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Principles of Intervention for Cardiovascular and Pulmonary Conditions Lecture Guide Principles of InterventionMedical ManagementUnderstanding the effects of drugs used to treat specific heart diseases is extremely important. Medical Management of symptoms caused by cardiac disease focuses primarily on reducing oxygen demand and increasing oxygen supply. Principles of Intervention Cont. Medical Management of symptoms caused by pulmonary disease focuses primarily on promoting bronchodilation and decreasing inflammation. Pulmonary drugs can have adverse effects such as alteration of heart function, nervousness, muscle tremor, headache, anxiety, sweating, and insomnia. Surgical ManagementCoronary Artery Bypass Graft (CABG) and PCI are used to improve coronary. In PCI a catheter is placed through an artery in the leg and then positioned in the coronary vessel blocked by arteriosclerotic plaque. A balloon is inflated, or a procedure using laser light, or a blade is used to destroy the plaque. CABG requires surgically opening the chest wall and grafting a small artery or a leg vein from the aorta to a point beyond the blockage or plaque. This technique bypasses the blockage and thereby reestablishes blood flow to the heart. Surgical Management Cont. Surgical intervention is also required for inserting a A cardiac pacemaker is an electronic device that produces a pulse to control heart depolarization. It replaces the. Done to control severe cardiac arrhythmias. Electrodes can be inserted through a vein in the arm up to the heart. When a pacemaker is present the PT must monitor the patient closely during exercise. Surgical Management Cont. Surgical management is not as frequently used for common diseases. If there is it is for removal of malignant and benign tumors, fungal infections, cysts, tuberculosis, fistulas, or bronchiectasis.When the chest wall is opened, the patient generally must be connected to a machine that breathes for the patient and in the case of heart surgery, a machine that pumps blood. Physical Therapy Cardiac Rehabilitation Proceduresis responsible for appropriate level of intensity, duration, frequency, and type of exercise. After cardiothoracic surgery, upper extremity lifting and ROM exercises should be restricted for 5 to 8 weeks. Factors Influencing Recovery after Chest SurgeryPreoperative FactorsFactors during OperationPostoperative FactorsUnderlying Pulmonary or heart diseasePulmonary collapse and hypoxemiaPostoperative FactorsDirect Trauma to heart or lungsAtelectasis (collapse of Alveoli)Heart ArrhythmiasNarcotics to suppress painDanger of emboli (clots) in lungsPain and weaknessPhysical Therapy Cardiac Rehabilitation ProceduresThe inpatient stage is often referred to as Phase 1 (acute), whereas the outpatient stage is generally broken down into phase 2 (subacute), Phase 3 (intensive rehabilitation) and Phase 4 (ongoing rehabilitation). Inpatient activities include self care activities, arm and leg ROM, postural/position changes, and Physical Therapy Cardiac Rehabilitation Procedures Cont. The early stages of outpatient rehabilitation (Phase 2) are performed under supervision and monitored closely. Patient will attend training sessions a week for 10-12 weeks. A stress test will be performed to help determine whether the patient has improved. Physical Therapy Cardiac Rehabilitation Procedures Cont. Progression to Phases 3 and 4 involves the individual being able to (1) self monitor the exercise program, (2) have no contraindications to exercise, and (3) be emotionally stable. Outpatient Phases emphasize aerobic training . Appropriate aerobic training involves a warm up period, a peak period, and a cool down period. Warm up and cool down phases should be at least 5-10 minutes each. Peak period should last minutes. Physical Therapy Cardiac Rehabilitation Procedures Cont. Several Techniques for quantifying exercise intensity including heart rate reserve and RPE is a subjective report from the patient that indicates how hard he feels their body is working. Physical Therapy Cardiac Rehabilitation Procedures Cont. In the heart reserve method, a target heart rate (THR) is calculated by subtracting the heart rate at rest from the maximum heart rate, multiplying that value by the intensity desired, and adding the product to the heart rate at rest. 220-age=THR is used to establish a person’s training zone, or the minimum and maximum heart rates that must be achieved to produce an aerobic training effect. To produce a training effect or a change in aerobic capacity, this individual would have to reach a HR in the established training zone. This type of exercise must allow for aerobic performance, which included rhythmic contraction of large muscle groups over several minutes (20-60) minutes. PT must continuously monitor heart rate, , and respiratory rate. PT Pulmonary Rehabilitation ProceduresPT treatment for patients with pulmonary disease include techniques for secretion removal, respiratory, muscle training and breathing, and energy conversation. For obstructive pulmonary disease is performed (postural drainage). The patient is placed in a certain position to passively drain fluid from a specific portion of the lung. The therapist applies percussion, vibration, and shaking, to specific areas of the chest wall overlying specific lobes of the lung.Percussion promotes movement of mucous through the bronchiole tubes. Positions for performing Postural Drainage to remove secretions from the lungsPT Pulmonary Rehabilitation Procedures Cont. Producing a good cough is essential for maintain normal lung function.PT can help the patient enhance coughing in three ways: 1. By strengthening both the primary and secondary muscles of ventilation. 2. 3. By teaching the patient how to use different devices to support the chest wall so that the expiration force generated during coughing is enhanced. The Well Individual The well individual (person without a diagnosis of any cardiovascular or pulmonary disease). PT’s have a responsibility to implement Proper nutrition, regular exercise, weight control, blood pressure control, cholesterol management, and smoking avoidance are all modifiable risk factors. As a person grows older, their maximum Heart rate ................
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