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PHYSDYS
Cardiopulmonary conditions (Respiratory)
| Term | Definition | Definition 2 | Definition 3 | Appropriate | Inappropriate | Activities of Daily Living | DL, Work, Play & Leisure |
|---|---|---|---|---|---|---|---|
| CHRONIC LUNG DISEASE | ● Chronic Obstructive Pulmonary Disease ● Emphysema ● Inflammation, fibrosis (thickening of the connective tissue), and narrowing of the terminal airways of the lungs ● Chronic Bronchitis | ● Asthma | |||||
| Chronic Obstructive Pulmonary Disease | ○ Is characterized by “damage to the alveolar wall and inflammation of the conducting airways”2 and includes emphysema, peripheral airway disease, and chronic bronchitis ○ Progressive chronic disease with insidious onset | ||||||
| Emphysema | ○ condition in which the alveoli become enlarged or ruptured, usually because of a restriction during expiration or a decrease in elasticity of the lungs | ||||||
| Inflammation, fibrosis (thickening of the connective tissue), and narrowing of the terminal airways of the lungs | ○ Physiologic changes with peripheral airway disease ○ Coughing and spitting mucus | ||||||
| Chronic Bronchitis | ○ diagnosed after a 2-year period of repeated episodes, lasting longer than 3 months, of mucus producing cough of unknown origin | ○ Related to history of cigarette smoking ○ Clinical manifestations of the disease increase as the pack-year history increases | |||||
| Asthma | ○ irritability of the bronchotracheal tree and is typically episodic in onset ○ experience wheezing and shortness of breath that may resolve spontaneously or necessitate the use of medication for calming the airway | ||||||
| Allergenic causes of asthma | - may include pollen and respiratory irritants such as perfume, dust, and cleaning agents | ||||||
| Bronchospasm | - occurring with exposure to cold air or induced by exercise is sometimes the first clinical manifestations of asthma | ||||||
| Pulmonary risk factors | ● Cigarette smoking as primary cause of COPD | ● Other environmental irritants, such as air pollution, chemical exposure, and dust, are contributory risk factors in the development of COPD and asthma. | |||||
| Smoking cessation | - will slow the progression of disability in persons with COPD | ||||||
| Cigarette smoke | - as a causative agent in asthmatic episodes | ||||||
| Medical management | ● Patient’s medical history and symptoms and performing a physical examination, x-ray and blood tests ● Assess the patient’s history of smoking and occupational exposure to respiratory irritants | ● Medications prescribed for persons with pulmonary disease include ● Persons in acute respiratory distress may initially be managed with a ventilator before being weaned to oxygen. | ● When a patient’s endurance decreases sufficiently to impair performance of ADLs, the physician may refer the patient to OT | ||||
| anti-inflammatory agents | (e.g., steroids and cromolyn sodium) | ||||||
| bronchodilators | (e.g., albuterol and theophylline) | ||||||
| to help open the airway, and expectorants | (e.g., iodides and guaifenesin) to help loosen and clear mucus | ||||||
| Signs and symptoms of respiratory distress; Dyspnea | - probably the most obvious sign of a breathing difficulty | ||||||
| Severe dyspnea | - Pt is short of breath even at rest ○ Unable to utter a short phrase without gasping for air | ||||||
| Signs that the body is not getting enough oxygen | - include extreme fatigue, a nonproductive cough, confusion, impaired judgment, and cyanosis | ||||||
| PSYCHOSOCIAL CONSIDERATIONS | ● Persons with anxiety and depression are more inclined to experience relapses after initial emergency department visits ● Other patients with COPD complain of faintness or difficulty concentrating | ● Training in progressive muscle relaxation can be a successful tool for controlling the dyspnea and anxiety and for lowering the HR | ● OT Role: Encouraging the patient to engage in activities that will develop his or her skills and promoting resumption of occupations that bring value, meaning, and participation back into the patient’s life | ||||
| Pulmonary Rehabilitation Goal | Stabilize or reverse the disease process and return the patient’s function and participation in activity/occupation to the highest capacity | ||||||
| Intervention techniques; Dyspnea Control Postures | In a seated position, the patient bends forward slightly at the waist while supporting the upper part of the body by leaning the forearms on a table or the thighs | In a standing position, relief may be obtained by leaning forward and propping oneself on a counter or shopping cart. | |||||
| Intervention techniques; Pursed Lip Breathing | ○ prevent tightness in the airway by providing resistance to expiration ○ increase use of the diaphragm and decrease accessory muscle recruitment | Instructions: ■ 1. Purse the lips as if to whistle. ■ 2. Slowly exhale through pursed lips. Some resistance should be felt. ■ 3. Inhale deeply through the nose. ■ 4. It should take twice as long to exhale as it does to inhale. | |||||
| Intervention techniques; | ○ increased use of the diaphragm to improve chest volume ○ placing a small paperback novel on the abdomen just below the xiphoid process (base of the sternum or breastbone) | ○ The patient lies supine and is instructed to inhale slowly and make the book rise. ○ Exhalation through pursed lips should cause the book to fall. | |||||
| Intervention techniques; | ○ effective in decreasing anxiety and controlling shortness of breath | ○ One technique involves tensing muscle groups while slowly inhaling and then relaxing the muscle groups while exhaling twice as slowly through pursed lips. It is helpful to teach the patient a sequence of muscle groups to tense and relax | ○ One common sequence involves tensing and relaxing first the face; followed by the face and the neck; then the face, neck, and shoulders; and so on, down the body to the toes. | ||||
| Intervention techniques; Other Treatments and Consideration | ○ PTs - chest expansion exercises ○ Percussion and postural drainage use gravity and gentle drumming on the patient’s back | ○ Isometrically contracting the arms and hands while they are placed on the patient’s thorax, the therapist may transmit vibration to the patient | ○ Consider environmental factors such as humidity, pollution, extremes of temperature, and stagnant air when planning activity | ||||
| Percussion and postural drainage | ■ contraindicated in acutely ill patients and those who are medically unstable | ||||||
| EVALUATION | ● Review of medical record ● Patient interview ● Clinical Evaluation | ||||||
| EVALUATION; Patient interview | ○ The therapist should observe the patient for signs of anxiety, shortness of breath, confusion, difficulty comprehending, fatigue, abnormal posture, reduced endurance, reduced ability to move, and stressful family dynamics | ○ Asking patients to describe a typical day, to identify activities that bring on shortness of breath or angina, and to tell how their physical limitations interfere with their activities or occupations | |||||
| EVALUATION; Clinical Evaluation | ○ establish the patient’s present functional ability and limitations ○ Clients with impairments in the cardiovascular system will require monitoring of HR, BP, signs and symptoms of cardiac distress | ||||||
| Cardiovascular Response to Activity ● Heart Rate (HR) | Increases with activity to no more than 20 beats/min above the resting heart rate | HR more than 20 beats/min above the resting heart rate (RHR) with activity, RHR ≥120, HR drops or does not rise with activity Blood pressure (BP) | |||||
| Cardiovascular Response to Activity ● Blood Pressure (BP) | Systolic blood pressure (SBP) rises with activity | SBP ≥220 mm Hg postural hypotension (<10-20-mm Hg drop in SBP, decrease in SBP with activity | |||||
| Cardiovascular Response to Activity ● Signs and Symptoms | Absence of adverse symptoms | Excessive shortness of breath, angina, nausea and vomiting, excessive sweating, extreme fatigue (RPE 215), cerebral symptoms | |||||
| Intervention | ● Client goals, present clinical status, recent occupational performance history, response to current activities and occupations, and prognosis all help guide the progression of intervention for persons with cardiovascular or respiratory impairment | ● Energy costs of an activity or occupation and the factors that influence energy costs can further guide the clinician in the safe progression of activity or participation in occupation. | |||||
| Basal Metabolic Equivalent Table of Self-care and Homemaking Tasks ● MET Level 1-2 | Eating, seated; transfers, bed to chair; washing face and hands; brushing hair; walking 1 mph | Hand sewing; machine sewing; sweeping floors; driving automatic car, drawing, knittings | |||||
| Basal Metabolic Equivalent Table of Self-care and Homemaking Tasks ● MET Level 2-3 | Seated sponge bath, standing sponge bath, dressing and undressing, seated warm shower, walking 2-3 mph, wheelchair propulsion 1.2 mph | Dusting, kneading dough, hand-washing small items, using electric vacuum, preparing a meal, washing dishes, golfing | |||||
| Basal Metabolic Equivalent Table of Self-care and Homemaking Tasks ● MET Level 3-4 | Standing shower, warm ; bowel movement on toilet; climbing stairs at 24 ft/min | Making a bed, sweeping, mopping, gardening | |||||
| Basal Metabolic Equivalent Table of Self-care and Homemaking Tasks ● MET Level 4-5 | Hot shower, bowel movement on bedpan, sexual intercourse | Changing bed linen : gardening, raking, weeding; rollerskating; swimming 20 yards/min | |||||
| Basal Metabolic Equivalent Table of Self-care and Homemaking Tasks ● MET Level 5-6 | Sexual intercourse, walking up stairs at 30 feet/ min | Biking 10 mph on level ground | |||||
| Basal Metabolic Equivalent Table of Self-care and Homemaking Tasks ● MET Level 6-7 | Walking with braces and crutches | Swimming breaststroke; skiing, playing basketball, walking 5 mph, shoveling snow, spading soil | |||||
| Intervention; Energy Conservation and Work Simplification | ○ When pts are taught methods to conserve their energy resources, they will be able to perform at a higher functional level w/o expending more energy | ○ UE activity has also been shown to require greater cardiovascular output than LE activity, and standing activity requires more energy than seated activity | ○ A skilled clinician can suggest modifications in activity that will decrease the amount of energy needed for the task ○ The most important part of educating the client is incorporating his or her active involvement in planning the day | ||||
| Intervention; Lifestyle Modification | ○ Key component in improving cardiovascular health | ○ Exercise education should include the benefits of exercise; a graded program of increased activity and participation in occupation; stretching, strengthening, and aerobic activity; guidelines for monitoring HR, BP, and rate of perceived exertion; | cool down; safety issues related to clothing, environmental factors, and warning signs | ||||
| Intervention; Patient and Family Education | Instruct the patient and family members in cardiac or pulmonary anatomy, the disease process, management of symptoms, risk factors, diet, exercise, and energy conservation and must reinforce the teaching |
Created by:
avemaria