CAD Phases (PRE & 1) Flashcards
What does preoperative physical therapy do for patients at increased risk of developing postoperative pulmonary complications (PPC)?
Reduces:
- Mortality rates
- Morbidity (fewer airways infections)
- Duration of ventilation
- Length of hospital stay
When should preoperative physical therapy start and end before open heart surgery?
Preferably start 4 weeks before and conclude on the day before the open heart operation
What are (7) parameters used to screen the risk of developing a PPC?
A 2-point scoring system consisting of:
- Age >70 years
- Productive cough
- Diabetes mellitus
- Smoking
- COPD: FEV1 <75% predicted or requiring medication
- BMI > 27.0 kg/m2
- Lung function: FEV1 <80% predicted and FEV1/FVC <70% predicted
What treatment is applied in preoperative physical therapy?
- Inspiratory muscle trianing (IMT)
- Breathing exercises
- Airway clearance techniques
What are the parameters required for IMT?
The use of a threshold device:
- Resistance: 30% of PI max, adding 5% every week if Borg score (1-10) <5
- Frequency: 7 days a week
- Duration: 20 min per session for 2 weeks, if possible 4 weeks before surgery
What is the intended outcome of preoperative physical therapy?
- An increased PI max (and inspiratory endurance time) measured with a PI max meter
- No detectable pulmonary problems (patient is functionally able to cough up sputum)
What information does the cardiologist provide to the physical therapist in the preoperative phase? (6)
- The diagnosis
- Any comorbidities
- Diagnostic data considered relevant by cardiologist
- Information about the type of surgery
- Hospital admission date
- Planned date of surgery
What information does the cardiologist provide to the physical therapist in the clinical phase? (7)
- Reason for referral
- Date of hospital admission
- Diagnosis
- Date of the event or treatment
- Medication use (type and dosage regime)
- Any complications or comorbidities
- Diagnostic data considered relevant by cardiologist
When is the patient admitted for relative rest at the coronary care unit?
- After an acute cardiac incident
- After their stay at the ICU following open-heart surgery
What therapy may be required during the clinical phase?
Pulmonary physical therapy due to pulmonary and/or respiratory problems
What does pulmonary physical therapy consist of?
- Teaching patients techniques aimed at improving ventilation and mobilizing
- Coughing up suptum (breathing, huffing and coughing techniques)
What should be implemented during the mobilization phase of the clinical phase?
- Dynamic mobilization exercises of the large muscle groups as soon as possible
- These exercises are gradually extended to include walking and stair climbing
What signs does the physical therapist look for?
Signs of strain upon exertion
What (7) signs of strain upon exertion does the physical therapist look for?
- Angina
- Impaired pump function: SOB disproportionate to exertion, abnormal fatigue disproportionate to exertion and increased peripheral / central edema
- Arrythmias: High HR not in proprotion to exertion, irregular heartbeat via changes in known arrythmias
- Abnormal increase or decrease of BP
- Fainting
- Dizziness
- Vegetative reactions (excessive perspiring, pallor)
What does the physical therapist explain to the patient? (5)
- Nature of the patient’s heart disease and/or surgery
- Further course of the rehabilitation program
- Ways of coping with cardiac and other complaints and the disease itself
- Ways to recognize signs of excessive strain
- Way the intensity of activities at home can be gradually increased
