acute care plan Flashcards
what is Primary Prevention
Active intervention for risk factors that cause cardiovascular disease
who are candidates fro primary prevention
individuals who are at moderate or high risk of developing cardiovascular disease and with family histories of CVD
high prevalence of modifiable risk factors
what are the two problems with primary prevention
compliance
lack of payment for services
Risk factors affected by primary prevention
high cholesterol,
aerobic capacity,
exercise tolerance,
weight,
resting
BP,
glucose,
well-being,
stress tolerance
Components of primary prevention program
- Therapeutic exercise—aerobic and resistance
- Dietary counseling
- Stress management or biofeedback
- Smoking cessation
- Pharmacological management
- Education and self-management techniques
Types of Cardiac Rehab Programs
Rehab of patients with cardiovascular disorders
Cardiac rehab
Formal Cardiac Rehab Program
what is a Formal Cardiac Rehab Program
Formal multidisciplinary program in outpatient, includes exercise, education and lifestyle modification, covered by Centers for Medicare and Medicaid
who can provide cardiac rehab
Can be provided by a number of medical professionals including
physical therapists and exercise physiologists
Phase I of cardiac rehab
Acute or hospital phase
This phases begins when a patient is considered to be medically stable after the CV event
Phase 2 of cardiac rehab
Early outpatient phase/ Intensive Monitoring
Begins after discharge and lasts 6 to 12 weeks
Phase 3 of cardiac rehab
Training or maintenance phase
Begins at end of Phase II; patients exercise in larger groups
Phase 4 of cardiac rehab
Disease prevention program
Individuals are at high risk for infarction because of risk factors; also includes those who continue to want to be seen in a supervised environment
the importance of early mobilization in cardiac pt
Early mobilization of acute coronary patient to activity reduces complications and improves mortality rate
Poor candidates for rehabilitation
- Overt CHF, unstable angina pectoris, hemodynamic instability, serious arrhythmias, conduction defects, impaired function of other organ systems
- Uncontrolled hypertension
- Other diseases or illnesses that preclude exercise
when is the Initial assessment/examination of cardiac pt done
when the pt is consider stable
what is included in the Initial assessment/examination
- Chart review
- Patient–family interview
- Physical examination
- Activity (self-care) and ambulation evaluation (ADL monitor)
- Ambulation activity
acute phase - Indications for an unmodified program
Patients who demonstrate appropriate hemodynamic, ECG, and symptomatic responses to self-care and ambulation evaluation
acute pahse - Indications for a modified program
Program is modified for persons designated as “complicated”
acute phase - Indications for withholding a program
Criteria that exclude patients from participation until instability improves
heart rate increase to stop during acture phase
great the 50 bpm increase
BP that will cause a stop in therpy in acute phase
BP indicative of hypertension SBP >210 or DBP>110 mmHg
systolic blood pressure the contradicts therapy during acute phase
drop of 10 mmHg SBP
HTN : BP>210 mmHg
Relative contraindications to continuing exercise during acute phase
activity of angina, excessive dyspnea, excessive fatigue, mental confusion, dizziness, severe leg claudication, signs of pallor, cold sweat, ataxia, changing heart sounds with activity, changing lung sounds with activity, ECG abnormality
Information that should be included in patient education - PT related
- General activity guidelines and home exercise program*
- Role of exercise*
- Self-monitoring techniques*
Outcome measures in acute phase
Due to limited hospital stay in the acute phase, outcomes expected are based on the functional limitations or disabilities
what is the aim of cardiac rehab
Aim is to reduce subsequent CV- related morbidity and mortality
do Patient who do not have a place to attend for rehabilitation or do not qualify still qualify for out pt rehab
yes
Traditionally, patient groups for cardiac rehab include
complicated/uncomplicated MI,
heart failure,
angioplasty,
heart transplant,
stable angina,
post-bypass, or
valve replacement
Candidates for home based Cardiac rehab
- heart disease & uncomplicated hospital course (low-risk) and considered to be
- unable to travel to the program
Exercise rehabilitation has made positive impact on what aspect of cardiac disease in cardiac rehab
- Risk factors
- Functional capacity
- Cardiovascular efficiency
- Cardiac mortality rate
Interventions Utilized in the Outpatient Cardiac Rehabilitation Setting
- Therapeutic exercice
Aerobic training, resistance training, flexibility
training, circuit training - Patient instruction/education
- Coordination/communication
Recommendations for Aerobic Training - mode
functional and fun
Recommendations for Aerobic Training - Intensity
establishing a target heart rate, use RPE or dyspnea scale to gauge
Recommendations for Aerobic Training - Duration
interval training of 2-5 mins, build to continuous 30-45 mins
Recommendations for Aerobic Training - freq.
higher frequency to make true CV changes, 5- 7d/wk
Formulas for calculating predicted and target heart rates - general population
220- age = PMHR
Formulas for calculating predicted and target heart rates - Fit individuals older than 40
205 – age = PMHR
what is HIIT training
alternating bouts of moderate and vigorous intensity exercise
what type in intensity is used for most cardiac programs
moderate intensity
what does moderate intensity look like
- Relative scale: 5 or 6 on a scale of 0 to 10
- Example: brisk walking
what does vigorous intensity look like
- Relative scale: begins at a 7 to 8 on a scale of 0 to 10
- Example: running or jogging
what is the talk test
As a rule of thumb, a person doing moderate-intensity aerobic activity can talk, but not sing, during the activity.
A person doing vigorous-intensity activity cannot say more than a few words without pausing for a breath.
Resistance exercise training CR
30-50% 1RM with 8-10
reps each mm group
how long to wait for strength training - MI
5 weeks
how long to wait for strength training - bypass
8 weeks
how long to wait for strength training - post-PTCA
2 weeks
Program progression in cardiac rehab
duration then intensity/mode
consider:
* Altitude
* Cold vs Heat and humidity
Early intervention education
Education about problem of CAD plays significant role in preventing further cardiovascular disease
weight and cardiac disease
Obesity is a significant risk factor for coronary artery disease
Low-density lipoprotein (LDL) high risk for cardiac issue
> 100
175
Legal problems stem from two aspects in CR
- Adverse effects of medically prescribed exercise testing and fitness conditioning
- Consideration of disability pension and insurance benefits that may influence patient’s motivation
Covered Diagnoses for CR
- Acute MI within 12 months
- CABG or PTCA
- heart transplant
- Stable angina
- HF with EF<35% (recently added in 2014)
what is CONDITION A
- cardiac or respiratory arrest requiring cardiopulmonary resuscitation
- unresponsive
- without a pulse
what is CONDITION C
- Pre-code to condition A
- unstable
- needs RAPID evaluation and/or treatment by medical team
what do you do with a pulseless condition A pt
- Assess situation and establish unresponsiveness
- Call for assistance
- Begin CPR
Condition C - respiratory RR
Rate over 36 or less than 8/min
Condition C - respiratory pulse ox
New pulse ox reading less than 85%
* unless patient has chronic hypoxemia
Condition C - respiratory breathing
New onset of difficulty breathing
Condition C - cardiac HR
less than 40 or over 140/min with new symptoms,
any rate over 160
Condition C - BP sytolic
less than 80 or over 200 systolic
Condition C - BP diastolic
over 110 diastolic with symptoms
* neuro change, chest pain, difficulty breathing
condition C - neuro change
- Acute loss of consciousness
- New onset lethargy, difficulty walking
- Sudden collapse
- Seizure
- Sudden loss of movement (or weakness) of face, arm or leg
during a codition C what to do until the team arrives
- Take vitals
- Position patient
- Maintain BLS
- Apply AED (if appropriate)
Potential Life-Threatening Situations
- Seizures
- Pre-syncope and Syncope * Falls
- Acute dyspnea
- Hypoglycemia
seizure and airway
make sure to maintain an open airway
do you restrain someone when they are haveing a seizure
no
seizure and pt mouth
Do not try to open the victim’s mouth or try to place any object between the victim’s teeth or in the mouth.
what normally happens after a seizure
It is not unusual for the victim to be unresponsive or confused for a short time after a seizure.
what is syncope
Syncope is a transient loss of consciousness that results from global cerebral hypoperfusion.
Pre-syncope signs
- Pallor
- Sweating
- Lightheadedness * Visual changes
- Weakness
what do you do when you recognize pre syncope
- Rapid first aid treatment could improve symptoms or prevent syncope from occurring
assume safe position
counter-pressure maneuvers for pre syncope
handgrip, arm tensing, abdominal muscle tensing, leg crossing with tensing, squatting, and neck flexion.
May reduce symptoms of presyncope and prevent syncope
Respiratory Distress signs and symptoms
- Abnormal breathing (shallow, labored, noise) or respiratory rate
- Cyanosis
- Nasal flaring
- Decreased level of consciousness
- Restlessness
Acute Dyspnea - Immediate Actions
- Maintain clear airway and place patient in comfortable breathing position.
- Observe and evaluate (vitals), suction if needed
- Notify appropriate personnel, call a code/911 if appropriate
symptoms of hypoglycemia
- confusion
- altered behavior
- diaphoresis
- tremulousness (trembling or tremors)
what are low glucose levels
70 and below
