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Cardiopulm > Cardiac and Pulmonary Rehabilitation > Flashcards

Cardiac and Pulmonary Rehabilitation Flashcards

The learner will describe and differentiate between the 4 phases of cardiac rehabilitation The learner will recall the criteria for discharge from acute care to other facilities including cardiac rehab phases related to cardiopulmonary conditions (including stroke) The learner will compare and contrast pulmonary and cardiac rehab

1
Q

What are the four phases of cardiac rehab?

A
  1. Inpatient Rehabilitation
  2. Subacute conditioning
  3. Intensive Rehabilitation
  4. Maintenance conditioning or prevention
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2
Q

Describe Phase I cardiac rehab

A

Ambulation within 1 day of intervention for 10-25 minutes/day
* Hemodynamically stable
* Stable/appropriate EKG
* Mildly asymptomatic with ADL or mobility

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3
Q

Reasons for modified or delayed phase I

A
  • Large MI – stable after 2-3 days
    Resting tachycardia
  • Inappropriate HR response to exercise
  • BP not increasing or dropping with ADL
  • EKG 6-8 multifocal PVC or progressive heart block with ADL
  • Angina or undue fatigue with ADL
  • Prolonged bedrest
  • Severe pump failure
  • Recurrent malignant arrhythmias
  • Angina at rest
  • Persistent hypotension (<90 SBP)
  • Rapid atrial rhythm
  • 2nd and 3rd degree heart blocks
  • Unstable angina or worsening symptoms in the past 24 hours
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4
Q

Contraindications to exercise after MI

A
  • <2 days without physician approval
  • Unstable angina
  • New EKG changes, or complex arrhythmias
  • Signs and symptoms of MI (see slide 3)
  • Arterial PaO2 <60mmHg
  • O2 Saturation <85%
  • Hemaglobin <8 g/dL; Hematocrit <26%
  • Digoxin toxicity
  • Aortic obstruction or dissection
  • Acute myocarditis or pericarditis
  • Severe CHF
  • RR >45 breaths/min
  • Recent thrombophlebitis, embolism
  • Untreated 3rd degree heart block
  • Severe hypertension unresponsive to medication
  • Uncontrolled DM
  • Acute infections
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5
Q

How to determine if a patient is ready for discharge

A

Is the patient able to:
* Self-manage and identify symptoms
* Aerobic capacity/endurance adequate for ADL [for their discharge location]
* Adequate physiological response to increased O2 demand
* Level of assistance or supervision needed for a task [and adequate caregiver help]
* Safety with all activities

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6
Q

Contraindications to exercise testing

A
  • Acute myocarditis, pericarditis, or other infection
  • Unstable angina
  • Severe heart failure
  • Serious arrhythmias at rest
  • 2nd or 3rd degree heart block
  • Severe EF from valvular heart disease
  • BP >180/100mm Hg
  • Pt refusal
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7
Q

Reasons to stop exercise testing

A
  • Achieve predicted max HR
  • Increased frequency or pairing of PVCs
  • Vtach
  • 2nd or 3rd degree heart block
  • Atrial arrhythmias
  • Hypotension with exercise (>20 SBP)
  • Severe elevation of BP
  • ST segment depression
  • Pallor and/or diaphoresis
  • Claudication pain
  • Patient requests to stop
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8
Q

Abnormal responses to exercise

A
  • Exercise Hypertension: >240 mmHg SBP, >110mHg DBP
  • Systolic Hypotension: >20 mmHg drop
  • HR: Failure to increase or decrease with exercise,too rapid of an increase
  • Signs: pallor, diaphoresis, ataxia, new murmur or 3rd heart sound,pulmonary rales
  • Symptoms: significant angina, undue dyspnea,excessive fatigue,mental changes,claudication pain
  • EKG abn: serious arrhythmias,2nd/3rd degree heart block,acute ST changes,onset of bundle branch block
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9
Q

Goals of phase II rehab

A
  • 2/3 days and increasing to 5 days per week minimum of 30 minutes of exercise per day
  • Complete Maximal exercise test (usually need to wait 4-6 weeks after MI)
  • Will still have telemetry
  • Understand risk factors
  • Independently manage ADL’s
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10
Q

Describe phase III rehab

A
  • Patients exercise in group with less supervision
  • No EKG/O2 monitoring – patients self-monitor HR
  • Starts after 6-12 weeks of Phase II
  • Extends indefinitely
  • Vtach arrest with heart damage, cardiac ablation, high risk that don’t qualify for Phase II
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11
Q

Describe phase IV rehab

A
  • Disease prevention program
  • Lifelong application of disease prevention
  • On their own
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12
Q

What patients are appropriate for pulmonary rehab?

A
  • More common - chronic obstructive pulmonary disease COPD, asthma, pulmonary hypertension and cystic fibrosis
  • Less common – lung transplant and lung cancer
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13
Q

Describe PFT evaluation of patient

A
  • Patient History
  • (Six-Minute) Walk Test – Gold standard (ATS) measure of progress
  • Expectations of the Program
  • Cardiopulmonary exercise stress test
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Cardiopulm (6 decks)

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