for long term rehab and lifestyle OT as more people live or survive cardiac conditions/emergencies
• Interdisciplinary cardiac rehab effective at decreasing death and improving quality of life, increasing return to work, increased ADL and IADL function, decrease LOS, increase independence
• CHF and CHD often result in ADL and IADL declines, requiring assistive devices and community services
• In-home rehab effective in increasing physical health and decreasing symptoms
• Community-based groups shown to provide mutual support system that assists in transition to home/community dwelling after hospital
• Paucity of evidence in availability and use of OT in schools and other settings for children with congenital heart defects

Question 23

Caregiver Concerns for Cardiac Conditions

Answer 23

• relatives always experience stress, anxiety, lower quality of life
• increased risk of death following diagnosis of loved one
• benefit from education on supporting family members and keeping self healthy

Question 24

Pulmonary Conditions

Answer 24

• Chronic obstructive pulmonary disease (COPD) - airflow blockages create breathing problems.
• Emphysema - type of COPD. Permanent damage to alveoli (CO2 and O2 exchange). Shortness of breath, difficulty exhaling.
• Chronic bronchitis - Type of COPD. Inflammation and scarring of bronchial tube lining.Produces thick mucus and restricts airflow. Diagnosed when person has mucus-producing cough most days of the month, 3 months of the year for two years w/o underlying disease.
• Others: Asthma, Cystic fibrosis, Pneumonia, tuberculosis
• Of these, OTs most likely to encounter COPD

Question 25

Prevalence of Lung Disease

Answer 25

- In 2009, > 2% (4.9 million) US adults 18+ years living with emphysema - In 2009, > 4% (9.9 million) US adults 18+years living with chronic diagnosis - Chronic lower respiratory disease is 4th leading cause of death in US - Death rate stable, but with growing population, this indicates number of deaths from COPD is increasing

Question 26

Cause and Etiology of Lung Disease

Answer 26

- Almost all cases of COPD due to exposure and inhalation of lung irritants. Most common irritant is cigarette smoke. Other forms of tobacco smoke can cause disease as well (cigars, pipe) - Risk is greater for developing COPD in first-hand inhalation, but both first and second-hand inhalation common - Other substances that can cause COPD: air pollution, duct, chemical fumes - Genetic condition alpha-1 antitrypsin (AAT) deficiency (low levels of lung protective protein) has increased risk for COPD, especially if a smoker

Question 27

Interdisciplinary interventions for Lung Disease

Answer 27

- Pulmonary rehab: multidisciplinary, therapeutic, educational, teaches physical and psychosocial strategies - Smoking cessation programs - Team members may include: respiratory therapist, thoracic surgeon, physicians, nurses, PTs, psychologists, social workers, nutritionists.

Question 28

Medication therapy for Lung Disease

Answer 28

- Inhalers or anti-inflammatory drugs often prescribed for COPD for maintenance or as-needed - Antibiotics to fight potential contraction of illnesses

Question 29

Oxygen therapy for Lung Disease

Answer 29

- supplementation when lungs don’t meet body’s oxygen needs. - supplement type determined by respiratory therapist or physician - Compressed oxygen containers, liquid oxygen, oxygen concentrators

Question 30

Surgery for Lung Disease

Answer 30

Lung transplants, lung volume reduction (removing damaged portions of lung), removal of damaged or diseased alveoli

Question 31

Occupational Therapy Evaluations for Lung Disease

Answer 31

- Focuses on what client needs, wants or is expected to do | - Analyzes what factors affect occupational performance

Question 32

Occupation-focused assessments for Lung Disease

Answer 32

- Role checklist - Occupational Performance History Interview - Occupational self-assessment version 2.2 - Performance Assessment of Self-Care skills - Canadian Occupational Performance Measure - Short Form-36 - Activity Card Sort

Question 33

Client Factor assessments for Lung Disease

Answer 33

- Chronic Respiratory Disease Questionnaire Self-Administered Standardized - Beck Depression Inventory-II - Borg Rating of Perceived Exertion scale - Range of Motion - Measures of pain - Measures of muscle strength - Monitoring of vital signs

Question 34

Occupational Therapy Interventions for Lung Disease

Answer 34

- Energy conservation techniques, may include environmental adaptations or breathing techniques - ADL retraining: grading activities , assistive devices - UE strength and ROM training: some pulmonary medications weaken muscles. Need to preserve muscles which assist with inhalation. - Educate client and family on risk factors and measures to take for prevention - Lifestyle modification: new/alternate occupations without exacerbating condition - Environmental assessment - Medication management - Support group and resource recommendations

Question 35

Occupational Therapy and the Evidence for Lung Disease

Answer 35

- Qualitative study showed that COPD patients often have to change their occupations and feel this as a loss, but OT helped them maintain or return to occupational satisfaction - OT shown to increase physical function, quality of life, independence and ADL/IADL efficiency and decrease dyspnea - OT can also improve social functioning and physical & psychological health

Question 36

Caregiver Concerns for Lung Disease

Answer 36

- As COPD increases, reliance on family/friends increases - Often caregivers experience: decreased quality of life, depression, feeling burdened - Can become patient’s only emotional and social outlet - Caregivers need support and education on how to care for themselves physically and emotionally too