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Cardio 2 > acute care plan > Flashcards

acute care plan Flashcards

1
Q

what is Primary Prevention

A

Active intervention for risk factors that cause cardiovascular disease

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2
Q

who are candidates​ fro primary prevention

A

individuals who are at moderate or high risk of developing cardiovascular disease and with family histories of CVD

high prevalence of modifiable risk factors

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3
Q

what are the two problems with primary prevention

A

compliance

lack of payment for services

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4
Q

Risk factors affected by primary prevention

A

high cholesterol,
aerobic capacity,
exercise tolerance,
weight,
resting
BP,
glucose,
well-being,
stress tolerance

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5
Q

Components of primary prevention program

A
  • Therapeutic exercise—aerobic and resistance
  • Dietary counseling
  • Stress management or biofeedback
  • Smoking cessation
  • Pharmacological management
  • Education and self-management techniques
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6
Q

Types of Cardiac Rehab Programs

A

Rehab of patients with cardiovascular disorders

Cardiac rehab

Formal Cardiac Rehab Program

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7
Q

what is a Formal Cardiac Rehab Program

A

Formal multidisciplinary program in outpatient, includes exercise, education and lifestyle modification, covered by Centers for Medicare and Medicaid

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8
Q

who can provide cardiac rehab

A

Can be provided by a number of medical professionals including
physical therapists and exercise physiologists

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9
Q

Phase I of cardiac rehab

A

Acute or hospital phase

This phases begins when a patient is considered to be medically stable after the CV event

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10
Q

Phase 2 of cardiac rehab

A

Early outpatient phase/ Intensive Monitoring

Begins after discharge and lasts 6 to 12 weeks

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11
Q

Phase 3 of cardiac rehab

A

Training or maintenance phase

Begins at end of Phase II; patients exercise in larger groups

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12
Q

Phase 4 of cardiac rehab

A

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

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13
Q

the importance of early mobilization​ in cardiac pt

A

Early mobilization of acute coronary patient to activity reduces complications and improves mortality rate

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14
Q

Poor candidates for rehabilitation

A
  • 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
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15
Q

when is the Initial assessment/examination of cardiac pt done

A

when the pt is consider stable

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16
Q

what is included in the Initial assessment/examination

A
  • Chart review
  • Patient–family interview
  • Physical examination
  • Activity (self-care) and ambulation evaluation (ADL monitor)
  • Ambulation activity
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17
Q

acute phase - Indications for an unmodified program

A

Patients who demonstrate appropriate hemodynamic, ECG, and symptomatic responses to self-care and ambulation evaluation

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18
Q

acute pahse - Indications for a modified program

A

Program is modified for persons designated as “complicated”

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19
Q

acute phase​ - Indications for withholding a program

A

Criteria that exclude patients from participation until instability improves

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20
Q

heart rate increase to stop during acture phase

A

great the 50 bpm increase

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21
Q

BP that will cause a stop in therpy in acute phase

A

BP indicative of hypertension SBP >210 or DBP>110 mmHg

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22
Q

systolic blood pressure the contradicts therapy​ during acute phase

A

drop of 10 mmHg SBP

HTN : BP>210 mmHg

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23
Q

Relative contraindications to continuing exercise during acute phase

A

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

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24
Q

Information that should be included in patient education - PT related

A
  • General activity guidelines and home exercise program*
  • Role of exercise*
  • Self-monitoring techniques*
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25
Q

Outcome measures in acute phase

A

Due to limited hospital stay in the acute phase, outcomes expected are based on the functional limitations or disabilities

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26
Q

what is the aim of cardiac​ rehab

A

Aim is to reduce subsequent CV- related morbidity and mortality

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27
Q

do Patient who do not have a place to attend for rehabilitation or do not qualify still qualify for out pt rehab

A

yes

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28
Q

Traditionally, patient groups for cardiac rehab include

A

complicated/uncomplicated MI,
heart failure,
angioplasty,
heart transplant,
stable angina,
post-bypass, or
valve replacement

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29
Q

Candidates for home based Cardiac rehab

A
  • heart disease & uncomplicated hospital course (low-risk) and considered to be
  • unable to travel to the program
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30
Q

Exercise rehabilitation has made po​sitive impact on what aspect of cardiac disease in cardiac rehab

A
  • Risk factors
  • Functional capacity
  • Cardiovascular efficiency
  • Cardiac mortality rate
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31
Q

Interventions Utilized in the Outpatient Cardiac Rehabilitation Setting

A
  • Therapeutic exercice
    Aerobic training, resistance training, flexibility
    training, circuit training
  • Patient instruction/education
  • Coordination/communication
32
Q

Recommendations for Aerobic Training - mode

A

functional and fun

33
Q

Recommendations for Aerobic Training - Intensity

A

establishing a target heart rate, use RPE or dyspnea scale to gauge

34
Q

Recommendations for Aerobic Training - Duration

A

interval training of 2-5 mins, build to continuous 30-45 mins

35
Q

Recommendations for Aerobic Training - freq.

A

higher frequency to make true CV changes, 5- 7d/wk

36
Q

Formulas for calculating predicted and target heart rates - general population

A

220- age = PMHR

37
Q

Formulas for calculating predicted and target heart rates - Fit individuals older than 40

A

205 – age = PMHR

38
Q

what is HIIT training

A

alternating bouts of moderate and vigorous intensity exercise

39
Q

what type in intensity​ is used for most cardiac programs

A

moderate intensity

40
Q

what does moderate intensity look like

A
  • Relative scale: 5 or 6 on a scale of 0 to 10
  • Example: brisk walking
41
Q

what does vigorous​ intensity look like

A
  • Relative scale: begins at a 7 to 8 on a scale of 0 to 10
  • Example: running or jogging
42
Q

what is the talk test

A

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.

43
Q

Resistance exercise training CR

A

30-50% 1RM with 8-10
reps each mm group

44
Q

how long to wait for strength training - MI

A

5 weeks

45
Q

how long to wait for strength training - bypass

A

8 weeks

46
Q

how long to wait for strength training - post-PTCA

A

2 weeks

47
Q

Program progression in cardiac rehab

A

duration then intensity/mode

consider:
* Altitude
* Cold vs Heat and humidity

48
Q

Early intervention education

A

Education about problem of CAD plays significant role in preventing further cardiovascular disease

49
Q

weight and cardiac disease

A

Obesity is a significant risk factor for coronary artery disease

50
Q

Low-density lipoprotein (LDL) high risk for cardiac issue

A

> 100
175

51
Q

Legal problems stem from two aspects in CR

A
  • Adverse effects of medically prescribed exercise testing and fitness conditioning
  • Consideration of disability pension and insurance benefits that may influence patient’s motivation
52
Q

Covered Diagnoses for CR

A
  • Acute MI within 12 months
  • CABG or PTCA
  • heart transplant
  • Stable angina
  • HF with EF<35% (recently added in 2014)
53
Q

what is CONDITION A

A
  • cardiac or respiratory arrest requiring cardiopulmonary resuscitation
  • unresponsive
  • without a pulse
54
Q

what is CONDITION C

A
  • Pre-code to condition A
  • unstable
  • needs RAPID evaluation and/or treatment by medical team
55
Q

what do you do with a pulseless condition A pt

A
  • Assess situation and establish unresponsiveness
  • Call for assistance
  • Begin CPR
56
Q

Condition C - respiratory RR

A

Rate over 36 or less than 8/min

57
Q

Condition C - respiratory pulse ox

A

New pulse ox reading less than 85%
* unless patient has chronic hypoxemia

58
Q

Condition C - respiratory breathing

A

New onset of difficulty breathing

59
Q

Condition C - cardiac HR

A

less than 40 or over 140/min with new symptoms,

any rate over 160

60
Q

Condition C - BP sytolic ​

A

less than 80 or over 200 systolic

61
Q

Condition C - BP diastolic

A

over 110 diastolic with symptoms
* neuro change, chest pain, difficulty breathing

62
Q

condition C - neuro change

A
  • Acute loss of consciousness
  • New onset lethargy, difficulty walking
  • Sudden collapse
  • Seizure
  • Sudden loss of movement (or weakness) of face, arm or leg
63
Q

during a codition C what to do until the team arrives

A
  • Take vitals
  • Position patient
  • Maintain BLS
  • Apply AED (if appropriate)
64
Q

Potential Life-Threatening Situations

A
  • Seizures
  • Pre-syncope and Syncope * Falls
  • Acute dyspnea
  • Hypoglycemia
65
Q

seizure and airway

A

make sure to maintain an open airway

66
Q

do you restrain someone when they are haveing a seizure

A

no

67
Q

seizure and pt mouth

A

Do not try to open the victim’s mouth or try to place any object between the victim’s teeth or in the mouth.

68
Q

what normally​ happens after a seizure

A

It is not unusual for the victim to be unresponsive or confused for a short time after a seizure.

69
Q

what is syncope

A

Syncope is a transient loss of consciousness that results from global cerebral hypoperfusion.

70
Q

Pre-syncope signs

A
  • Pallor
  • Sweating
  • Lightheadedness * Visual changes
  • Weakness
71
Q

what do you do when you recognize​ pre syncope

A
  • Rapid first aid treatment could improve symptoms or prevent syncope from occurring

assume safe position

72
Q

counter-pressure maneuvers for pre syncope

A

handgrip, arm tensing, abdominal muscle tensing, leg crossing with tensing, squatting, and neck flexion.

May reduce symptoms of presyncope and prevent syncope

73
Q

Respiratory Distress signs and symptoms

A
  • Abnormal breathing (shallow, labored, noise) or respiratory rate
  • Cyanosis
  • Nasal flaring
  • Decreased level of consciousness
  • Restlessness
74
Q

Acute Dyspnea - Immediate Actions

A
  • 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
75
Q

symptoms of hypoglycemia

A
  • confusion
  • altered behavior
  • diaphoresis
  • tremulousness (trembling or tremors)
76
Q

what are low glucose levels

A

70 and below

Cardio 2 (12 decks)

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