OT and Cardiac Patients in Acute Care

This post highlights considerations for OT practice with patients who have a cardiac history or symptoms of cardiac distress.

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Factors Contributing to Heart Disease: What OT should know…

In hospital settings, OTs will frequently work with clients that have a cardiac condition. The American Heart Association (AHA) reports that over 90 million individuals have some form of cardiovascular disease.

In the acute care setting, the OT can provide client with education about modifiable risk factors and provide support to change habits and routines. Individually assessing what is reasonable for each patient is key to success !! Using motivational interviewing can be effective!!

Modifiable risk factors: Smoking, diet, alcohol consumption, low physical activity levels, high blood pressure

Non-Modifiable risk factors: Heredity, age, gender, history of CAD

GENERAL CONSIDERATIONS:

  • It is important to monitor vital signs in patients with a cardiac history. (Don’t know what you are looking for? See previous blog post on monitoring vital signs here)
  • Do not work with patients who have abnormal lab values or uncontrolled arrhythmias (unless you get an MD order and talk with the team about your safety concerns. Get clear parameters from the medical team and proceed slowly if you are asked to proceed with OT)

CONTRAINDICATIONS FOR THERAPY: OT should not continue with OT services if patient has:

  • Active signs/symptoms of heart attack and/or acute heart attack (< 1 day or 2 days after)
  • Active infection
  • Acute myocarditis or pericarditis
  • Digoxin toxicity (patient will present with confusion, irregular pulse,vision changes)
  • Uncontrolled diabetes
  • Recent Pulmonary Embolism
  • Severe Congestive Heart Failure

Commonly experienced cardiac conditions in clients working with OT:

Coronary Artery Disease: narrowing of arteries due to a buildup of plaque. What OT can do:

  • Educate client on symptoms (cramping/pain when walking, chest pain, nausea and vomiting, excessive sweating, fatigue, pallor, cool extremities, and SOB).
  • Implement a gradual HEP to maintain blood flow to vascular system and increase endurance for functional activity.
  • Help client modify personal risk factors through habit change techniques; motivational interviewing can be helpful.

Angina: Chest pains due to narrowed arteries. This pain can be described as squeezing, pressure, tightness in chest, and can also be felt in the neck, jaw, and left arm. What OT can do:

  • Alter activities so that less strain is put on the heart (for example: do activities in seated positions, limit overhead motions).
  • Educate on rest breaks during strenuous activities

Myocardial Infarction: What OT can do:

  • Educate client on symptoms of heart attack (chest pain, nausea/vomiting, fatigue, SOB, perspiration, cool/clammy skin, anxiety, restlessness).
  • Treatment in acute setting focuses on limiting pain and minimizing strain on heart

Cardiomyopathy: diseases of the heart muscle. What OT can do:

  • Educate client on symptoms (trouble breathing, fatigue, swelling in extremities, dizziness, lightheadedness, fainting, arrhythmias, chest pain, heart murmurs),
  • Alter activities to be less strenuous
  • Educate on energy conservation
  • Encourage lifestyle changes–use habit change approach, motivational interviewing.

Arrhythmias: changes in electrical impulse that causes the heart to beat too fast, slowly, or abnormally. What OT can do:

  • Be aware of normal heart rates (normal RHR: 60-100 bpm- see blog on MONITORING CLIENTS) and note any variation in rate during treatment. Ventricular changes are the most significant change to be aware of!

Heart Failure and Congestive Heart Failure: weakening of the heart resulting in insufficient pumping of blood to meet the body’s needs. What OT can do:

  • Educate on contributing conditions (hypertension, damage to heart tissue following a heart attack, valve disease, cardiomyopathy, congenital heart defects)
  • Educate on symptoms (dyspnea, orthopnea, fatigue, exercise intolerance, coughing, hepatomegaly, weight gain, LE edema
  • Alter activities and emphasize lifestyle changes

FINAL CONSIDERATIONS FOR OTs…

  • Psychosocial concerns such as depression, anxiety, and stress negatively impact heart function and OT outcomes in clients with cardiac disease. OT should understand each client individually and note any psychosocial concerns impacting function.
  • In the acute setting, OT’s main role is to improve functioning through education, participation in ADLs, and exercise
  • Education can include any of the following topics:
    • Energy conservation
    • Lifestyle and risk factor modification
    • Client monitoring of body response to activity (measuring vital signs)
    • Enhance stress management (relaxation) and coping skills
    • Improve sleep hygiene and encourage adequate amounts of rest and sleep

Acknowledgement: This blog post would not be possible without the help of Andrea Matanovic, a student in the MOT program at CSU when this was written. She has a passion for acute care and hopes to be working in an acute care setting soon!

References

American Heart Association. (2018). Heart disease and stroke statistics: 2018 update at a glance. Learn and Live. Retrieved August 20, 2018 from https://www.heart.org/-/media/data-import/downloadables/heart-disease-and-stroke-statistics-2018—at-a-glance-ucm_498848.pdf

Smith-Gabai, H. (ed.) (2011). Occupational Therapy in Acute Care. Rockville, MD: American Occupational Therapy Association.

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