Cardiac Rehab: Post MI & CABG Flashcards Preview

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Flashcards in Cardiac Rehab: Post MI & CABG Deck (30):
1

Phase I

-'in hospital' acute stage: constantly changing
-begin as soon as vitals & angina are stable
(2-3 days or 5 days after MI)

2

Contraindications for cardiac rehab

-unstable angina
-MI or extension of infarction in past 2 days
-HTN (resting SBP>200, DBP >110)
-Hypotension (SBP <80)
-Hemodynamic instability
-uncompensated CHF
-uncontrolled HTN
-Serious arrhytmias
-dissecting aortic aneurysm
-unstable psychological condition

3

Cardiac rehab

-process to restore & maintain individual with coronary problems to optimal physiological, sociological, psychological, educational, vocational status

4

Indications for inpatient &/or outpatient cardiac rehab

-Acute post MI (w/n 12 months)
-Stable angina
-post CABG
-post valve repair/replacement
-post PTCA/stent
-post heart/lung transplant
-CHF (w/n guidelines)
-at risk for CAD

5

cardiac rehab program phases

-Phase I
-Phase IB
-Phase II
-Phase III
-Phase IV

6

Post Surgery vs. Post MI

-surgery:
--heal faster
--shorter hospital stay
--UE & trunk stretching
--Cough/breathing ex's important
--restricted lifting 6 weeks

-MI:
--slower recovery
--longer hospital stay

7

Lifting Restrictions
(Surgery & MI)

restricted for 6 weeks:
-Surgery: 8-10#
-MI: 15-20#

8

Phase I Goals

-screen for complications
-prevent deconditioning
-prevent pneumonia
-edu pt/family
-measure effectiveness of meds

9

Phase I Ex's

-Resting HR, BP, EKG, SO2, lung Auscultation

-warm up, ambulate, aerobic ex's
MONITOR VITALS

10

Phase II Ex's Intensity

-RPE -or RHR + 20 (MI)/ RHR + 30 (surgical)
-1-2 METS

11

Phase I PT Session

-edu
-ROM
-breathing ex's
-Self-care
-monitored walking
-stairs (2 flights=same METS required for sex)

12

Phase I
ex's frequency

-days 1-3=3-4x/day
-day 4+=2x/day

13

Phase I ex's time

-intermittant (3-5 min bouts)
-total daily time 20 min
-Goal: 10-15 min (then increase ex's intensity)

14

Phase I
mod/term ex's

-RPE >/=13
-HTN
-Hypotension
-decr PP to <20mmHg
-unusual incr HR
-PVC couplet or 3+ PVC in row
-PVC w/ R-onT phenomenon
-Onset of 2* or 3* heart block
-1+ angina/3+ angina?
-3+ claudication
-fatigue
-dizziness
-pallor
-cold sweat
-ataxia

15

Phase I begins:

-as soon as vitals & angina stable
-uncomplicated MI=2-3 days post
-complicated MI=5 days post
-begin at 1-2 METS

16

Phase I Discharge Planning

-Sx to monitor
-Ex's Rx
-Dietary guidelines
-meds
-referral to outpt phase II
-ideally involves LLGXT

17

Phase IB

-done in home with goal to get ready for phase II

18

Phase II goals

-monitor cardiovascular response to mild-mod workload & communicate w/ docs
-return to prior activities
-condition heart & respiratory systems
-help pt cope with psychological stresses
-develop lifestyle ex's habit modificaiton
-edu to pt/fam on 2* prevention

19

Phase II

-'out of hospital'
-begin soon after discharge from hospital
-must be w/n 6 months for insurance to cover
-in hospital or satellite setting

20

Phase II session components

-warm up
-stretch
-endurance conditioning
-cool down

21

Phase II ex's goals
I:
T:

-up to 9 METS
-20-30 min continuous ex's then increase intensity

22

Phase II resistance ex's time frame

-5 weeks post MI
-8 weeks post CABG
-2 weeks post PTCA

23

Phase II Ex's

-SUPERVISED
-monitor vitals
-about 36 visits
-3 days/week + home ex's

24

Phase II Ex's Intensity

If SLGXT Prior:
-10 bpm lower than anginal threshold
-80% last ex's test (HR)
-incr HR 10 bpm after 2-3 weeks

If no SLGXT Prior:
-RPE 11-13
-THR=60-70% PMHR
-Karvonen (HRR): 40-60 % HRR
-by 3-6 months burn 1,000 KCal/week

25

Phase II criteria for resistance ex's

-mod-good L ventricle function
-ex's capacity >5 METS w/o angina or ST segment depression

26

Phase II Resistance Ex's Guidelines

-start w/ low weight (RPE 11-14)
-1 set of 10-15 reps
-incr 2-3 #/week arms
-incr 5-10#/week legs
-RPP not > RPP during aerobic
-Full ROM
-No valsalva
-Exhale during exertion

27

Phase II Contraindications for Resistance Ex's

-symptomatic CHF
-uncontrolled arrhythmias
-severe valvular disease
-unstable Sx
-uncontrolled HTN

28

What questions to rule out Angina?

-what are the Sx?
-where is it located?
-What's the effect of palp?
-deep breath/cough?
-body position/ROM?
-cardiovascular Ex's?
-rest?
-NTG?

29

Phase III

-out of hospital
-not covered by insurance
-purpose: fitness, endurance, incr knowledge & independence

30

Phase III Ex's

-incr time from 30 to 40-60 min
-check p GXT periodically
-call in their EKG
-discharge in 6-12 months