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Cardio 2 > acute care plan > Flashcards

acute care plan Flashcards

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1
Q

what is Primary Prevention

A

Active intervention for risk factors that cause cardiovascular disease

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2
Q

who are candidates​ fro primary prevention

A

individuals who are at moderate or high risk of developing cardiovascular disease and with family histories of CVD

high prevalence of modifiable risk factors

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3
Q

what are the two problems with primary prevention

A

compliance

lack of payment for services

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4
Q

Risk factors affected by primary prevention

A

high cholesterol,
aerobic capacity,
exercise tolerance,
weight,
resting
BP,
glucose,
well-being,
stress tolerance

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5
Q

Components of primary prevention program

A
  • Therapeutic exercise—aerobic and resistance
  • Dietary counseling
  • Stress management or biofeedback
  • Smoking cessation
  • Pharmacological management
  • Education and self-management techniques
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6
Q

Types of Cardiac Rehab Programs

A

Rehab of patients with cardiovascular disorders

Cardiac rehab

Formal Cardiac Rehab Program

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7
Q

what is a Formal Cardiac Rehab Program

A

Formal multidisciplinary program in outpatient, includes exercise, education and lifestyle modification, covered by Centers for Medicare and Medicaid

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8
Q

who can provide cardiac rehab

A

Can be provided by a number of medical professionals including
physical therapists and exercise physiologists

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9
Q

Phase I of cardiac rehab

A

Acute or hospital phase

This phases begins when a patient is considered to be medically stable after the CV event

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10
Q

Phase 2 of cardiac rehab

A

Early outpatient phase/ Intensive Monitoring

Begins after discharge and lasts 6 to 12 weeks

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11
Q

Phase 3 of cardiac rehab

A

Training or maintenance phase

Begins at end of Phase II; patients exercise in larger groups

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12
Q

Phase 4 of cardiac rehab

A

Disease prevention program

Individuals are at high risk for infarction because of risk factors; also includes those who continue to want to be seen in a supervised environment

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13
Q

the importance of early mobilization​ in cardiac pt

A

Early mobilization of acute coronary patient to activity reduces complications and improves mortality rate

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14
Q

Poor candidates for rehabilitation

A
  • Overt CHF, unstable angina pectoris, hemodynamic instability, serious arrhythmias, conduction defects, impaired function of other organ systems
  • Uncontrolled hypertension
  • Other diseases or illnesses that preclude exercise
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15
Q

when is the Initial assessment/examination of cardiac pt done

A

when the pt is consider stable

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16
Q

what is included in the Initial assessment/examination

A
  • Chart review
  • Patient–family interview
  • Physical examination
  • Activity (self-care) and ambulation evaluation (ADL monitor)
  • Ambulation activity
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17
Q

acute phase - Indications for an unmodified program

A

Patients who demonstrate appropriate hemodynamic, ECG, and symptomatic responses to self-care and ambulation evaluation

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18
Q

acute pahse - Indications for a modified program

A

Program is modified for persons designated as “complicated”

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19
Q

acute phase​ - Indications for withholding a program

A

Criteria that exclude patients from participation until instability improves

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20
Q

heart rate increase to stop during acture phase

A

great the 50 bpm increase

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21
Q

BP that will cause a stop in therpy in acute phase

A

BP indicative of hypertension SBP >210 or DBP>110 mmHg

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22
Q

systolic blood pressure the contradicts therapy​ during acute phase

A

drop of 10 mmHg SBP

HTN : BP>210 mmHg

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23
Q

Relative contraindications to continuing exercise during acute phase

A

activity​ of angina, excessive dyspnea, excessive fatigue, mental confusion, dizziness, severe leg claudication, signs of pallor, cold sweat, ataxia, changing heart sounds with activity, changing lung sounds with activity, ECG abnormality

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24
Q

Information that should be included in patient education - PT related

A
  • General activity guidelines and home exercise program*
  • Role of exercise*
  • Self-monitoring techniques*
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25
Outcome measures in acute phase
Due to limited hospital stay in the acute phase, outcomes expected are based on the functional limitations or disabilities
26
what is the aim of cardiac​ rehab
Aim is to reduce subsequent CV- related morbidity and mortality
27
do Patient who do not have a place to attend for rehabilitation or do not qualify still qualify for out pt rehab
yes
28
Traditionally, patient groups for cardiac rehab include
complicated/uncomplicated MI, heart failure, angioplasty, heart transplant, stable angina, post-bypass, or valve replacement
29
Candidates for home based Cardiac rehab
* heart disease & uncomplicated hospital course (low-risk) and considered to be * unable to travel to the program
30
Exercise rehabilitation has made po​sitive impact on what aspect of cardiac disease in cardiac rehab
* Risk factors * Functional capacity * Cardiovascular efficiency * Cardiac mortality rate
31
Interventions Utilized in the Outpatient Cardiac Rehabilitation Setting
* Therapeutic exercice Aerobic training, resistance training, flexibility training, circuit training * Patient instruction/education * Coordination/communication
32
Recommendations for Aerobic Training - mode
functional and fun
33
Recommendations for Aerobic Training - Intensity
establishing a target heart rate, use RPE or dyspnea scale to gauge
34
Recommendations for Aerobic Training - Duration
interval training of 2-5 mins, build to continuous 30-45 mins
35
Recommendations for Aerobic Training - freq.
higher frequency to make true CV changes, 5- 7d/wk
36
Formulas for calculating predicted and target heart rates - general population
220- age = PMHR
37
Formulas for calculating predicted and target heart rates - Fit individuals older than 40
205 – age = PMHR
38
what is HIIT training
alternating bouts of moderate and vigorous intensity exercise
39
what type in intensity​ is used for most cardiac programs
moderate intensity
40
what does moderate intensity look like
* Relative scale: 5 or 6 on a scale of 0 to 10 * Example: brisk walking
41
what does vigorous​ intensity look like
* Relative scale: begins at a 7 to 8 on a scale of 0 to 10 * Example: running or jogging
42
what is the talk test
As a rule of thumb, a person doing moderate-intensity aerobic activity can talk, but not sing, during the activity. A person doing vigorous-intensity activity cannot say more than a few words without pausing for a breath.
43
Resistance exercise training CR
30-50% 1RM with 8-10 reps each mm group
44
how long to wait for strength training - MI
5 weeks
45
how long to wait for strength training - bypass
8 weeks
46
how long to wait for strength training - post-PTCA
2 weeks
47
Program progression in cardiac rehab
duration then intensity/mode consider: * Altitude * Cold vs Heat and humidity
48
Early intervention education
Education about problem of CAD plays significant role in preventing further cardiovascular disease
49
weight and cardiac disease
Obesity is a significant risk factor for coronary artery disease
50
Low-density lipoprotein (LDL) high risk for cardiac issue
>100 >175
51
Legal problems stem from two aspects in CR
* Adverse effects of medically prescribed exercise testing and fitness conditioning * Consideration of disability pension and insurance benefits that may influence patient’s motivation
52
Covered Diagnoses for CR
* Acute MI within 12 months * CABG or PTCA * heart transplant * Stable angina * HF with EF<35% (recently added in 2014)
53
what is CONDITION A
* cardiac or respiratory arrest requiring cardiopulmonary resuscitation * unresponsive * without a pulse
54
what is CONDITION C
* Pre-code to condition A * unstable * needs RAPID evaluation and/or treatment by medical team
55
what do you do with a pulseless condition A pt
* Assess situation and establish unresponsiveness * Call for assistance * Begin CPR
56
Condition C - respiratory RR
Rate over 36 or less than 8/min
57
Condition C - respiratory pulse ox
New pulse ox reading less than 85% * unless patient has chronic hypoxemia
58
Condition C - respiratory breathing
New onset of difficulty breathing
59
Condition C - cardiac HR
less than 40 or over 140/min with new symptoms, any rate over 160
60
Condition C - BP sytolic ​
less than 80 or over 200 systolic
61
Condition C - BP diastolic
over 110 diastolic with symptoms * neuro change, chest pain, difficulty breathing
62
condition C - neuro change
* Acute loss of consciousness * New onset lethargy, difficulty walking * Sudden collapse * Seizure * Sudden loss of movement (or weakness) of face, arm or leg
63
during a codition C what to do until the team arrives
* Take vitals * Position patient * Maintain BLS * Apply AED (if appropriate)
64
Potential Life-Threatening Situations
* Seizures * Pre-syncope and Syncope * Falls * Acute dyspnea * Hypoglycemia
65
seizure and airway
make sure to maintain an open airway
66
do you restrain someone when they are haveing a seizure
no
67
seizure and pt mouth
Do not try to open the victim’s mouth or try to place any object between the victim’s teeth or in the mouth.
68
what normally​ happens after a seizure
It is not unusual for the victim to be unresponsive or confused for a short time after a seizure.
69
what is syncope
Syncope is a transient loss of consciousness that results from global cerebral hypoperfusion.
70
Pre-syncope signs
* Pallor * Sweating * Lightheadedness * Visual changes * Weakness
71
what do you do when you recognize​ pre syncope
* Rapid first aid treatment could improve symptoms or prevent syncope from occurring assume safe position
72
counter-pressure maneuvers for pre syncope
handgrip, arm tensing, abdominal muscle tensing, leg crossing with tensing, squatting, and neck flexion. May reduce symptoms of presyncope and prevent syncope
73
Respiratory Distress signs and symptoms
* Abnormal breathing (shallow, labored, noise) or respiratory rate * Cyanosis * Nasal flaring * Decreased level of consciousness * Restlessness
74
Acute Dyspnea - Immediate Actions
* Maintain clear airway and place patient in comfortable breathing position. * Observe and evaluate (vitals), suction if needed * Notify appropriate personnel, call a code/911 if appropriate
75
symptoms of hypoglycemia
* confusion * altered behavior * diaphoresis * tremulousness (trembling or tremors)
76
what are low glucose levels
70 and below

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