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
Atherosclerosis
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
60%
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
TRUE
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.
4th
CVA kills nearly ___,___ Americans each year or __ in 20 deaths
130,000; 1
T or F: CVA is the most common cause of disability
TRUE
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 ________
pnemonia
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
#NAME?
CVA Impact on Sensory Functions
#NAME?
CVA Impacts on Motor Functions
- muscle tone (hyper/hypotonus)- hemiplegia- painful shoulder- shoulder subluxation- abnormal reflexes- orofacial weakness
CVA Impacts on Mental Functions
#NAME?
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
Bradycardia
< 60 BPM
Tachycardia
> 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%
Hypoxemia
< 90% oxygen saturation
Cardiopulmonary Artery Disease (CAD) - Description/Definition
#NAME?
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
#NAME?
Cardiopulmonary Artery Disease - Course & Prognosis
#NAME?
Cardiopulmonary Artery Disease - Management: Lifestyle Changes
#NAME?
Cardiopulmonary Artery Disease - Management: Medication
#NAME?
Cardiopulmonary Artery Disease - Management: Surgery
#NAME?
Angioplasty (CAD)
a catheter with a deflated balloon is inserted into the blocked artery, inflated to open up
Stenting
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
#NAME?
Congestive Heart Failure (CHF) - Etiology
#NAME?
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
#NAME?
Chronic Obstructive Pulmonary Disease (COPD) - Definition/Description
#NAME?
Emphysema (COPD)
#NAME?
Bronchitis (COPD)
#NAME?
Chronic Obstructive Pulmonary Disease (COPD) - Etiology
#NAME?
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
#NAME?
Cyanosis
bluish-colored skin (especially lips, nails) due to decreased oxygen levels
COPD and ADLs
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
#NAME?
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
atherosclerosis
Myocardial Infarction (MI) - Etiology
#NAME?
Myocardial Infarction (MI) - Incidence/Prevalence
every 34 seconds an MI occurs in the U.S.
Every year, about ___,___ Americans are diagnosed with MI
735,000
Myocardial Infarction (MI) - Signs/Symptoms
#NAME?
Myocardial Infarction (MI) - Course/Prognosis
#NAME?
Myocardial Infarction (MI) - Management
#NAME?
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
#NAME?
Hypertension - Management
#NAME?
Cardiopulmonary Disorder - Impact on Occupational Performance
ALL DOMAINS*safety
Diabetes Mellitus - Description/Definitions
- group of metabolic conditions characterized by malfunction of the body's ability to make and use insulin, or a combination
Insulin
- hormone produced by pancreas- regulates glucose metabolism-> transports glucose into body's cells for growth and energy
Hyperglycemia
buildup of glucose in the bloodstream
Without insulin to transport glucose, the body breaks down its own fat and lipids creating a byproduct called _______
ketones
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
#NAME?
Type I Diabetes is more frequent in children or adults?
children
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
#NAME?
Women with gestational diabetes are ___ times more likely to develop type II diabetes in the future
7
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
Prediabetes
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
#NAME?
T or F: Type I Diabetes is more prevalent in males
FALSE; equal
Type II - Prevalence
#NAME?
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
#NAME?
Diabetes - Course/Prognosis
#NAME?
Hypoglycemia
#NAME?
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
>6.5%
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
#NAME?
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
#NAME?
Diabetes - Impact on Client Factors/Occupational Performance
#NAME?
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
61%
(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
seizures
Most common medical complication following TBI
#NAME?
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
TRUE
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
#NAME?
Level of Cognitive Functioning Scale (LCFS) - Level II
#NAME?
Level of Cognitive Functioning Scale (LCFS) - Level III
#NAME?
Level of Cognitive Functioning Scale (LCFS) - Level IV
#NAME?
Level of Cognitive Functioning Scale (LCFS) - Level V
#NAME?
Level of Cognitive Functioning Scale (LCFS) - Level VI
#NAME?
Level of Cognitive Functioning Scale (LCFS) - Level VII
#NAME?
Level of Cognitive Functioning Scale (LCFS) - Level VIII
#NAME?