Conditions - Final Exam - Chapters 17 - 20

Stroke (brain accident, CVA)

an interruption in the blood flow to the brain from either a blocked or ruptured vessel*results in inadequate supply of oxygen and nutrients; brain cells die

Stroke warning signs (FAST)

F - face: sudden unilateral numbness/weakness of faceA - arms: can they lift both armsS - speech: is their speech slurring, can they understand youT - time: call 911 immediately

2 Main types of CVA

1. ischemic2. hemorrhagic

Ischemic strokes

when blood that normally circulates to the brain fails*brain cells die due to the lack of blood supply to the area

3 Types of Ischemic stroke

1. thrombosis2. embolic3. stenosis

Thrombosis (ischemic)

clot in the brain causing obstruction at the point of its formation*atherosclerosis*onset during sleep is common


gradual degenerative disease of blood vessel wallsfatty deposits lead to generation of a thrombus*most common cause of CVA

Large vessel atherosclerosis accounts for __% of ischemic stroke


Lacunar strokes are

small infarcts in deep brain structures such as the basal ganglia, thalamus, pons, internal capsule, and deep white matter. *25% of CVAs

Hemorrhagic strokes include (2)

intracerebral and subarachnoid hemorrhages

Embolism (ischemic)

clot formed elsewhere that breaks off and travels to artery too small *atrial fibrillation, coronary artery disease, cardiac surgery, arrythmias*typically occur during daytime activity

Stenosis (ischemic)

narrowing of vessel wall

Hemorrhagic Stroke

weakened blood vessel within brain ruptures (intracerebral) or bleeding occurs within subarachnoid space (subarachnoid hemorrhage)*fatalities rates higher BUT recovery rate better

T of R: Hemorrhagic strokes are more common in younger people


Intracerebral hemorrhage

bleeding directly into brain irritating tissue, causes swelling, and causes hematoma *hypertension, hemophilia, sickle cell anemia, leukemia, liver disease

Subarachnoid hemorrhage

- 3% of CVAs- 95% occur from aneurysms*congenital and degenerative factors

Transient Ischemic Attack (TIA)

- "Mini stroke"- blood flow blocked for short time (< 5 minutes)- warning sign for future stroke

More than a third of people who have a TIA end up having a major stroke within __year(s) if not followed medically

1 year*10%-15% will have major stroke within 3 months of TIA

The brain makes up __% of the body's weight, receives __% of cardiac output, and consumes __% of the body's oxygen

2%, 17%, 20%

Extracranial anterior circulation of the brain consists of (2)

2 carotid arteriescarotid means: "to stupefy" or render unconscious

CVA Etiology

1. hypertension2. smoking3. waist-to-hip ratio4. diet risk score5. regular physical activity6. diabetes7. alcohol intake8. physiological stress9. cardiac problems10. age11. herediy12. TIAs13. oral contraceptives14. geographic location15. infections/inflammation

Extracranial posterior circulation of the brain consists of

vertebral artieries

T or F: ischemic stroke is the second most common type of CVA

FALSE; 88% are ischemic

CVA is the __ leading cause of death in the U.S.


CVA kills nearly ___,___ Americans each year or __ in 20 deaths

130,000; 1

T or F: CVA is the most common cause of disability


T or F: CVA is the 3rd most common widespread diagnosis among clients seen by OTs for treating the physically disabled

FALSE; it is the MOST common

Childhood CVA incidence is __ to __ per 100,000 children annually

5 to 8

Seizures develop in up to __% of patients with CVA and are more common with _______than _______ infarcts

10%; embolic; thrombotic

Alteration of swallowing function, aspiration, hypoventilation, and immobility in the patient with CVA often lead to ________


Characteristics of a R. CVA

- speed/time distortion- left neglect- emotionally labile- poor body awareness- L hemiplegia- short attention span- distractibility- loss of numerical concepts- very impulsive- lethargy*poor insight into impairment; high safety concern

Characteristics of a L. CVA

- aphasia (Broca's, Wernicke's)- apraxia- initiation difficulty- bilateral perceptual issues- low verbal- inappropriate use of objects- perserveration- difficulty with new learning- R hemiplegia- may not be reliable with yes/no

Subclavian Steal Syndrome

rare condition in which subclavian artery is narrowedarm movement on side of narrowed vessel causes light-headedness, numbness, and weakness*blood is "stolen" from the brain and delivered to arm

CVA Course & Prognosis

Difficult to predict because individual variability of anatomy and extent of brain damage*recovery of function greater in younger patients due to plasticity

CVA Diagnosis

- CT: differentiates b/t hemorragic and ischemic- MRI: better than CT- PET: oxygen and glucose use of brain; used experimentally - Duplex sonography: carotid, subclavian, and vertebral arteries- cerebral angiography: injecting dye - ECG

CVA Management

1. Antiplatelet therapy: aspirin (ischemic)2. Anticoagulant: clot inhibition ( heparin, warfarin)3. Thrombolytics (tPA): dissolve thrombus, early intervention4. Surgery: carotid endarterectomy (CEA), stenting, surgical clipping (aneurysm)5. Treating secondary effects: edema (corticosteroids)

CVA Impacts on Occupational Performance


CVA Impact on Sensory Functions


CVA Impacts on Motor Functions

- muscle tone (hyper/hypotonus)- hemiplegia- painful shoulder- shoulder subluxation- abnormal reflexes- orofacial weakness

CVA Impacts on Mental Functions


CVA Impacts on Emotional Functions

1. affective mood disorders (depression, anxiety)2. behavioral & personality (anger, irritability, apathy, sexual changes, OCD)3. cognitive & behavioral disintegration (confusion, delirium)4. perception-identify disorders: of self or others

Cardiopulmonary System consists of

the lungs & heart and their interconnections

The _____ lung contains three lobes and is larger than the ____ lung

right; left

Cardiopulmonary vital signs measure (5)

1. cardiac pulse rate2. respiratory rate3. blood pressure4. oxygen saturation5. temperature

Normal Pulse Rate

60 - 100 BPM


< 60 BPM


> 100 BPM

Atrial Fibrillation

irregular, rapid heart rate that can lead to poor blood flow to the body

Normal Respiratory Rate

15 to 20 breaths per minute

Normal Blood Pressure

- adults: <120/80 mmHg

Normal Oxygen Saturation

95% to 100%


< 90% oxygen saturation

Cardiopulmonary Artery Disease (CAD) - Description/Definition


Cardiopulmonary Artery Disease - Etiology

combination of lifestyle choices and genetics- smoking, high cholesterol, high bp, diabetes, obesity, sedentary lifestyle*begins with damage to the inner layer of a coronary artery

Cardiopulmonary Artery Disease - Incidence and Prevalance

- leading cause of death for both men and women- most common type of heart disease in U.S. - > 370,000 die per year

Cardiopulmonary Artery Disease - Signs & Symptoms


Cardiopulmonary Artery Disease - Course & Prognosis


Cardiopulmonary Artery Disease - Management: Lifestyle Changes


Cardiopulmonary Artery Disease - Management: Medication


Cardiopulmonary Artery Disease - Management: Surgery


Angioplasty (CAD)

a catheter with a deflated balloon is inserted into the blocked artery, inflated to open up


Following angioplasty, metal mesh tube is inserted into the narrowed artery*some release medicine to keep artery open

Coronary artery bypass graft (CABG)

arteries or veins from other body parts are removed and attached to bypass blocked arteries in heart*often from leg

Sternal precautions following heart surgery

- no pushing- no pulling- or lifting anything more than 5 to 10 lbs

Congestive Heart Failure (CHF) - Description/Definition


Congestive Heart Failure (CHF) - Etiology


Congestive Heart Failure (CHF) - Incidence/Prevalence

- > 5.1 million Americans with CHF- most common reason those 65+ go into the hospital*2009: 1 in 9 deaths due to CHF

Congestive Heart Failure (CHF) - Signs/Symptoms

- dyspnea- angina- arrhythmias- coughin- wheezing- weigh gain (fluid retention)-> edema- ascites- frequent urination at night

Congestive Heart Failure (CHF) - Course/Prognosis

- requires life-long management- slowly progresses depriving body of oxygen*about 50% who develop CHF die within 5 years

Congestive Heart Failure (CHF) - Management


Chronic Obstructive Pulmonary Disease (COPD) - Definition/Description


Emphysema (COPD)


Bronchitis (COPD)


Chronic Obstructive Pulmonary Disease (COPD) - Etiology


Chronic Obstructive Pulmonary Disease (COPD) - Incidence/Prevalence

- 3rd leading cause of death in U.S. - 15 million Americans diagnosed- affects all ages but-> 65+ highest rate- 2011: women had more emphysema; men chronic bronchitis

Chronic Obstructive Pulmonary Disease (COPD) - Signs/Symptoms



bluish-colored skin (especially lips, nails) due to decreased oxygen levels


1. 51% report limited work ability2. 70% report normal physical exertion3. 53% report social activities4. 50% report sleep5. 46% report family activities

Chronic Obstructive Pulmonary Disease (COPD) - Course/Prognosis


Chronic Obstructive Pulmonary Disease (COPD) - Management

spirometry test to assess- smoke cessation- bronchodilators (inhalers)- steroids- antibiotics- oxygen therapy- medication

Cardiopulmonary OT Implications

- assessing one's ability to safely complete ADLs- education on energy conservation- strenghtening exercises- endurance training

Myocardial Infarction (MI) - Definition/Description

A.K.A. Heart Attack- severely reduced blood flow to heart cutting off oxygen

Leading cause of MI


Myocardial Infarction (MI) - Etiology


Myocardial Infarction (MI) - Incidence/Prevalence

every 34 seconds an MI occurs in the U.S.

Every year, about ___,___ Americans are diagnosed with MI


Myocardial Infarction (MI) - Signs/Symptoms


Myocardial Infarction (MI) - Course/Prognosis


Myocardial Infarction (MI) - Management


Hypertension - Definition/Description

2: Primary, Secondaryhigh blood pressure: increased amount of force that is pushed against artery walls

Primary Hypertension

no identifiable cause and tends to develop gradually over years

Secondary Hypertension

- caused by underlying condition- sudden onset- causes higher blood pressure than primary*kidney, thyroid, adrenal gland problems; congenital blood vessel defects, medications, illegal drugs, chronic alcohol use, sleep apnea

Hypertension - Incidence/Prevalence

- 1 in 3 Americans have hypertension- most common in African American women- older populations

Hypertension - Signs/Symptoms

Often asymptomatic- dull headaches- dizzy spells- increased nose bleeds- SOB

Hypertension - Course/Prognosis


Hypertension - Management


Cardiopulmonary Disorder - Impact on Occupational Performance


Diabetes Mellitus - Description/Definitions

- group of metabolic conditions characterized by malfunction of the body's ability to make and use insulin, or a combination


- hormone produced by pancreas- regulates glucose metabolism-> transports glucose into body's cells for growth and energy


buildup of glucose in the bloodstream

Without insulin to transport glucose, the body breaks down its own fat and lipids creating a byproduct called _______


A life-threatening acutely ill state associated with the onset of Type I Diabetes

Diabetic ketoacidosis

Type I Diabetes

Formerly known as insulin-dependent, juvenile-onset diabetes- complete insulin deficiency and requires insulin replacement for survival

Diabetic ketoacidosis signs


Type I Diabetes is more frequent in children or adults?


Type I Diabetes accounts for __% to __% of people with diabetes

5%; 10%

Type II Diabetes

Formerly known as non-insulin dependent, adult onset- pancreas secretes insulin but resistance is present and amount of insulin may be insufficient*results in chronic state of hyperglycemia

Type II Diabetes accounts for __% to __% of all diabetes cases

90%; 95%*more common with increased age, those who are obese

Gestational Diabetes


Women with gestational diabetes are ___ times more likely to develop type II diabetes in the future


Maturity-onset Diabetes of The Young (MODY)

- presents in those before age 25- hyperglycemia due to impaired insulin secretion

Neonatal Diabetes

appears in first 6 months of life and may be transient


people in intermediate zone b/t normal blood glucose and diabetespresent with impaired fasting glucose (100 to 125 mg/dL)impaired glucose tolerance levels (140 to 199 mg/dL)*at risk for developing actual diabetes

Type I Diabetes - Etiology

formed by autoimmune response: antibodies destroy pancreatic insulin-producing cells (beta cells)- genetic factors- environmental factors (infections, infant diet, microbial toxins)*infant ingestion of cow's milk, short duration of breastfeeding

Type II Diabetes - Etiology

- LARGELY genetics- age- obesity- sedentary lifestyle*body fat distribution; abdominal fat higher risk

Diabetes - Children & Adolescent Incidence

- 22 per 1,000- non-Hispanic white youth highest rate of newly diagnosed cases

Diabetes - Adult Incidence

- 2012: 1.7 million new cases were diagnosed (age 20+)- majority aged 45 - 64*African Americans, Hispanic, and Asian Americans are 2 to 3 times more likely than Caucasians

Diabetes - Prevalence

29.1 million (9.3%) of Americans

Type I Diabetes - Prevalence


T or F: Type I Diabetes is more prevalent in males

FALSE; equal

Type II - Prevalence


T or F: Type II Diabetes is slightly higher for men than women

TRUE; 10.% male, 7.6% female

Type I Diabetes - Signs/Symptoms

Hyperglycemia related:- polydipsia (thirsty)- polyuria (pee a lot)- polyphagia (increased hunger)additional symptoms:- muscle cramps- abdominal apain- irritability- emotional lability- headaches- anxiety attacks- diarrhea- constipation*ketonuria

Type II Diabetes- Signs/Symptoms


Diabetes - Course/Prognosis




Peripheral Artery Disease (PAD)

decreased arterial blood flow to: - extremities- stomach- kidneys*intermittent claudication: pain or discomfort during walking)*resting pain

Diabetic Retinopathy

Damage to the eye via: - macular edema- vessel hemorrhage- retinal detachment- neovascular glaucoma*visual impairment

Diabetic Nephropathy

Structural/function kidney changes resulting in nonfunctioning kidneys

T or F: Diabetes is the leading cause of end-stage renal disease (ESRD)

TRUE; 20% to 40% of those with diabetes are diagnosed with kidney disease

Diabetic Peripheral Neuropathy

Nerve damage causing numbness, loss of sensation, and pain of extremities*50% of those with diabetes have this

Diabetic Autonomic Neuropathy

Organ systems:- cardiovascular (tachycardia, orthostatic hypotension)- gastrointestinal (increase/decrease gastric motility)- genitourinary (bladder dysfunction)*erectile dysfunction common

Diabetic Foot

autonomic neuropathy -> dry/cracked skin -> foot ulcers, infection -> possible amputation*males more at risk* animicrobial therapy, debridement

Periodontal disease

bidirectional relationship with diabetes

Diabetes HBA1c value


Prediabetes HBA1c value

5.7% - 6.4%

Diabetes Fasting Plasma Glucose value (FPG)

> 126 mg/dL

Prediabetes Fasting Plasma Glucose value (FPG)

100 - 125 mg/dL

Type I Diabetes - Management

- insulin replacement- glycemic control- pancreatic transplants*diet/exercise, diet education**self-monitor blood glucose levels

Type I Diabetes - Nutrition Management


Those with Type I Diabetes should engage in __ minutes of physical activity per day

60 minutes*monitor glucose levels/food intake accordingly

Type II Diabetes - Management


Diabetes - Impact on Client Factors/Occupational Performance


Nocturia (diabetes)

nighttime urination

Traumatic Brain Injury (TBI) - is defined by

a mild, moderate, or severe brain trauma with specific characteristics that include at least one of these:- loss of consciousness- posttraumatic amnesia- disorientation- confusion- neurological signs (severe)*must present immediately after brain injury*persist past acute period

(TBI) The extent of disability is typically identified within __ hours of medical evaluation and based on ____ __ _____________ or ____

48 hours; loss of consciousness; coma

Mild TBI

- loss of consciousness: <30 minutes- posttraumatic amnesia: <24 hourss*Glascow Coma Scale score: 13 to 15

Moderate TBI

- loss of consciousness: 30 minutes to 24 hours- posttraumatic amnesia: 24 hrs to 7 days*Glascow Coma Scale score: 9 to 12

Severe TBI

- loss consciousness: > 24 hours- posttraumatic amnesia: > 7 days*Glascow Coma Scale score: 3 to 8

Mild TBI represents __% of all brain injury

80%*85% will recover without intervention within 3 months

**3 Leading Causes of TBI**

1. falls2. motor vehicle accidents3. violence*falls most common*MVAs most common for severe TBI

Most commonly seen groups with TBI in hospital emergency department

- < 5 y/o- > 85 y/o

Males are responsible for __% of of all motor vehicles


(TBI) Persons intoxicated when injured tend to be

1. hospitalized longer2. more severely injured3. higher chance of death4. lower cognitive status post-discharge

Frequent medical complication of moderate to severe TBI


Most common medical complication following TBI


Dysautonomia (TBI)

ANS disorder characterized by:- hypertension- tachycardia- increased body temp- profuse sweating

*Neurobehavioral deficits from TBI* (7)

1. impulsivity2. perserveration3. irritability4. poor temper5. aggression6. disinhibition7. apathy

_______ ____-_________ or a lack of ______ may slow TBI rehabilitation progress

limited self-awareness; insight

(TBI) Increased awareness of their deficits coupled with decreased academic achievement may lead to ________ in ________

Depression; children

T or F? (TBI) Suicide rates are 2.7 to 4.1 times more likely


T or F? Perceptual deficits are more common than visual in those with TBI

FALSE; visual more common

**TBI Visual impairments**

1. diplopia2. accommodation deficits3. convergence deficits4. saccadic dysfunction5. strabismus6. visual field deficits

Level of Cognitive Functioning Scale (LCFS) - Level I


Level of Cognitive Functioning Scale (LCFS) - Level II


Level of Cognitive Functioning Scale (LCFS) - Level III


Level of Cognitive Functioning Scale (LCFS) - Level IV


Level of Cognitive Functioning Scale (LCFS) - Level V


Level of Cognitive Functioning Scale (LCFS) - Level VI


Level of Cognitive Functioning Scale (LCFS) - Level VII


Level of Cognitive Functioning Scale (LCFS) - Level VIII