Section 7: Cardiac Rehabilitation Phases l-lll Flashcards

1
Q

What is the primary goal of Cardiac rehabilitation

A
  • Enable the patient to regain full physical, psychological and social status and to promote secondary prevention in order to optimise long-term prognosis
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2
Q

What are the 10 improvements of Cardiac rehabilitation alongside improved survival?

A

1) Reduced hospital admission
2) Reduced angina
3) Improved lipid profiles
4) Improved blood pressure
5) Improved functional capacity
6) Improved compliance with lifestyle modifications
7) Reduced anxiety and depression
8) Improved confidence and well-being
9) Improved return to work and leisure activities
10) Education for family and friends

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3
Q

What 10 groups can participate in Cardiac rehabilitation and who are the primary participants?

A

1) Acute cardiac event - MI
2) Had or awaiting revascularisation - CABG/PCI
3) Stable angina
4) Heart failure
5) Valve surgery
6) Heart transplant
7) Heart transplant
8) Cardioverter defibrillator (ICD implant)
9) Congenital heart disease
10) Ventricular assist device implant

Myocardial infarction and Revascularisation patients are prioritised

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4
Q

Outline the 4 basic phases of Cardiac rehabilitation

A

Phase l - Inpatient stage due to a change (revascularisation), new or worsening in the condition
Phase ll - Following discharge from hospital back to GP
Phase lll - Structured rehab program beginning at 2 weeks following the event usually
Phase lV - Long term maintenance of physical activtiy

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5
Q

What typically occurs during Phase l and what is the overarching aim?

A

1) Diagnosis and treatment
2) Management of chest pain
3) Psychological and emotional support
4) Risk factor modification and lifestyle change
5) Prescribed medication
6) Mobilisation and progression of physical activity
7) Feeling and relationships
8) Work
9) Driving, insurance and airline travel
10) Local Phase ll and lll resources
Overarching aim: To assess the patients physical, pscyhological and social needs

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6
Q

What is the average stay of a hospital stay after a cardiac event and how long might the stay be in uncomplicated cases? What would be the typical criteria for discharge?

A
  • Average stay of 5 days
  • 2-4 days in uncomplicated cases
    Clinically stable and able to carry out self-care such as washing/dressing and able to walk short distances
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7
Q

What is typically included in Phase ll and how long does it last?

A

2-6 weeks typically
Includes:
- Assessment of cardiac risk
- Assessment of physical, psychological and social needs
- Provision of lifestyle advice and psychological intervention
- Provision of resuscitation training to family members

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8
Q

What are the 4 typical approaches used in Phase ll rehab?

A

1) Telephone call with health professionals
2) Visits by cardiac specialist nurse
3) visits by community staff nurses or district nurses
4) Heart manual, Angioplasty plan, Angina plan and revascularisation plan (can be used on its own for low-risk individuals particularly if resources are low)

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9
Q

What is the recommendation for Phase lll rehab?

A
  • Begins 2-6 weeks following event

- Twice a week for 6-12 weeks

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10
Q

What are the 9 factors undertaken in Phase lll assesment?

A

1) Current clinical status (heart rate, BP, BMI, Risk factor profile
2) Cardiac status - revascularisation details, cardiac history, size of infarct
3) Current medication
4) Results of investigations - ECG ETT, Echocardiogram, Angiogram
5) Psychological status
6) Risk stratification (Determines exercise intensity)
7) Functional capacity assessment
8) Physical limitation those of cardiac or orthopaedic origin
9) Calculation of individual training heart rates

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11
Q

What tests are used to assess functional capacity and why?

A
  • ECG ETTs - used less often due to movement towards primary angioplasty following diagnosis
  • Submaximal tests - Shuttle walk tests, 6 minute walk tests, Cycle ergometer, Chester step test
  • Assess current status and improvements in functional capacity
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12
Q

What 3 factors are influenced by a patients risk stratification?

A

1) Exercise intensity
2) Level of supervision
3) Level of monitoring

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13
Q

What factors should a patient by asked about before participating in a session?

A
  • Changes in medication
  • Symptoms
  • Home exercise activity
  • Problems and concerns
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14
Q

What 9 factors are absoltue contraindications to Phase lll rehab?

A

1) Fever or systemic illness
2) Unstable angina
3) >180 mmHg systolic and >110 mmHg diastolic
4) Unexplained drop in blood pressure during exercise
5) >100 bpm HR
6) Uncontrolled atrial or ventricular arrhythmia
7) Unstable/Uncontrolled diabetes
8) Symptomatic hypotension
9) New or recurrent symptoms of breathlessness, palpitation, dizziness or lethargy

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15
Q

What is the FITT principle for Phase lll

A

F: 2-3 times per week (other days undertake walking and stuff
I: 40-70% HRR, 11-14 RPE Borg Scale, 2-4 CR10 scale
T: 20-30 minutes conditioning
T: Aerobic endurance training

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16
Q

What is the ultimate goal of Phae lll?

A

Achieve 20 minutes of cotinous aerobic endurance activity

17
Q

What are the subjective and objective measure of intensity used during Phase lll?

A
Subjective:
1) Observation
2) Signs and symptoms of overexertion (dyspnea)
3) Loss of coordinated movement
4) RPE
Objective:
1) Blood pressure
2) Heart rate
3) MET level achieved
18
Q

Outline 7 safety considerations of cardiac rehabilitation?

A

1) Staff to patient ratio: Usually 5:1
2) Room size: Large for good ventilation and freedom to move
3) Temperature (18-22C) and Humidity (65%)
4) 15 minutes post-exercise obsevation
5) EAP should be available
6) Drinking water available throughout
7) Defibrillator on site and excess to a telephone in case of emergency

19
Q

What is a typical home program and how is compliance achieved?

A
  • 30 minutes of walking RPE 2-4 or 11-14 to achieve recommended 3 times a week
  • Compliance can be achieved using a exercise log
20
Q

What are the 7 key education topics used in Phase lll?

A

1) Heart disease procedures and relevant investigations
2) Risk factors for CHD
3) Effects and benefits of exercise
4) Diet
5) Medication
6) Relaxation
7) Stress management

21
Q

Outline the significance of Psychological aspects of rehab

A
  • 34% reduction in cardiac mortality when psychological intervention was utilised in conjunction with PT
  • Depression associated with 3-4 fold increase
  • Psychological distress has 4 fold increase in hospital cost
22
Q

What are the typical psychological assessments used?

A
  • Hospital anxiety and depression scale (HADS)
  • SF 36
  • Dartmouth Coop
  • MacNew
23
Q

What are 6 typical tools used to address patients’ psychological issues?

A

1) Cognitive behavioural techniques
2) Individual Counselling
3) Motivational interviewing
4) Relaxation
5) Stress management
6) Referral to clinical psychologist or other trained professional

24
Q

What is the 8 criteria required for discharge from Phase lll

A

1) Exercise independently, safely and effectively
2) Monitor own intensity
3) Recognise warning signs/symptoms and take action (GTN)
4) Identify specific goals for long term maintenance
5) Identify goal relating to psychological interventions
6) Demonstrate knowledge of their condition
7) Demonstrate compliance with home-based activity
8) Typically a functional capacity of 5 METs (not essential though)

25
Q

What are the issues considered in a patients long term management plan with the cardiac rehab team?

A
  • Who will monitor risk factors
  • Details of medical follow up
  • Details of venues for Phase lV
  • Advice on long term exercise
  • Details on services available for information and support
  • Plan for potential relapse
  • Local support group information
  • Contact details for cardiac rehab team
  • Importance of social support