Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Semester 5 PMCP Exam 4 > Cardaic Rehab > Flashcards

Cardaic Rehab Flashcards

1
Q

Cardiac rehab is a

A

comprehensive exercise education, and bx modification program

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cardiac rehab is designed to

A

improve physical and emotional condition of a pt with heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cardiac rehab is prescribed to do what

A

control symptoms, improve exercise tolerance, and improve overall quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cardiac rehab - primary goal

A

enable the participant to achieve his/her optimal physical, psychological, social and vocational function through exercise training and lifestyle change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

T of F Cardiac rehab is medically supervised

A

True - need to have a medical director for it - often a physician but can be a PA too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Goals of cardiac rehab (6)

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Practitioners involved in cardiac rehab

A 
Physicians
Nurses
Exercise physiologists
PTs
OTs
Dieticians
Psychologists
Behavioral medicine specialists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Eligible patients

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Phase 1 occurs where

A

inpatient - acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Phase 1 starts when

A

usually 24 hours post surgery or 2-4 days post MI

Patient must be pain free for 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Phase 1 - general focus

A

gradual transition from PROM to AROM and low intensity, short duration ambulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Phase 1 - ADLs

A

incorporated as the pts exercise tolerance improves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Phase 1 - what happens prior to hospital discharge

A

graded low level exercise test (modified bruce protocol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - resting BP

A

Systolic over 200

Diastolic over 110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - orthostatic BP drop

A

over 20 mmHg with symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - aortic stenosis

A

moderate or severe aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - angina

A

Unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - fever

A

acute systemic illness or fever of over 101

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - dysrhythmias

A 
uncontrolled atrial or ventricular dysrhythmias
uncontrolled tachycardia (over 120 bpm at rest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - CHF

A

uncontrolled CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - AV block

A

3rd degree AV block - after something gets put in though they can - but while they have the 3rd degree AV block = no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - infection

A

active infection like pericarditis or myocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - diabetes

A

uncontrolled diabetes - A1C above 10% (like higher than 200)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - misc.

A

Thrombophlebitis
Recent embolism (PE)
Orthopedic problems that would prohibit exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
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 ```
26
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
27
Risk stratification - low
uncomplicated clinical course | no evidence of ischemia
28
Risk stratification - low - functional capacity
over 6 METS, 3 weeks post event
29
Risk stratification - low - EF
normal (over 50%) | Find out with echocardiogram
30
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
31
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 ```
32
Risk stratification - high - EF
Less than 40% at rest
33
Risk stratification - high - functional capacity
Less than 5 METS with hypotensive BP response or more than 1 mm of ST segment depression
34
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
35
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
36
Subjective physical exam includes info about
previous and present physical activity level | patient's goals
37
Objective physical exam includes info about
``` appearance, alertness, orientation breathing pattern are they in any distress BS cough vvitals ROM ```
38
treatment - avoid what (phase 1?)
isometric activity - lifting no more than 10 lbs | Push/pull with both arms!!
39
progression of activity
``` walking treadmill stationary bike UE calisthenics stairs ```
40
treatment includes (phase 1)
``` bed exercises gentle UE calisthenics shoulder/neck mobility position changes bed mobility ```
41
frequency phase 1
2 times per day at least
42
intensity phase 1
declared through objective and subjective measurements - is patient dependent
43
duration phase 1
begin with 5 min warm up and cool down | progress duration out of bed 10-15 min and then increase activity as tolerated
44
reasons for modification of exercise
``` pt intolerance drop SBP more than 10 or equal to 200 diastolic over 110 innapropriate bradycardia HR higher than 120 for those with MI HR over 130 for surgical Onset of dysrhythmias ```
45
Phase 1 termination guidelines - heart rate
Post MI = 20 higher than resting | Post CABG = 30 higher than resting
46
Phase 1 termination guidelines - BP
SBP more then 10 mmHg drop SBP higher than 220 DBP higher than 110
47
Phase 1 termination guidelines - RPE
13 or higher
48
Phase 1 termination guidelines - ST
ST segment displacement 3 mm
49
Phase 1 termination guidelines - angina
1 need to stop | do not let them get to 2
50
Phase 1 termination guidelines - dyspnea
2 you are done
51
Phase 1 termination guidelines - pain
severe leg pain - claudication | 8/10 or higher
52
Phase 1 discharge planning
you need to get them ready for home
53
Phase 1 pt education
ADLs Recreation - walking Educate on being in cold and heat
54
precautions - phase 1?
``` no driving 3-4 weeks max lifting 5-10 lbs avoid weather extremes max HR wait 1 hr after eating to exercise no scapular abd or add no unilateral grabbing no pushing up from chair no shoulder flexion or abduction over 90 degrees ```
55
Notify physician if the following occurs
upper body pain/discomfort chronic fatigue faintness or nausea after exercise excessive SOB
56
What if a patient cannot go to a rehab facility
give more extensive discharge instructions keep activity log cardiac rehab member will contact pt every week telemedicine - can check on them via monitor or phone return to doctor 3-6 weeks
57
Home exercise for those that can't attend cardiac rehab
continue walking or stationary bike
58
Training program over 6-12 wks for patients at home
3 min warm up and progress to 5 5 min training and progress to 20 3 min cool down and progress to 5
59
Training program for patients at home - target HR to be
18-24 beats above resting | with warm and cool down - 6 to 12 beats above resting
60
Training program frequency for patients at home
2 times daily for 5-7 days a week
61
Training program for patients at home - activity level determined by
MET level - the amount of oxygen required to sustain an individual in a seated upright position
62
Phase 2 is where
outpatient
63
Phase 2 begins when
when patient is discharged from the hospital and continues for next 6 to 12 weeks
64
Phase 2 - who is present
nurse and PT
65
Phase 2 - description
patients rotate between various exercise stations including treadmill, stiars, arm and leg bike ergometers, rowing machines
66
Phase 2 - how long is the exercise performed at each station
5 minutes at an individually prescribed intensity | Followed by 1 minute of recovery
67
Phase 2 - when do a graded exercise test
depends on patient progress - two to three months after entry into phase 2
68
Phase 2 - with a doctors referral and based on resutls of GXT, patient is instructed in a new exercise program with guidelines - exercise rx by HR
60-70% of VO2 max HR If didn't do GXT go off of 220 minus the age and multiply by 0.6
69
Phase 2 - with a doctors referral and based on resutls of GXT, patient is instructed in a new exercise program with guidelines - METs
60-70% of METs = max METs | Max METs minus 1 = starting point
70
Phase 2 - with a doctors referral and based on resutls of GXT, patient is instructed in a new exercise program with guidelines - by RPE
RPE x 0.6
71
Phase 2 goals
``` improve functional capacity risk factor modification education promote psychosocial well beng develop and assist pt to implement a safe and effective exercise plan provide education to maximize prevention ```
72
Phase 2 frequency
start week 2 of event or 1 to 2 weeks after leaving hospital 4-7 days a week Lasts 6 to 12 weeks
73
Program progression with phase 2 - review how often
every 2 weeks
74
Program progression with phase 2 - CABG - start overhead activity when
Can do UE overhead ROM around 6-8 weeks with dr approval
75
Program progression with phase 2 - strengthening
can do gentle strengthening around 6-8 weeks
76
Program progression with phase 2 - weight training
emphasis on higher rep rather than inc in weight | coordinate with breath
77
Phase 3 - is what type of program
maintenance program! | usually outpatient but depends on the facility
78
Phase 3 - patients are involved in
conditioning activities at an intensity predetermined through graded exercise test
79
Phase 3 - sessions last how long
about an hour
80
Phase 3 - progress measured through
graded exercise test performed annually
81
Phase 3 - in order to enter phase 3 or 4 the patient has to
maintain their precautions self monitor have to have good psychosocial well being
82
Phase 3 - participants are taught to
take their own pulses as a means of judging their exercise intensity and the RPE is used to obtain subjective intensity data
83
Goals of phase 3
exercise training | risk factor modication
84
How long does phase 3 last
6 to 8 weeks beyond phase 2
85
Phase 3 - exercise rx by HR, METs, RPE - what percent
70-85%
86
Phase 4 is what
long term maintenance program
87
Phase 4 - insurance
does not reimburse
88
Evidence for cardiac rehab - For MI, patients who attended 36 sessions showed
most improvement in risk reduction
89
Evidence for cardiac rehab - total mortality decreased
13-27%
90
Evidence for cardiac rehab - | lipids, SBP, smoking, QOL
lower lipids, SBP, deceased smoking, QOL improved
91
Evidence for cardiac rehab - Reduced recurrent MI by ___ and what percent of mortality benefit at 2 yrs
17% reduced recurrent MI | 47% mortality benefit
92
Evidence for cardiac rehab - decreased hospitalizations, recurrent MI, and mortality
:)
93
Evidence based benefits of cardiac rehab
Reduced sx Inc exercise performance Inc functional mobility Reduced use of medications

Semester 5 PMCP Exam 4 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions