584 Cardiac pt. 2

  1. 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
  2. Primary OT goals of Cardiac ICU
    • •Prevent muscle loss and joint contracture
    • while on bed rest
    • •Pressure ulcer prevention 
    • •Seating assessment/recommendations
  3. 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
  4. OT initial assessment
    Previous level of function - 4 areas to consider
    • •Mobility
    • •Functional Activity Endurance
    • •Fall Hx
  5. What precautions do you have to be aware of for open heart surgery patients?
    Sternal precautions/pain
  6. •Sometimes referred to as “acute confusional
    •Occurs in about 21% of post cardiac surgery patients with a mean duration of 2.5 days 
  7. 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
  8. What area of the brain is very sensitive to
    ischemic insult?
  9. Is cognitive impairment common after a CABG?
    Yes, at d/c from hospital 53% have cognitive impairment
  10. How long does post cardiac surgery leg edema last?
    About 6 months
  11. Are compression stockings always appropriate for edema?
    • No, compression is NOT indicated for
    • uncontrolled HF
  12. How long does healing of heart muscle take?
    About 4-8 weeks
  13. •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
  14. 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
  15. 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
  16. What are symptoms of overdoing it? (5)
    • •Angina
    • •Muscle Discomfort
    • •Breathlessness
    • •Fatigue
    • •Lightheadedness
  17. 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
  18. 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
  19. Education re: Shortness of Breath (SOB) (2)
    • Pursed Lip Breathing
    • Positioning - support and relax the arms
  20. Key for stress management?
    Identifying it
  21. 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)
  22. When going up stairs should you put your stronger or weaker leg first?
    • strong leg first
    • Going down step with weaker leg
  23. 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
  24. To assess the physiological response of
    people with no known cardiovascular disease
    Exercise stress testing
  25. 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)
  26. 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
Card Set
584 Cardiac pt. 2
584 Cardiac pt. 2