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Cardiopulmonary > Cardiac Rehabilitation > Flashcards

Cardiac Rehabilitation Flashcards

1
Q

Cardiac Rehabilitation Basics

A
  • Medically supervised
  • Lifestyle modification
  • Phase 1 Inpatient - 2 Outpatient - 3 Maintanence
  • Individualized, typically 3x/week, up to 36 weeks
  • Physican referral required
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2
Q

Typical length of stay following uncomplicated cardiac surgery is?

A

4 days

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3
Q

Goals of Phase 1

A

Education
* Provide Written information

Exercise
* Monitor: HR, BP, RPE, O2 Sat, Angina Scale and Claudification Scale

Pathways
* Follow and document what was done when

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4
Q

Phase 1 Rehab includes…

A
  • Diet and Nutrition
  • Psychological Rehab
  • Activity Guidelines
  • Risk Stratification
  • Education
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5
Q

Exercise - Phase 1

A
  • Goal – 4-5 METS (climb 1 flight of stairs)
  • Walking and ROM programs
    – Instruction of self monitoring
    – HR
    – Exertion levels - RPE (11-13 range)
    Symptoms
  • Functional mobility
  • Talk about home (preparation)
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6
Q

Phase 2 Goals

A

Physician supervision required

  1. Provide individual exercise programs (ITP); Improve CV fitness and monitor with EKG
  2. Emphasis on education (modifable risk factors)
  3. Enhance confidence to return to hobbies and leisure/work
  4. Group interactions (psychological, behavioral, educational)
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7
Q

Chronic vs Stable HF

A

Chronic: Left ventricular EF less than 35% and (NYHA) Class II - IV symptoms despite being on optimal heart failure therapy for at least 6 weeks.

Stable: pts who have not had recent (less than or equal to 6 weeks) or planned (less than or equal to 6 months) major cardiovascular hospitalizations or procedures.

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8
Q

Phase 2 Time period and programs

A
  • Start 24-48 hours post discharge
  • Duration 1-36 weeks
  • Staff ratio of 1:1 to 1:5

Intensive Cardiac Rehab
* Pt. recieves 72 one-hour sessions within 18 weeks
– Up to 6 sessions per day
– Must exercise aerobically everyday of rehab

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9
Q

Phase 2 Exercise Program Guidelines

A

Warm up
* Stretch (if needed and document limitations)
* Active mmvt

Training session (based off info from GXT or other tests)
* Aerobic
* Resistive
* Flexibility (if needed)

Cool down

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10
Q

Phase 3 goals

A
  • Indep in self monitoring (HR, RPE)
  • Compliance with home ex
  • Medically stable
  • No long need ECG monitoring
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11
Q

Is phase 3 covered by insurance? What programs do patients do here?

A
  • Typically self pay or a 3rd party payer.
  • Typically Community Based Program.
  • Emergency equipment on premise (AED and protocols)
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12
Q

Angina Scale

A
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13
Q

Dyspnea Scale

A
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14
Q

Claudification Scale

A
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15
Q

What is the acronym for a comprehensive exam for chest pain?

A

OLD CART

O = onset – sudden vs gradual
L = location – substernal, left side, jaw
D = duration – Cardiogenic chest pain generally 2-20 mins
C = characteristics – pressure, tightness, heaviness vs sharp with inspiration
A = accompanying symptoms – associated with diaphoresis, dyspnea, light-headedness
R = radiation – Does the pain radiate to the arms, neck, jaw or teeth?
T = treatment – relieved by rest, O2, Nitro?

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16
Q

What would make someone high risk (exercise) risk stratification?

A
  • Presence of complex ventricular dysrhythmias during ex testing or recovery
  • Presence of angina or Sx(e.g., SOB, light-headedness, at low levels of exertion (less than 5 METs) or during recovery)
  • High level of silent ischemia during ex testing or recovery (ST-segment depression greater or equal than 2 mm from baseline)
  • Presence of abnormal hemodynamics with ex testing or recovery
17
Q

What considers someone high risk (non-exercise)?

A
  • Resting EF less than 40%
  • History of Cardiac Arrest or Sudden Death
  • Complex Dysrhythmias at rest
  • Complicated MI or revascularization procedure
  • Presence of heart failure
  • Presence of S & S or post-event/post-procedure ischemia
  • Prescence of clinical depression
18
Q

When preparing to make an Exercise Presciption, what factors need to be considered?

A
  • Clinical history
  • Risk Stratification
  • Degree of L Ventricular impairment
  • Ischemic or anginal threshold
  • Any cognitive or psychological impairment
  • Vocational (work) requirements
  • Musculoskeletal limitaitons
  • Personal health and fitness goals
19
Q

How many classes are there for cardiac rehab?

A

6!

20
Q

Examples of Class 1 exercises

A
  • Sit in bed with assistance
  • Self care seated
  • Stands at bedside with assist
  • Sits in chair 15-30 minutes (2-3x/day)
21
Q

Examples of Class 2 exercise

A
  • Sits up in bed independently
  • Stands independently
  • Self care in bathroom - seated
  • Walks in rooms and to bathroom (may need assist)
22
Q

Examples of Class 3 exercise

A
  • Sits and stands independently
  • Does own self cares in bathroom - standing
  • Walks in hall with assist (50-100 ft)
23
Q

Examples of Class 4 Exercise

A
  • Own self cares and bathes
  • Walks in hall (150-200 ft; 3-4x/day w/ min assist)

Typically d/c at this point

24
Q

Example of Class 5 exercise

A

Walks in hall (250-300 ft; 3-4x/day

25
Q

Example of Class 6 exercise

A
  • Individual ambulation on unit 3-6x/day
26
Q

Inpatient Guidelines - Intensity

A
  • RPE less than 13 (6-20) or less than 3 (0-10)
  • Post MI HRrest + 20 bpm
  • Post surgery (CABG valve) HRrest + 30 bpm

Must consider congition if going by RPE

27
Q

Inpatient Guidelines - Duration

A
  • Intermittent bouts for 3-5 min
  • Rest periods - as needed, 1-2 min (2 exercise:1 rest)
  • Up to 10-15 minute of continuous exercise
28
Q

Inpatient Guidelines - Frequency

A
  • Days 1-3: 3-4x dat
  • After day 3: 2x a day
  • Progression: increase duration to 10-15 minutes, then increase intensity
29
Q

What are some indications for discontinue or modify activity?

A
  • Resting HR: greater than 130 or less than 40
  • Rise in SBP is greater than 250 or DBP is greater than 110
  • Acute infection or fever, greater than 100 degrees
30
Q

Evidence shows that length of stay for cardiac patients can be shortened by…

A

performing cardiac rehabilitation right away!

31
Q

List of CV/P deficits that may limit someone

A
  • Airway clearance
  • Lungs
  • Gas exchange
  • Blood
  • Respiratory muscles (Ventilation)
  • Myocardial perfusion
  • Heart function
  • Neurological control
  • Fluid Volume Excess (Ex: Edema)
  • Fluid volume deficit (Ex: blood, vomiting)
32
Q

Medical Chart Review Questions

A

Determine the patient’s diagnosis - MI, CABG, PTCA
Was the patient defibrillated?
What does the EKG report say?
Was TPA or Streptokinase used?
Look at lipid panels (Risk factors)
Look at EKG report (electrical)
Look at Echo report (structure & function)
Catheterization lab report - what percentage of vessels blocked
Read the PFT report (Ventilation/perfusion)
Patients Medications

33
Q

Patient interview questions

A

Do they know what happened to them?
Did/Does the patient smoke?
Do they have any chest pain or angina?
Did they have predisposing RFs?
Do they have a supportive family?

34
Q

Patient Examination

A
  • ROM - passive & active
  • Gross muscle strength
  • Skin (integumentary) - Color, Scars, edema
  • Pulse check/bruis - pedal, femoral, popliteal (hard), carotid
  • Breathing patterns (incentive spirometer)
  • Auscultate lungs
  • BP - supine and compare supine/sit
  • EKG - supine and sitting
35
Q

What values should you monitor with your cardiac patient?

A

BP, EKG, HR, and O2

Use pain scale and dyspnea scale

36
Q

Submax GXTs to 5 METs are often performed in order to?

A

clear someone to perform ADLs at home

Typically performed day 3 after surgery

37
Q

The modified bruce protocol does what?

A

For cardiac patients, splits up Stage 1 to show progressions in their rehab

Cardiopulmonary (21 decks)

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