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Cardio Unit 2 > Week 7 - Cardiac Rehab > Flashcards

Week 7 - Cardiac Rehab Flashcards

1
Q

Phase 1 of cardiac rehab

A

Inpatient covered by DRG

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2
Q

Phase II

A

Outpatient with monitoring —> EKG at all times
Covered by good plans 1 up to 8-12 weeks

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3
Q

Phase III

A

Outpatient with less individual monitoring
Not covered by most places

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4
Q

Phase IV

A

Independent maintenance program (never covered by insurance)

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5
Q

Goals of Inpatient CR one stabilized medically

A

Mobilize ASAP to prevent effects of bed rest
Educate - risk factors, s/s of CAD, ex tolerance, ex benefits
Progressive activity - 4 MET level
Normal hemodynamic response
Patient psychologically prepared to return home
Independent in HEP & self-monitoring of response to exercise

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6
Q

Responsibilities of the PT

A

Assess physiologic responses
Supervising exercise program
Accurately char and record pt program and response to treatment
Assist in pt and fam education
Prepare the pt for discharge and HEP
Adjusting protocol to optimize it for pt

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7
Q

When is exercise not initiated when it comes to resting HR for phase I?

A

> 120 bpm if medical tx (MI)
130 if surgical tx

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8
Q

Exercise intensity decreased if HR increases …

A

20 bpm if medical tx
30 bpm if surgical tx

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9
Q

When is exercise ceased in phase I of inpatient cardiac rehab

A

If HR fails to increase with an increase in activity level
** HR may be increased in anticipation of exercise**

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10
Q

Why would you use RPE?

A

For anyone whose HR response isn’t a reliable indicator
Pt post-cardiac transplant
Those w most types of pacemakers
Those using beta blockers

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11
Q

Equivalent of 20/30 rule for RPE in phase I inpatient cardiac rehab

A

12 to 13 or increase of 2 or 3 on 7-20 borg scale

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12
Q

When is exercise not initiated w/o specific approval by physician when it comes to BP?

A

Resting SBP exceeds 200 mmHg
Resting DBP exceeds 110 mmHg

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13
Q

General rules of progression

A

Pt response to exercise guides progression
Activity increased from: AAROM, AROM, AROM w/ trunk
Position progressed from reclined to sitting to standing
Bedrest to 10-25’ w assistance at bed, to 50-100’ in hall to 900’ or more w PT supervision
Pt performs shorter distances w/in unit w visual and telemetry monitoring w/o PT

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14
Q

Expected Outcomes by the time of discharge from phase I CR

A

Ascend and descend two fights of stairs w/o adverse symptoms
Ambulate > 1000’ w/o adverse symptoms
Independently perform exercise program
Demonstrate understanding of limits, precautions and be able to self-monitor responses to exercise

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15
Q

Entry points for Outpatient CR (Phase II)

A

Shortly following hospitalization for MI, CABG or PCI
May be 1-2 wks or several weeks post-DC from acute care
Outpatients being managed medially
May also be used as a supervised exercise program w/o MI or CAD w/o MI

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16
Q

Outpatient Cardiac Rehab

A

Close supervision w medical personnel and equipment on site
3 visits per week for 12 weeks
Some programs more flexible
Pts monitored visually and by telemetry

17
Q

Phase III Cardiac rehab

A

Outpatient
Functional capacity at least 5 METS
No direct medical supervision
Less structured
More individualized
Self-monitoring of response to exercise
Components must be rolled into end of Phase II

18
Q

Phase IV Cardiac Rehab

A

Outpatient
Maintenance or improvement from phase II and III
Not distinguishable from non cardiac population
Not supervised by PT
Program can be set up by the PT for the client to follow
Must also roll this component into end of “phase II”

19
Q

Exercise Prescription for all Outpt Phases

A

Select activities the patient enjoys
Incorporate aerobic, flexibility and strengthening
Progress as tolerance improves within limitations of condition
Education and communication continues to be essential

20
Q

Resistance exercise

A

Pt must first show normal response to aerobic exercise
Large muscle group
Weights that can be lifted for at least 20 reps
Weight increased when they reach 30 reps

21
Q

Education sessions

A

Exercise independently
Choose foods wisely
Take and monitor the effects of meds

22
Q

Modes of exercise for outpatient cardiac rehab

A

Three groupings based upon reliability of cardiac demand of activity both over time and across patients
Treadmill is most reliable within and among patients
Games are least reliable both within and among patient

23
Q

Group 1 exercise for outpatient cardiac rehab

A

Constant intensity
Low variation from person to person
Treadmill and cycle, rowing and other ergometers
Potential for boredom

24
Q

Group 2 for exercise for outpatient cardiac rehab

A

Intensity can vary based on skill level and over time
Swimming
Running or cycling
Cross-country skiing

25
Q

Group 3 for exercise for outpatient cardiac rehab

A

Intensity varies over time and w skill level
Provides variety
Suitable for low-risk patient/clients only
Sports and games
More useful for phase III or IV than II
Risk of MSK or CV injury

26
Q

Intensity of prescribed tolerated exercise

A

Mortality related to max intensity
Large increase in mortality between 7 and 6 METS
Progress patient to high levels when deemed safe (using GXT)

27
Q

Prudently aggressive

A

High enough to increase exercise tolerance, VO2 max (>70%) but low enough to be safe (40%)
Prescribing intensity is easy for low risk or high risk and difficult for moderate risk

28
Q

Prescribing activity by METs

A

Prescribe home exercise for low risk individuals to add variety/alleviate boredom
Restrict activities to safe MET level for moderate and high risk
Some lighter home activities can be prescribed immediately for moderate and high risk patients

29
Q

HIIT

A

Intersperse intervals of exercise >85% of peak HR or workload w periods of low intensity exercise intervals (or rest)
Can mimic real life

30
Q

HIIT qualities vs MICE

A

Mod to high intensity continuous exercise can reduce all-cause mortality
Appears safe and better tolerated by patients compared to MICE
Gives rise to many short and long term central and peripheral adaptations
Elicits greater changes in VO2peak
Increases risk factor control in diabetes, dyslipidemia, overweight and HTN

31
Q

What is a strong independent predictor of morbidity/mortality in pts w/CAD and HF

A

VO2 peak

32
Q

Benefits of HIIT vs MICE

A

HTN and CAD: greater improvement in VO2peak
MI: no different between low volume and high volume
Cardiac rehab: HIIT group did not experience any cardiac arrhythmias or excessive HR responses - safe intervention

33
Q

When to start HIIT

A

For coronary pts w non altered ejection fraction and exercise tolerance >5 METS, introduce HIIT using 2 sessions at 60% of peak power output
If tolerated, workload increased to 80%
In case of altered ejection fraction and/or low exercise tolerance, usually start w minimum of 2 wks or 8-10 sessions in continuous mode before starting HIIT

Cardio Unit 2 (13 decks)

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