Cardiopulmonary Rehabilitation

Question 1

Pain or pressure radiating to jaw, teeth, arm or midback

Answer 1

Acute coronary syndrome

Question 2

Lack of blood flow leading to tissue death (heart attack)

Answer 2

Myocardial Infarction

Question 3

Heart muscle is stretched beyond ability to contract; ineffective pump

Answer 3

Congestive Heart Failure (CHF)

Usually a chronic condition. Pt.’s have specialized diets (i.e. low sodium)

Question 4

Secondary effects of CHF

Answer 4

Edema (in LE), SOB, fatigue, cough or SOB in side lying.

Pt.’s should be weighing themselves daily, if there is a 3lb increase they need to call the Dr

Question 5

Enlarged heart, decreased pumping & leads to CHF

Answer 5

Cardiomyopathy

75% of cases are dilated

Question 6

Abnormal heart rhythm which usually leads to CHF

Answer 6

Artial fibrillation (afib) 
Afib= increase in clot production

Question 7

high blood pressure d/t narrowing of blood vessels

Answer 7

Hypertension (HTN)
Systolic 140
Dystolic >90

Question 8

Congestive Heart Failure: Overview

Answer 8

Coronary artery disease or coronary heart disease (CAD or CHD): buildup of plaque on wall vessels
Diuretics = increase in urination & increased fall risk due to frequency & urgency of bathroom trips
Digitals
Heart transplant
Decreased salt and fluid intake

Question 9

Cardiac Catheterization

Answer 9

Insert tube and dye into the heart muscle to elevate blood pumping (?)

Question 10

Angioplasty & stent placement

Answer 10

Mini step before CABG by pass

Pushes plaque against vessel wall to decrease Bp

Question 11

Bypass Surgery or CABG : Overview

Answer 11

Open heart procedure
Transfer of donor vein- usually great saphenous from LE
Sternomoty precautions for 6-8 weeks following

Question 12

Sternotomy Precautions

Answer 12

No pushing or pulling 
No lifting anything greater than 5lbs 
No sh flexion greater than 90 degrees 
No UE retraction
Holf pillow when coughing 
No driving

Question 13

Pacemaker : Overview

Answer 13

Creates artificial action potential
Control arrhythmia
SA node disorders- bradycardia
AV nodes disorders: tachycardia

Question 14

Ventricular Assistive Device (VAD): Definition

Answer 14

May be a left (LVAD), right (RVAD), or both (BiVad)

For end-stage heart disease as a bridge to heart transplant

Question 15

VAD Function

Answer 15

Produces continuous flow of blood

• No pulse, hard to get BP read
• Must be careful of driveline or power source

Question 16

VAD precautions

Answer 16

No driving, No contact sports 
No pregnancy, No bike riding 
No showers w/o clerance & bag 
No swimming, no static, no vacuming 
Sternotomy precautions for 6-8 weeks 
No touch screen on computer or tv monitor 
Not chest compressions unless unit stop
Avoid magnets and metal detectors 
No MRI 
Avoid exposure to infections

Question 17

Theracotomy : Overview

Answer 17

Incision to chest to Tx

• Artificial airway
• Daohragm, esophagus, kidneys, lung
• liver, spleen

Question 18

Anestheisa: Phrenic N. Irritation/Compression

Answer 18

Decreased diaphragm contraction
Several days duration
O2 decreased hypoxemia
Confusion & mental effects can be long lasting

Question 19

Narcotics

Answer 19

Interruption of normal breathing & HR

Causes alveoli collapse

Question 20

Post - Op ICU : Overview

Answer 20

Mobility 
Positioning 
Endurance 
Light ADL's 
Incentive spirometer

Question 21

Metabolic Equivalent Level

Answer 21

Unit of measure of oxygen that body needs for a given activity
Used in cardiac rehab to determine activity tolerance during recovery
1 MET = 3.5 ML/02/min/kg body weight = oxygen consumption at rest

Question 22

Cardiac Rehab : Candidates

Answer 22

Post MI 
Post CABG 
Poor ventricular fxn
Cardiomyopathmy 
Cardiac transplant 
Elderly - deconditioned 
Assymptomatic at risk population 
Pt.s have to be stable and beyond the point of sternal precautions

Question 23

Phases of Cardiac Rehab

Answer 23

Phase 1: Acute
Phase 2: Out pt. or home health (4x weekly typically out pt. )
Phase 3: Community program (i.e. smoking programs)
Phase 4: Maintenance

Question 24

Non Candidates for cardiac rehab

Answer 24

Overt CHF
Unstable agina=chest pain
Serious arrythmia
Uncontrolled HTN

Question 25

Benefits of cardiac rehab

Answer 25

``` Weight loss Decreased lipid levels Elevation of HDL Decreased BP Increased Glucose ```

Question 26

Exercise guidelines

Answer 26

``` HR : 20-30 bpm above resting BP: 15-20 mmHG from resting Monitor SOB, dizziness, chest pain, nausea, diaphoresis (i.e. sweating and clammy feeling), fatigue Check vitals regularly Give frequent and regular rest breaks Move slowly Work w/in MET levels prescribed ```

Question 27

Exercises Precautions

Answer 27

``` DVT (appears in calf: redness & swelling) Unstable angina Increased BP Uncontrolled arrythmia (blood clot) Active pericarditis Temp of 100 or more No isometices (breath holding and increase in BP) No valSalva No UE overhead No lateral UE ex. Sternal Precautions No driving ```

Question 28

Pulmonary Dysfunction (COPD) : overview

Answer 28

Progressive and irreversible destruction of alveolar walls Lungs lose elasticity and air is trapped Decrease airflow during expiration; lung cannot shrink Result of chronic bronchitis & emphysema #5 cause of death Use of Borg Scale

Question 29

Respiratory Arrest

Answer 29

May be related to recent surgical procedure, frail health or complex co-morbidities May lead to anoxia and decline in cognitive processes

Question 30

OT Eval & Tx

Answer 30

UE function: limited to 90 degress FF ADL performance Home safety accessibility Endurance: stanima to do daily tasks: use of energy conservation and pacing Strength: No MMT: look at it in terms of function (i.e. walking to the bathroom) Cognition and insight into limitations Vocational abilities Incorporation of precautions (sternotomy) into ADL's

Question 31

Occupational therapy Eval & Tx : Continued

Answer 31

``` Pt. self monitoring & Pacing: Recognize when they are SOB, know how to follow sternal precautions Psychosocial Caregiver education Community re-entry pt. education ```