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Cardiopulmonary - Exam I > 5: Phase I Cardiac Rehab > Flashcards

5: Phase I Cardiac Rehab Flashcards

1
Q

What types of patients are in Phase I rehab?

A

MI, post-op are most common. Can also include new onset arrhythmias, CHF exacerbations, syncope

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2
Q

What are the three goals of Phase I rehab?

A
  1. Develop plan of management for disease or symptoms and ensure a safe response to activity at home
  2. Prevent effects of bed rest
  3. Protect heart while in injury recovery stage
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3
Q

How long is the injury recovery stage?

A

Up to 6 weeks

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4
Q

What activity level should a pt be at when they finish Phase I rehab?

A

Exercise at 2-3 METS up to 15-20 minutes per day

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5
Q

A pt should be able to perform a submax stress test at what level when exiting Phase I rehab?

A

4-6 METS ideally, but will probably be 2-3

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6
Q

How do you monitor exercise tolerance or response to activity?

A

HR, BP, RPE, talk test

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7
Q

Describe pt presentation of an uncomplicated, low risk MI

A

Small to moderate infarct size, stable EKG by the end of the 4th day

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8
Q

What is the normal hospital course for a pt with an uncomplicated MI with low risk?

A

5 days with gradual increase in low level aerobic exercise, functional activities, transition to phase II rehab

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9
Q

What tests will be done on a pt with an uncomplicated MI that is low risk and why?

A

Stress test, angio, echo to determine the level of the blockage and determine further treatment

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10
Q

What will a uncomplicated MI low risk pt be discharged to?

A

HEP

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11
Q

What three things would put a pt in the uncomplicated MI with moderate-high risk subgroup?

A
  1. Low ventricular function (EF 30-45%)
  2. Ischemia with low level activity
  3. Occasional EKG changes
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12
Q

What will a uncomplicated MI with moderate-high risk pt be discharged to?

A

Close follow-ups, Phase II rehab or home program

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13
Q

What type of infarcts will people in the complicated MI with high risk subgroup experience?

A

Large area or thickness of myocardium

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14
Q

Describe a pt in the complicated MI with high risk subgroup?

A

EKG changes or symptoms persist or exacerbate with exercise, very high BP or signs of unstable angina

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15
Q

What is the typical EF for pts with a complicated MI in the high risk subgroup?

A

< 30% EF, will likely be candidates for surgery

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16
Q

What is the typical Phase I rehab progression for day 2 after an MI?

A

Assess physiologic responses to change in position, and low level activity. Educate of RPE

17
Q

What is the duration of exercise for a pt on day 2 after an MI?

A

5-7 minutes

18
Q

What will treatment day 3 after an MI look like?

A

Reassess responses to activity, review pt education, increase activity duration and initiate unsupervised activity. Add ambulation and general conditioning exercises

19
Q

What will you progress activity to on treatment day 4 following an MI?

A

3 METS BID for 5-7 minutes each time

20
Q

How do you educate a pt on day 4 following an MI?

A

Self monitoring at home and their transition for a home program

21
Q

What three things are done on treatment day 5 following an MI

A
  1. Assess moderate activity levels with minimal rest for 10-12 minutes
  2. Low-level stress test up to 5-6 METS
  3. Discharge
22
Q

What are the traditional sternal precautions?

A
  • Shoulder flexion 90
  • No horizontal ADD or ABD
  • No lifting over 5 lbs
  • No overhead reaching
23
Q

What are the current recommended guidelines following sternotomy incisions?

A

Lifting, pushing, pulling, UE movements inside tube

24
Q

When can pts move outside of the tube following sternotomy incisions?

A

4 weeks following surgery

25
Q

Following CABG and other post-op patients, what will day 1 look like?

A
  1. Eval
  2. Hip flexion, knee flexion and extension, ankle pumps in sitting
  3. Shoulder flexion < 90, elbow flexion
  4. SLR, heel slides, hip ABD, ankle pumps in supine
  5. Incentive spirometer
26
Q

What will post-op day 2 look like?

A
  1. UE exercises in sitting
  2. LE exercises in standing
  3. Ambulation is appropriate
  4. Incentive spirometer
27
Q

What will post-op day 3 and forward look like?

A
  1. UE and LE exercises in standing
  2. Progress ambulation
  3. Stairs, home environment
  4. Incentive spirometer
  5. HEP and prepare for discharge
28
Q

What are key things to keep in mind when progressing post-op pt’s?

A

Monitor vitals, cardiac complaints, duration of exercise

29
Q

How long should an exercise session be by the time a post-op pt is discharged?

A

15-20 minutes

30
Q

What level on the Borg scale should a pt be able to exercise at when they are d/c?

A

10-12

Cardiopulmonary - Exam I (19 decks)

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