CAD Phases (2) Flashcards
In the rehabilitation phase, where does the cardiologist refer the patient to?
Multidisciplinary cardiac rehabilitation team
What relevant diagnostic cardiologic information (5) is provided?
- Details of hemodynamic stability during and after treatment of event, size and location of infarct and/or left ventricular dysfunction, any remaining ischemia and status of (untreated) coronary arteries
- Arrythmias and conduction defects
- PCIs (number and location(s), fitted with stent)
- Surgical details (CABG/VR)
- Presence/absence implantable cardioverter defibrillator (ICD) or pacemaker
What referral information (6) is provided by the cardiologist?
- (Medical) diagnosis
- Diagnostic cardiologic information
- Data from maximum or symptom limited exerise test
- Any relevant comorbidity
- Prior history (cardiac or non-cardiac)
- Medication (type and dosage)
Screening questions (5) to assess indications for cardiac rehabilitation
- Physical functioning affected or threatened?
- Psychological functioning affected or threatened?
- Social functioning affected or threatened?
- What is the patient’s cardiovascular risk profile?
- Does the patient engage in unhealthy behaviour?
Screening for physical functioning (2)
- Is the patient’s exercise capacity objectively reduced in relation to future functioning?
- Is the patient able to realistically estimate their own current exercise capacity?
Screening for psychological functioning (1)
- Is the patient’s emotional functioning affected (incl. anxiety and/or depression)?
Screening for social functioning (3)
- Is the patient’s social functioning affected and/or is there a lack of social support?
- Does the patient have a caregiver they can rely on?
- Are there problems expected regarding return to work?
Screening for cardiovascular risk profile (4)
- Is the patient overweight or obese?
- Does the patient have high BP?
- Does the patient have diabetes mellitus?
- Does the patient have an elevated blood cholestrol level?
Screening for unhealthy behaviour (3)
- Smoker before hospital admission?
- Meet the Dutch recomm. for healthy physical activity?
- Does the patient drink excessive amounts of alcohol or risk of alcohol dependence?
What are the focal points in history taking during the rehabilitation phase?
- Identifying patient’s presenting problem or target activity level (Use PSC)
- Identifying the patient’s activity level before current health status
- Exploring the patient’s health status
- Assessing the patient’s current status
- Other information (Personal, social, demands made on the patient, motivation and requirements)
History taking exploring the patient’s health status consists of:
- Nature and severity of the complaints (Body function, activities, participation)
- Start, duration and course of the coronary heart disease
- Prognosis and risk factors
- Comorbidities
- Physical activity behaviour
History taking assessing the patient’s current status consists of:
- Functional impairments, activity limitations (PSC) and restrictions of participation associated with the coronary heart disease
- Current general health status
- Internal and external factors
- Current treatment (medication / additional treatment)
With the use of the PSC, the physical therapist can:
Analyze the performance of the problematic activities
The physical therapist assesses
the quality of the patient’s basic motor skills (relevant to the patient) and the degree to which the patient is able to use them
- endurance
- strength
- speed
- coordination
- agility
The problematic activities can be..
..scored in terms of duration and intensity
..scored in fatigue (Borg RPE)
..scored in anxiety, chest pain and dyspnea (scales)
