Cardiac Rehab

Question 1

Phase one:

Inpatient Rehab (acute)

Goals

Activities:

Exercise Guidelines

Answer 1

Usually < 1 week for an uncomplicated MI

Exercise:

• 2-3 METs initially to 3-5 METs by discharge
• short exercise sessions 2-3x/day
• ETT may determine functional capacity prior d/c

Goals:

• family and patient education
• provide medical surveillance and prevent deconditioning

Activities:

• self care (ADLs require 5 METS)
• selected arm/leg AROM
• very light weights
• independent transfers
• bedside sitting w/ progression to supervised ambulation and stairs at discharge

Question 2

Phase Two: Outpatient Rehab or Home

(subacute)

Answer 2

Begins 1-2 weeks after infarct/surgery, up to 3 mo

• Exercise:
  
  • 3-4 sessions/week
  • 30-60 min w/ 5-10 min warm/cool down
  • discharge at 9 METs
• Goals:
  
  • < 50% funx capacity/return to activities
  • modify lifestyle to decrease risk factors
  • begin low level conditioning
• Activities:
  
  • independent self-care at home
  • walk-jog or step aerobics program
  • activities between 4-9 METs

Question 3

Cardiac Rehab Phase Three: Community Exercise

Answer 3

_ 3-6 mo after incident and 12 wks long._

• Exercise:
  
  • _progress supervised to self-regulation _
  • progress to _50-80% of functional capacity _
  • 3-4 x/wk, 45 min/session
• Goals:
  
  • individualized training program
  • long term commitment to risk factor modification
• Activities:
  
  • must be at 5 MET level to begin program
  • aerobic exercise
  • low level resistance
  • relaxation training

Question 4

Termination from Inpatient exercise session & criteria that further diagnostic evaluation and changes in program are indicated

Answer 4

• pt not tolerating level of activity prescribed
• fatigue, light headed, confusion, ataxia, pallor, dyspnea, nausea, or onset of angina
• _ST displacement (2mm) _
• Ventricular tachycardia
• >3 PVCs consecutive
• Drop of SBP >20mmHg
• SBP > 220 mmHg
• DBP > 110 mmHG

Question 5

CPR Summary (adult)

Answer 5

• ACTIVATE EMERGENCY RESPONSE SYSTEM
• get AED
• perfom compressions immediately
  
  • (5 cycles, 2 min), open airway
• follow AED instructions
• Restore breathing/circulation
  
  • 30 compressions per 2 breaths (100 /min)
  • compression depth 1.5-2 inches **(1/3 chest in children) **

Question 6

Absolute Contraindications for Inpatient/Outpatient Cardiac Rehab

Answer 6

• acute MI (within 2 days)
• unstable angina not previously stabilized
• uncontrolled arrhythmias causing sx or hemodynamic compromise
• acute PE or pulmonary infarction
• acute myocarditis or pericarditis
• acute aortic dissection

Question 7

Relative Contraindications for Inpatient Cardiac Rehab

Answer 7

• Left main coronary stenosis
• moderate stenotic valve disease
• electrolyte abnormalities
• severe arterial hypertension
• tachy/brady arrhythmias
• hypertonic cardiomyopathy and other forms of outflow tract obstruction
• mental or physical impairment leading to inability to exercise adequately
• high degree AV block

Question 8

Cardiac Rehab and Resistance Exercise

Answer 8

• improve strength/funx endurance
• decrease cardiac demands during activities

Patient criteria

• Post MI: must remain under 70% max HR or 5 METs for 6 weeks
• Post op cardiac: UE resistance 6 wks
• Post op Catheter: Avoid UE resist 3 weeks

Exercise:

• _percieved exertion 11-13 _
• 50% or more of 1RM

Question 9

Goals Throughout Cardiac Rehab

Answer 9

independept self care

psychological recovery

risk factor modification