5: Phase I Cardiac Rehab

Question 1

What types of patients are in Phase I rehab?

Answer 1

MI, post-op are most common. Can also include new onset arrhythmias, CHF exacerbations, syncope

Question 2

What are the three goals of Phase I rehab?

Answer 2

1. Develop plan of management for disease or symptoms and ensure a safe response to activity at home
2. Prevent effects of bed rest
3. Protect heart while in injury recovery stage

Question 3

How long is the injury recovery stage?

Answer 3

Up to 6 weeks

Question 4

What activity level should a pt be at when they finish Phase I rehab?

Answer 4

Exercise at 2-3 METS up to 15-20 minutes per day

Question 5

A pt should be able to perform a submax stress test at what level when exiting Phase I rehab?

Answer 5

4-6 METS ideally, but will probably be 2-3

Question 6

How do you monitor exercise tolerance or response to activity?

Answer 6

HR, BP, RPE, talk test

Question 7

Describe pt presentation of an uncomplicated, low risk MI

Answer 7

Small to moderate infarct size, stable EKG by the end of the 4th day

Question 8

What is the normal hospital course for a pt with an uncomplicated MI with low risk?

Answer 8

5 days with gradual increase in low level aerobic exercise, functional activities, transition to phase II rehab

Question 9

What tests will be done on a pt with an uncomplicated MI that is low risk and why?

Answer 9

Stress test, angio, echo to determine the level of the blockage and determine further treatment

Question 10

What will a uncomplicated MI low risk pt be discharged to?

Answer 10

HEP

Question 11

What three things would put a pt in the uncomplicated MI with moderate-high risk subgroup?

Answer 11

1. Low ventricular function (EF 30-45%)
2. Ischemia with low level activity
3. Occasional EKG changes

Question 12

What will a uncomplicated MI with moderate-high risk pt be discharged to?

Answer 12

Close follow-ups, Phase II rehab or home program

Question 13

What type of infarcts will people in the complicated MI with high risk subgroup experience?

Answer 13

Large area or thickness of myocardium

Question 14

Describe a pt in the complicated MI with high risk subgroup?

Answer 14

EKG changes or symptoms persist or exacerbate with exercise, very high BP or signs of unstable angina

Question 15

What is the typical EF for pts with a complicated MI in the high risk subgroup?

Answer 15

< 30% EF, will likely be candidates for surgery

Question 16

What is the typical Phase I rehab progression for day 2 after an MI?

Answer 16

Assess physiologic responses to change in position, and low level activity. Educate of RPE

Question 17

What is the duration of exercise for a pt on day 2 after an MI?

Answer 17

5-7 minutes

Question 18

What will treatment day 3 after an MI look like?

Answer 18

Reassess responses to activity, review pt education, increase activity duration and initiate unsupervised activity. Add ambulation and general conditioning exercises

Question 19

What will you progress activity to on treatment day 4 following an MI?

Answer 19

3 METS BID for 5-7 minutes each time

Question 20

How do you educate a pt on day 4 following an MI?

Answer 20

Self monitoring at home and their transition for a home program

Question 21

What three things are done on treatment day 5 following an MI

Answer 21

1. Assess moderate activity levels with minimal rest for 10-12 minutes
2. Low-level stress test up to 5-6 METS
3. Discharge

Question 22

What are the traditional sternal precautions?

Answer 22

• Shoulder flexion 90
• No horizontal ADD or ABD
• No lifting over 5 lbs
• No overhead reaching

Question 23

What are the current recommended guidelines following sternotomy incisions?

Answer 23

Lifting, pushing, pulling, UE movements inside tube

Question 24

When can pts move outside of the tube following sternotomy incisions?

Answer 24

4 weeks following surgery

Question 25

Following CABG and other post-op patients, what will day 1 look like?

Answer 25

1. Eval 2. Hip flexion, knee flexion and extension, ankle pumps in sitting 3. Shoulder flexion < 90, elbow flexion 4. SLR, heel slides, hip ABD, ankle pumps in supine 5. Incentive spirometer

Question 26

What will post-op day 2 look like?

Answer 26

1. UE exercises in sitting 2. LE exercises in standing 3. Ambulation is appropriate 4. Incentive spirometer

Question 27

What will post-op day 3 and forward look like?

Answer 27

1. UE and LE exercises in standing 2. Progress ambulation 3. Stairs, home environment 4. Incentive spirometer 5. HEP and prepare for discharge

Question 28

What are key things to keep in mind when progressing post-op pt's?

Answer 28

Monitor vitals, cardiac complaints, duration of exercise

Question 29

How long should an exercise session be by the time a post-op pt is discharged?

Answer 29

15-20 minutes

Question 30

What level on the Borg scale should a pt be able to exercise at when they are d/c?

Answer 30

10-12