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Primary goals of inpatient cardiac rehab (7)
- •Prevent muscle loss during bed rest
- •Assess and monitor overall function in
- daily activities
- •Help patients regain function after major
- illness
- •Instruct patients on home activities and
- how to modify/adapt them given there own individual precautions and/or risk
- factors
- •Assess cardiovascular response to
- exercise and activity
- •Risk factor education
- •Discharge planning
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Primary OT goals of Cardiac ICU
- •Prevent muscle loss and joint contracture
- while on bed rest
- •Pressure ulcer prevention
- •Seating assessment/recommendations
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OT initial assessment:
What to check for current physical status (6)
- •Resting Vitals- HR, BP, O2 Saturation, telemetry*
- •Note breathing (SOB, Resp Rate, Type)
- •Note IV’s, Foley Catheters and other medical lines
- •Pain-BP goes up
- •Color
- •Edema
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OT initial assessment
Previous level of function - 4 areas to consider
- •Mobility
- •ADLS/IADLS
- •Functional Activity Endurance
- •Fall Hx
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What precautions do you have to be aware of for open heart surgery patients?
Sternal precautions/pain
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•Sometimes referred to as “acute confusional
state”
•Occurs in about 21% of post cardiac surgery patients with a mean duration of 2.5 days
Delirium
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What are the 3 types of delirium?
- Hyperactive- agitation, restlessness,
- attempts to remove catheter, tubes, hitting, biting, emotional lability
- Hypoactive- withdrawal, flat affect,
- apathy, lethargy, decreased responsiveness
- Mixed- concurrent or sequential
- appearance of some features of both hyperactive and hypoactive
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What area of the brain is very sensitive to
ischemic insult?
Hippocampus
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Is cognitive impairment common after a CABG?
Yes, at d/c from hospital 53% have cognitive impairment
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How long does post cardiac surgery leg edema last?
About 6 months
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Are compression stockings always appropriate for edema?
- No, compression is NOT indicated for
- uncontrolled HF
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How long does healing of heart muscle take?
About 4-8 weeks
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•Patients
who have had a MI are taught to gradually progress from light to moderate ADL
and IADL activities. Keeping activity level between ___ and ___ METS until
they are assessed at cardiac rehab and given
2 to 4 METS
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What do OTs educate on in Acute Care? (4)
- •Heart Health and Activity Risk Factors
- •Physical Precautions and their functional implications
- •Energy Conservation & Activity Modification
- •Stress Management
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What are the cardiac activity risk factors? (10)
- •Extreme temp, or wind
- •Stress
- •A recent large meal
- •Excessive alcohol
- •Tobacco, or street drugs
- •Fast pace
- •Prolonged activity
- •Fumes or dust
- •Feeling tired or unwell
- •Stooping, bending or working overhead
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What are symptoms of overdoing it? (5)
- •Angina
- •Muscle Discomfort
- •Breathlessness
- •Fatigue
- •Lightheadedness
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What are some energy conserving tips? (3)
- •Most patients have more energy in the
- morning
- •Adequate rest break between activities or
- sessions
- •Take med effects into account
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What are the 6 P's of energy conservation?
- 1. Pacing
- 2. Planning
- 3. Prioritizing
- 4. Posture (body mechanics)
- 5. Physical activities
- 6. Practicing the P's
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Education re: Shortness of Breath (SOB) (2)
- Pursed Lip Breathing
- Positioning - support and relax the arms
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Key for stress management?
Identifying it
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Stress management education (7)
- •Physical/Behavioral Coping Skills
- •Physical Activity
- •Yoga and Slow Stretching
- •Healthy Diet
- •Incorporating good sleeping habits into lifestyle
- •Relaxation Exercises (ex. Deep breathing, imagery, progressive muscle relaxation)
- •Cognitive/Mental Coping Strategies (ex. Problem solving, reappraisal, meditation)
- •Personal/Social Coping Skills (ex. Integration of leisure time in lifestyle, explore spirituality, develop hobbies and interests, give to others, implement vacation and rest)
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When going up stairs should you put your stronger or weaker leg first?
- strong leg first
- Going down step with weaker leg
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OT Role in outpatient cardiac rehab
- •Activity guidelines for functional activity/work/play
- •Facilitating independence or return to
- productive role: ADL equipment, community supports, family education
- •Address changes in cognitive function
- •Self management skill building: stress
- management
- •Post op complication management
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To assess the physiological response of
people with no known cardiovascular disease
Exercise stress testing
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When is the exercise stress test stopped?
- •When target HR has been reached
- •Pt. develops symptoms (angina, dizziness,
- dyspnea, leg claudication, marked tiredness (19 on Borg scale)
- •Specific ECG changes (Ex. Arrhythmias)
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What work conditions are not ideal for people
who have HF?
- •Work day lasting more than 8 hours
- •Shift work
- •Working in cold, dust or flames
- •Doing assembly-line work that doesn’t
- allow for short breaks
- •Safety sensitive work
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