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Semester 5 PMCP Exam 4 > Cardaic Rehab > Flashcards

Cardaic Rehab Flashcards

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1
Q

Cardiac rehab is a

A

comprehensive exercise education, and bx modification program

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2
Q

Cardiac rehab is designed to

A

improve physical and emotional condition of a pt with heart disease

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3
Q

Cardiac rehab is prescribed to do what

A

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

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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

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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

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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

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7
Q

Practitioners involved in cardiac rehab

A 
Physicians
Nurses
Exercise physiologists
PTs
OTs
Dieticians
Psychologists
Behavioral medicine specialists
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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
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9
Q

Phase 1 occurs where

A

inpatient - acute

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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

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11
Q

Phase 1 - general focus

A

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

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12
Q

Phase 1 - ADLs

A

incorporated as the pts exercise tolerance improves

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13
Q

Phase 1 - what happens prior to hospital discharge

A

graded low level exercise test (modified bruce protocol)

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14
Q

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

A

Systolic over 200

Diastolic over 110

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15
Q

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

A

over 20 mmHg with symptoms

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16
Q

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

A

moderate or severe aortic stenosis

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17
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - angina

A

Unstable angina

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18
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - fever

A

acute systemic illness or fever of over 101

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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)
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20
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - CHF

A

uncontrolled CHF

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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

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22
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - infection

A

active infection like pericarditis or myocarditis

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23
Q

Contraindications for entry into inpatient and outpatient cardiac rehab - diabetes

A

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

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24
Q

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

A

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

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25
Q

Adverse response to inpatient exercise that would make you need to alert the physician

A 
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
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26
Q

Risk stratification - assists in determining what

A

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

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27
Q

Risk stratification - low

A

uncomplicated clinical course

no evidence of ischemia

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28
Q

Risk stratification - low - functional capacity

A

over 6 METS, 3 weeks post event

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29
Q

Risk stratification - low - EF

A

normal (over 50%)

Find out with echocardiogram

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30
Q

Risk stratification - moderate (3)

A

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

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31
Q

Risk stratification - high

A 
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
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32
Q

Risk stratification - high - EF

A

Less than 40% at rest

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33
Q

Risk stratification - high - functional capacity

A

Less than 5 METS with hypotensive BP response or more than 1 mm of ST segment depression

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34
Q

Goals of inpatient program

A

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

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35
Q

Medical hx - need to gather info about

A

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

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36
Q

Subjective physical exam includes info about

A

previous and present physical activity level

patient’s goals

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37
Q

Objective physical exam includes info about

A 
appearance, alertness, orientation
breathing pattern
are they in any distress
BS
cough
vvitals
ROM
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38
Q

treatment - avoid what (phase 1?)

A

isometric activity - lifting no more than 10 lbs

Push/pull with both arms!!

39
Q

progression of activity

A 
walking
treadmill
stationary bike
UE calisthenics
stairs
40
Q

treatment includes (phase 1)

A 
bed exercises
gentle UE calisthenics
shoulder/neck mobility
position changes
bed mobility
41
Q

frequency phase 1

A

2 times per day at least

42
Q

intensity phase 1

A

declared through objective and subjective measurements - is patient dependent

43
Q

duration phase 1

A

begin with 5 min warm up and cool down

progress duration out of bed 10-15 min and then increase activity as tolerated

44
Q

reasons for modification of exercise

A 
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
Q

Phase 1 termination guidelines - heart rate

A

Post MI = 20 higher than resting

Post CABG = 30 higher than resting

46
Q

Phase 1 termination guidelines - BP

A

SBP more then 10 mmHg drop
SBP higher than 220
DBP higher than 110

47
Q

Phase 1 termination guidelines - RPE

A

13 or higher

48
Q

Phase 1 termination guidelines - ST

A

ST segment displacement 3 mm

49
Q

Phase 1 termination guidelines - angina

A

1 need to stop

do not let them get to 2

50
Q

Phase 1 termination guidelines - dyspnea

A

2 you are done

51
Q

Phase 1 termination guidelines - pain

A

severe leg pain - claudication

8/10 or higher

52
Q

Phase 1 discharge planning

A

you need to get them ready for home

53
Q

Phase 1 pt education

A

ADLs
Recreation - walking
Educate on being in cold and heat

54
Q

precautions - phase 1?

A 
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
Q

Notify physician if the following occurs

A

upper body pain/discomfort
chronic fatigue
faintness or nausea after exercise
excessive SOB

56
Q

What if a patient cannot go to a rehab facility

A

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
Q

Home exercise for those that can’t attend cardiac rehab

A

continue walking or stationary bike

58
Q

Training program over 6-12 wks for patients at home

A

3 min warm up and progress to 5
5 min training and progress to 20
3 min cool down and progress to 5

59
Q

Training program for patients at home - target HR to be

A

18-24 beats above resting

with warm and cool down - 6 to 12 beats above resting

60
Q

Training program frequency for patients at home

A

2 times daily for 5-7 days a week

61
Q

Training program for patients at home - activity level determined by

A

MET level - the amount of oxygen required to sustain an individual in a seated upright position

62
Q

Phase 2 is where

A

outpatient

63
Q

Phase 2 begins when

A

when patient is discharged from the hospital and continues for next 6 to 12 weeks

64
Q

Phase 2 - who is present

A

nurse and PT

65
Q

Phase 2 - description

A

patients rotate between various exercise stations including treadmill, stiars, arm and leg bike ergometers, rowing machines

66
Q

Phase 2 - how long is the exercise performed at each station

A

5 minutes at an individually prescribed intensity

Followed by 1 minute of recovery

67
Q

Phase 2 - when do a graded exercise test

A

depends on patient progress - two to three months after entry into phase 2

68
Q

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

A

60-70% of VO2 max HR
If didn’t do GXT go off of 220 minus the age
and multiply by 0.6

69
Q

Phase 2 - with a doctors referral and based on resutls of GXT, patient is instructed in a new exercise program with guidelines - METs

A

60-70% of METs = max METs

Max METs minus 1 = starting point

70
Q

Phase 2 - with a doctors referral and based on resutls of GXT, patient is instructed in a new exercise program with guidelines - by RPE

A

RPE x 0.6

71
Q

Phase 2 goals

A 
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
Q

Phase 2 frequency

A

start week 2 of event or 1 to 2 weeks after leaving hospital
4-7 days a week
Lasts 6 to 12 weeks

73
Q

Program progression with phase 2 - review how often

A

every 2 weeks

74
Q

Program progression with phase 2 - CABG - start overhead activity when

A

Can do UE overhead ROM around 6-8 weeks with dr approval

75
Q

Program progression with phase 2 - strengthening

A

can do gentle strengthening around 6-8 weeks

76
Q

Program progression with phase 2 - weight training

A

emphasis on higher rep rather than inc in weight

coordinate with breath

77
Q

Phase 3 - is what type of program

A

maintenance program!

usually outpatient but depends on the facility

78
Q

Phase 3 - patients are involved in

A

conditioning activities at an intensity predetermined through graded exercise test

79
Q

Phase 3 - sessions last how long

A

about an hour

80
Q

Phase 3 - progress measured through

A

graded exercise test performed annually

81
Q

Phase 3 - in order to enter phase 3 or 4 the patient has to

A

maintain their precautions
self monitor
have to have good psychosocial well being

82
Q

Phase 3 - participants are taught to

A

take their own pulses as a means of judging their exercise intensity
and the RPE is used to obtain subjective intensity data

83
Q

Goals of phase 3

A

exercise training

risk factor modication

84
Q

How long does phase 3 last

A

6 to 8 weeks beyond phase 2

85
Q

Phase 3 - exercise rx by HR, METs, RPE - what percent

A

70-85%

86
Q

Phase 4 is what

A

long term maintenance program

87
Q

Phase 4 - insurance

A

does not reimburse

88
Q

Evidence for cardiac rehab - For MI, patients who attended 36 sessions showed

A

most improvement in risk reduction

89
Q

Evidence for cardiac rehab - total mortality decreased

A

13-27%

90
Q

Evidence for cardiac rehab -

lipids, SBP, smoking, QOL

A

lower lipids, SBP, deceased smoking, QOL improved

91
Q

Evidence for cardiac rehab - Reduced recurrent MI by ___ and what percent of mortality benefit at 2 yrs

A

17% reduced recurrent MI

47% mortality benefit

92
Q

Evidence for cardiac rehab - decreased hospitalizations, recurrent MI, and mortality

A

:)

93
Q

Evidence based benefits of cardiac rehab

A

Reduced sx
Inc exercise performance
Inc functional mobility
Reduced use of medications

Semester 5 PMCP Exam 4 (6 decks)

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