5: Phase I Cardiac Rehab Flashcards
What types of patients are in Phase I rehab?
MI, post-op are most common. Can also include new onset arrhythmias, CHF exacerbations, syncope
What are the three goals of Phase I rehab?
- Develop plan of management for disease or symptoms and ensure a safe response to activity at home
- Prevent effects of bed rest
- Protect heart while in injury recovery stage
How long is the injury recovery stage?
Up to 6 weeks
What activity level should a pt be at when they finish Phase I rehab?
Exercise at 2-3 METS up to 15-20 minutes per day
A pt should be able to perform a submax stress test at what level when exiting Phase I rehab?
4-6 METS ideally, but will probably be 2-3
How do you monitor exercise tolerance or response to activity?
HR, BP, RPE, talk test
Describe pt presentation of an uncomplicated, low risk MI
Small to moderate infarct size, stable EKG by the end of the 4th day
What is the normal hospital course for a pt with an uncomplicated MI with low risk?
5 days with gradual increase in low level aerobic exercise, functional activities, transition to phase II rehab
What tests will be done on a pt with an uncomplicated MI that is low risk and why?
Stress test, angio, echo to determine the level of the blockage and determine further treatment
What will a uncomplicated MI low risk pt be discharged to?
HEP
What three things would put a pt in the uncomplicated MI with moderate-high risk subgroup?
- Low ventricular function (EF 30-45%)
- Ischemia with low level activity
- Occasional EKG changes
What will a uncomplicated MI with moderate-high risk pt be discharged to?
Close follow-ups, Phase II rehab or home program
What type of infarcts will people in the complicated MI with high risk subgroup experience?
Large area or thickness of myocardium
Describe a pt in the complicated MI with high risk subgroup?
EKG changes or symptoms persist or exacerbate with exercise, very high BP or signs of unstable angina
What is the typical EF for pts with a complicated MI in the high risk subgroup?
< 30% EF, will likely be candidates for surgery
What is the typical Phase I rehab progression for day 2 after an MI?
Assess physiologic responses to change in position, and low level activity. Educate of RPE
What is the duration of exercise for a pt on day 2 after an MI?
5-7 minutes
What will treatment day 3 after an MI look like?
Reassess responses to activity, review pt education, increase activity duration and initiate unsupervised activity. Add ambulation and general conditioning exercises
What will you progress activity to on treatment day 4 following an MI?
3 METS BID for 5-7 minutes each time
How do you educate a pt on day 4 following an MI?
Self monitoring at home and their transition for a home program
What three things are done on treatment day 5 following an MI
- Assess moderate activity levels with minimal rest for 10-12 minutes
- Low-level stress test up to 5-6 METS
- Discharge
What are the traditional sternal precautions?
- Shoulder flexion 90
- No horizontal ADD or ABD
- No lifting over 5 lbs
- No overhead reaching
What are the current recommended guidelines following sternotomy incisions?
Lifting, pushing, pulling, UE movements inside tube
When can pts move outside of the tube following sternotomy incisions?
4 weeks following surgery
Following CABG and other post-op patients, what will day 1 look like?
- Eval
- Hip flexion, knee flexion and extension, ankle pumps in sitting
- Shoulder flexion < 90, elbow flexion
- SLR, heel slides, hip ABD, ankle pumps in supine
- Incentive spirometer
What will post-op day 2 look like?
- UE exercises in sitting
- LE exercises in standing
- Ambulation is appropriate
- Incentive spirometer
What will post-op day 3 and forward look like?
- UE and LE exercises in standing
- Progress ambulation
- Stairs, home environment
- Incentive spirometer
- HEP and prepare for discharge
What are key things to keep in mind when progressing post-op pt’s?
Monitor vitals, cardiac complaints, duration of exercise
How long should an exercise session be by the time a post-op pt is discharged?
15-20 minutes
What level on the Borg scale should a pt be able to exercise at when they are d/c?
10-12
