Cardiopulmonary Conditions
I. Heart conditions (Huntley, 2014; see also Matthews, 2013, pp. 1210–1211; Smith-Gabai
& Holm, 2017)
A. Heart disease risk factors
1. Not controllable: age, sex, family history
2. Controllable: smoking, high lipids, high cholesterol, hypertension, obesity, diabetes, mental
stress, lack of exercise
B. Heart diagnoses (Huntley, 2014, pp. 1301–1305)
1. Myocardial infarction
2. Coronary artery disease and angina pectoris
a. Occupational therapy intervention: sternal precautions and home program guidelines
3. Congestive heart failure
4. Cardiomyopathies
C. Treatment (Huntley, 2014, pp. 1301–1305)
1. Surgery
a. Open heart surgery: types include coronary artery bypass graft and valve replacement
b. Angioplasty
c. Atherectomy
2. Medication
3. Lifestyle change
D. Risk factors for heart disease (Huntley, 2014, pp. 1308–1309)
1. Not controllable:
a. Age
b. Family history
c. Gender
2. Controllable:
a. Smoking
b. Hyperlipidemia
c. Hypertension
d. Sedentary lifestyle
e. Obesity
f. Diabetes
g. Stress
E. Cardiac rehabilitation (Huntley, 2014, pp. 1305–1314)
1. Inpatient: Phase 1 of occupational therapy intervention
a. Monitoring of electrocardiogram, blood pressure, and pulse
b. Clinical pathway: checklist of therapy treatment for a particular diagnosis; variances from
the list are recorded.
c. Progression of ADLs and activity according to metabolic equivalent (MET) levels
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d. Monitoring of symptoms of activity intolerance
e. Development of a home program describing activity guidelines, pacing and simplification of
activities, temperature precautions, social and sexual activity guidelines, risk factors, and
symptoms of activity intolerance
2. Outpatient: Phase 2 of occupational therapy intervention
a. Occupational therapy 3 days a week for 4–8 weeks
b. Exercise and activity to tolerance with progression of MET levels
c. Weight training at 2–4 weeks if symptoms are controlled
d. Education in risk factor modification
e. Evaluation for psychosocial issues and referral if indicated
f. Work hardening if indicated
3. Community: Phase 3 of occupational therapy intervention
a. Physician referral
b. Stress test
c. Continuation of Phase 2 activities and progress as tolerated, with less therapy supervision
and in community settings
II. Respiratory conditions (Huntley, 2014; see also Matthews, 2013, pp. 1210–1211;
Smith-Gabai & Schmitz, 2017)
A. Diagnoses
1. Chronic obstructive pulmonary disease: condition with damage to the alveolar wall and
inflammation of the conducting airways
2. Emphysema: condition in which alveoli rupture or enlarge, lungs lose elasticity
3. Chronic bronchitis: long-term inflammation of the bronchioles with dyspnea
B. Symptoms: dyspnea, fatigue, cough, sputum production, decreased nutrition, anxiety,
depression (Huntley, 2014, pp. 1315–1317)
C. Occupational therapy evaluation
1.
2.
3.
4.
ADL assessment, noting ROM, muscle strength, sensation, cognition, and psychosocial status
Monitoring of heart rate, blood pressure, and oxygen saturation
Daily activity interview
Evaluation of the need for adaptive equipment
D. Occupational therapy intervention (Huntley, 2014, pp. 1315–1323)
1. Pulmonary rehabilitation medical team including physician, nurse, occupational therapist,
physical therapist, respiratory therapist, dietitian, pharmacist
2. ADL training, administration of oxygen if O saturation goes below 90%, bathing and dressing
of one extremity at a time, frequent rest breaks
3. Education of client to use pursed lip and diaphragmatic breathing during activity and to lean
forearms on thighs and practice breathing to decrease anxiety and panic and shortness of
breath
4. Upper-extremity strengthening: weights, elastic bands, arm ergometer (arm bike)
5. Adaptation of community activities to foster increased participation
6. Training on stress management and relaxation techniques
7. Instruction on work simplification and energy conservation techniques
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8. Training to increase functional endurance
References
Huntley, N. (2014). Cardiac and pulmonary diseases. In M. V. Radomski & M. C. Trombly Latham (Eds.),
Occupational therapy for physical dysfunction (7th ed., pp. 1300–1326). Lippincott Williams & Wilkins.
Matthews, M. M. (2013). Cardiac and pulmonary disease. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s
occupational therapy: Practice skills for physical dysfunction (7th ed., pp. 1194–1214). Mosby/Elsevier.
Smith-Gabai, H., & Holm, S. E. (2017). The cardiac system. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational
therapy in acute care (pp. 223–251). AOTA Press.
Smith-Gabai, H., & Schmitz, M. (2017). The pulmonary system. In H. Smith-Gabai & S. E. Holm (Eds.),
Occupational therapy in acute care (2nd ed., pp. 269–291). AOTA Press.
Resources
Hudson, R. (2017). The vascular system. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational therapy in acute care
(2nd ed., pp. 253–268). AOTA Press.
Evangelist, M., & Smith-Gabai, H. (2017). Transplantation. In H. Smith-Gabai & S. E. Holm (Eds.), Occupational
therapy in acute care (2nd ed., pp. 599–626). AOTA Press.
Copyright © 2020 by the American Occupational Therapy Association. All
rights reserved. For permissions, contact www.copyright.com.
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