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Flashcards in Cardiopulm Rehab Deck (38):

Is there a growing need for cardiac rehab?

Approximately 66% of heart attack patients do not make a complete recovery
71.5% of 65 year olds with CAD have three or more comorbidities and physical limitations, only 3.8% have none


What are utilization and underutilization trends for cardiac rehab?

Utilization: greater than 2 million are eligible after MI or coronary revasc, on average only 26% of those eligible actually participate

Under utilization: women, non white, elderly, and underinsured are under represented in rehab; initial referral to cardiac rehab essential; barriers include insurance reimbursement, patient motivation, geographic/transportation limitations


What is cardiac rehab?

Comprehensive long term program involving: medical evaluation, prescribed monitored exercise, risk factor modification, education and counseling, multidisciplinary team approach


What are modifiable CAD risk factors?

Tobacco use, lipids, BP, physical inactivity, excess body weight, diabetes, stress


What are non modifiable CAD risk factors?

Age: risk increases as we get older
Gender: men higher risk, risk increases for post menopausal women
Race: African American, native American, Mexican American at higher risk because of higher occurrences of diabetes, HTN, and obesity in these groups
Family history: if either or both of your patients have CAD, your risk for developing CAD is greatly increased


What are characteristic of HTN as modifiable risk factor?

Defined at 140/90
Treatment: antihypertensive therapies, nutrition (sodium intake- decrease to 2500) and exercise
Important to educate patient, check it often, keep records, be consistent


What are characteristics of smoking as a modifiable risk factor?

Single most preventable cause of death in US
Smoking cessation can lower risk by almost 50%
After one year, CAD level of risk equals that of a non smoker
Referral to smoking cessation class is best option


Modifiable risk factor cholesterol (5)

Cholesterol is fatty substance found in human body and in food that come from animals
Drug and nutrition therapies have been indicated to reduce death and disability
Know current research
Changes in diet


What is obesity, why is it a risk factor, how is it treated, and what are associated risk factors with obesity?

Excessive accumulation of fat on body
Why: creates problems with respiration and circulation, added strain on heart by increasing work and blocking arteries
Associated risks: HTN, hyperlipidemia, increased blood glucose, patterns of sedentary lifestyle
Treatment: weight loss, proper nutrition, exercise


What are treatments/tips for patients to control diabetes as a modifiable risk?

Interferes with body's ability to produce adequate amounts of insulin needed for your body to use sugars and carbs.
Higher risk for CAD
Info for pt: knowledge of disease, dietary mgmt., medication admin, prevention of complications, methods of monitoring blood sugar
OP programs


Why is physical inactivity a modifiable risk factor?

Inactive people are twice as likely to develop heart disease as active people
Numerous systems of body are affected
Inactivity Decreases: HDL levels, collateral circulation and vessel size
Inactivity increases: total cholesterol, glucose intolerance, body weight, BP


T/F: cardiac rehab involves inpatient, outpatient, lifetime



What are phases of cardiac rehab?

1: inpatient cardiac rehab
2: monitored outpatient cardiac rehab (initiated 1-3 weeks after event, usually lasts 3-4 mo)
3: maintenance (long term outpatient cardiac rehab)


What are goals of cardiac rehab?

Identify, modify, manage risk factors to reduce disability/morbidity and mortality
Improve functional capacity
Alleviate/lessen activity related symptoms
Educate patients about management of heart disease
Improve quality of life


Program components: initial and ongoing eval typically includes?

Medical history
Risk factor identification and assessment
Functional assessment
Psychological and quality of life indicators
Exercise prescription


What is monitored in sessions of the program?

ECG, HR, BP, signs/symptoms


program components: lifestyle education/counseling sessions target what? and the topics include?

Individual and/or group interactions targeting: risk factor education, intervention, modification; symptom recognition; medication usage; others as indicated by POC
Topics: physical activity, nutrition, lipid management, BP management, smoking cessation, weight management, diabetes management, psychosocial management


What are eligible diagnoses for outpatient rehab?

Stable angina
Myocardial infarction
Interventional procedure (PCI, PTCA, stent)
Valve surgery
Heart transplant


What are benefits of cardiac rehab?

Reduced risk of fatal MI
Decreased severity of angina and need for anti angina meds
Decreased hospitalizations
Decreased cost of physician office visits and hospitalizations
Fewer ER visits


What is pulmonary disease?

Pathological limitations of airflow in lungs
Generally not reversible
Lung disease is not only a fatal condition but is chronic in nature, making breathing difficult
Affects 35 million people
CB, emphysema, asthma, COPD


T/F: lung disease death rate continuously increased while the rates of heart disease and cancer dropped



Why is pulm rehab important?

When you have chronic lung disease routine activities may cause SOB
For many the SOB affects every aspect of daily living
As a result they may become fearful of physical activity and become less active with increased SOB


What is pulm rehab?

Exercise and lifestyle modification
Supervised by variety of health care professionals and requires physician referral
An outpatient service at hospital or clinic
Meets two to three times a week


What are benefits of participation in pulm rehab?

Improve breathing
Increase endurance and strength
Control symptoms
Management of meds and/or oxygen
Minimize frequency or length of hospital stays
Manage stress, anxiety, and/or depression
Improve one's energy


What are goals of pulm rehab?

Control and alleviate symptoms
Improve activity tolerance
Promote self reliance and independence
Decreased need for acute responses
Improve quality of life


What are components of pulm rehab?

Supervised progressive exercise/activity
Functional and ADL training
Energy conservation
Breathing retraining
Stress management
Medication education


What diagnoses are covered by medicare for pulm rehab?



What are utilization benefits of pulm rehab?

Decreased severity of dyspnea with functional activities
Decreased hospitalizations
Decreased cost of physician office visits and hospitalizations
Decreased ER visits


What are patient benefits of pulm rehab?

Improved functional capacity
Increased knowledge of pulm disease
Improved adherence to positive lifestyle changes
Better compliance with medical regime
Reduce anxiety/panic
Increased self esteem and confidence


What are factors to consider for exercise prescription in cardiopulm populations?

Health status
Risk factor profile
Behavior characteristics
Personal goals
Exercise preferences
Exposure to exercise
Changes in health status
Expectations of others
Genetic potential
Ability to comply
Your expectations vs theirs
Physician input
Blend of exercise class


In exercise prescription you may need to make modifications due to...?

Observed individual responses
Adaptations to exercise
Activities done outside of therapy
Differences in exercise modalities
Health status
Addition/deletion of meds
Health status change
Work status change


What are considerations for exercise with angina?

Prolonged warm up and cool down: ROM, stretching, low level aerobic activities
Upper body exercises may precipitate angina more readily


What are considerations for exercise in MI?

Warm up should last 5-10 min that consist of: stretching, light aerobic activity
Aerobic activity should last 20-30 min and should be discontinued if signs or symptoms arise
Cool down should last as long as it takes for HR to reach resting level


What is intervention for percutaneous cardiac revasc?

Exercise training can begin almost immediately
Progress more rapidly if no myocardial damage
Watch closely for potential reoccurrence manifested by signs/symptoms of ischemia


What are considerations for exercise in CABG and valve surgeries?

Start lower level and progress at slower rate
Be cautious of sternal precautions, no upper body exercises for 6-8 weeks post surgery


What are considerations for exercise in pulmonary diagnoses?

Be very aware of oxygen saturation throughout
Intermittent bouts are generally used, anywhere to 5-10 minutes with 2-3 minute rest
Upper body exercises are found to be more beneficial due to specificity


What are contraindications for exercise prescription?

Unstable angina
Severe CAD
Serious ventricular arrhythmias
Others that could be aggravated by exercise


T/F: cardiopulm rehab is important because it will give the patient the tools, knowledge, and motivation needed to fight the progression of cardiovascular and pulmonary disease?