Cardaic Rehab Flashcards
Cardiac rehab is a
comprehensive exercise education, and bx modification program
Cardiac rehab is designed to
improve physical and emotional condition of a pt with heart disease
Cardiac rehab is prescribed to do what
control symptoms, improve exercise tolerance, and improve overall quality of life
Cardiac rehab - primary goal
enable the participant to achieve his/her optimal physical, psychological, social and vocational function through exercise training and lifestyle change
T of F Cardiac rehab is medically supervised
True - need to have a medical director for it - often a physician but can be a PA too
Goals of cardiac rehab (6)
Limit physiologic and psychological effects
Reduce sudden death or re-infarct
Sx control
Stabilize atherosclerotic process
Enhance psychosocial and vocational status
Improve independence with ADLs
Practitioners involved in cardiac rehab
Physicians Nurses Exercise physiologists PTs OTs Dieticians Psychologists Behavioral medicine specialists
Eligible patients
s/p MI s/p angioplasty (PTCA) s/p pacemaker insertion s/p CABG s/p valve repair or replacement s/p heart transplant Stable CHF CAD and stable angina Heart failure and those with LVAD DM PVD PAD
Phase 1 occurs where
inpatient - acute
Phase 1 starts when
usually 24 hours post surgery or 2-4 days post MI
Patient must be pain free for 24 hours
Phase 1 - general focus
gradual transition from PROM to AROM and low intensity, short duration ambulation
Phase 1 - ADLs
incorporated as the pts exercise tolerance improves
Phase 1 - what happens prior to hospital discharge
graded low level exercise test (modified bruce protocol)
Contraindications for entry into inpatient and outpatient cardiac rehab - resting BP
Systolic over 200
Diastolic over 110
Contraindications for entry into inpatient and outpatient cardiac rehab - orthostatic BP drop
over 20 mmHg with symptoms
Contraindications for entry into inpatient and outpatient cardiac rehab - aortic stenosis
moderate or severe aortic stenosis
Contraindications for entry into inpatient and outpatient cardiac rehab - angina
Unstable angina
Contraindications for entry into inpatient and outpatient cardiac rehab - fever
acute systemic illness or fever of over 101
Contraindications for entry into inpatient and outpatient cardiac rehab - dysrhythmias
uncontrolled atrial or ventricular dysrhythmias uncontrolled tachycardia (over 120 bpm at rest)
Contraindications for entry into inpatient and outpatient cardiac rehab - CHF
uncontrolled CHF
Contraindications for entry into inpatient and outpatient cardiac rehab - AV block
3rd degree AV block - after something gets put in though they can - but while they have the 3rd degree AV block = no
Contraindications for entry into inpatient and outpatient cardiac rehab - infection
active infection like pericarditis or myocarditis
Contraindications for entry into inpatient and outpatient cardiac rehab - diabetes
uncontrolled diabetes - A1C above 10% (like higher than 200)
Contraindications for entry into inpatient and outpatient cardiac rehab - misc.
Thrombophlebitis
Recent embolism (PE)
Orthopedic problems that would prohibit exercise
Adverse response to inpatient exercise that would make you need to alert the physician
DBP at or over 110 Dec SBP more than 10 with exercise dysrhythmias with or w/o sx 2 or 3 AV block angina, marked dyspnea, ECG changes
Risk stratification - assists in determining what
type and duration of supervision and frequency of monitoring
If they need further monitoring and how much you can progress them with phase 2 and 3
Risk stratification - low
uncomplicated clinical course
no evidence of ischemia
Risk stratification - low - functional capacity
over 6 METS, 3 weeks post event
Risk stratification - low - EF
normal (over 50%)
Find out with echocardiogram
Risk stratification - moderate (3)
Mod to good EF (40-49%)
Angina at moderate levels of exercise (5-6.9 METS) ?
Those who don’t meet criteria for low or high
Risk stratification - high
MI involving more then 35% of LV Fall in SBP or failure of it to rise Ventricular ectopy (PVC) CHF more than 2 mm ST segment depression with exercise test
Risk stratification - high - EF
Less than 40% at rest
Risk stratification - high - functional capacity
Less than 5 METS with hypotensive BP response or more than 1 mm of ST segment depression
Goals of inpatient program
Prevent advanced effects of bedrest
Improve pulmonary function and prevent complications
Evaluate pt response to activity
Establish functional level for home activity
Pt and family education
Reduction in smoking
Improve psychosocial well being and reduce stress
Assess safety to perform activities
Medical hx - need to gather info about
age, sex, reason for admission
hx of present illness and current presentation
medications
lab results
cardiac cath results
risk factors
social history - who are they going to live with and where are they going
Subjective physical exam includes info about
previous and present physical activity level
patient’s goals
Objective physical exam includes info about
appearance, alertness, orientation breathing pattern are they in any distress BS cough vvitals ROM