Cardiac Rehab and Early Mobility Flashcards
cardiac rehab AHA definition
supervised program to help patients recover from
- MI
- heart surgery such as bypass, ventricular assist device (VAD), valve repair
- minimally invasive procedures such as angioplasty, stenting, valve replacement, pacemaker or implantable cardioverter defibrillator (ICD)
- risk factors such as CAD or angina
- heart failure (HF)
core components of cardiac rehab
optimize CV risk reduction
foster healthy behaviors and compliance with these behaviors
reduce disability
promote an active lifestyle
general principles/goals of cardiac rehab
decrease length of hospital stay to 3-5 days
early mobilization
assessment
prepare for readiness for discharge home
recommendations for home care
referral to outpatient cardiac rehab program
initial assessment
-review chart and note the following…
past medical history
S/S
employment
risk factor assessment and plan for intervention or teaching
-stress management, psychological concerns
medications
what cardiac rehab can’t do
reverse atherosclerotic process
decrease myocardial ischemia
have much effect on ejection fraction
reverse effects of lung disease such as COPD
indications for cardiac rehab
-begins after initial acute phase when patient is relatively medically stable as evidenced by…
stable angina (no pain for at least 8 hours)
control of dangerous dysrhythmias
control of myocardial insufficiency
labs trending toward normal
compensated HF (when the heart compensates by increasing rate of contraction)
s/p cardiac surgery
cardiac rehab contraindications
unstable angina
dnagerous arrhythmias
decompensated HF (when the heart cannot compensate even on medications)
embolism
metabolic instability
critical labs such as high blood sugars in the 400 range, hyperkalemia (K+ above 5.8)
precautions to activity
low EF -20% or less presence of other medical conditions: diabetes, obesity, renal failure, stroke active infection abnormal labs high oxygen requirements shortness of breath at rest sternal precautions
medical vs surgical activity guidelines
medical
-post-MI: HR < 120 beats/min or 20 beats above resting allowed with activity
surgical
-post-surgery: 30 beats above resting is allowed
-surgical patients may have sternal precautions
why different guidelines for medical vs. surgical activity
surgical
-can go higher because the problem is “fixed”
importance of activity
prevents complications of bed rest
improve cardiac and pulmonary function
prevent secondary chest infection
prepare for home discharge through self-care
traditional sternal precautions
no lifting more than 10 pounds
no shoulder flexion greater than 90 degrees
keep hands in visual field
no driving
no pushing or leaning
no pulling self up on a trapeze bar while in the hospital
6-8 weeks following medial sternotomy
safety in the clinic
selection of appropriate patients proper monitoring all professional exercise personnel must be able to do basic life support including defibrillators emergency procedures must be specified warm up and cool down are required
guiding metrics for exercise
VO2 peak
-closely related to cardiac output and functional capacity of the heart
VO2 peak increases most effectively with exercise of large muscle groups in a rhythmic pattern such as walking or bicycling
HRR and VO2R have a linear relationship
maximal HR empirically is 208-0.7xage
use of betablockers precludes use of…
HRR
target is 50% HRR at cardiac phase II, 60-80% of HRR by phase IV
cardiac rehab: includes a _____
monitored recovery
monitored recovery
-what does it include
gives the patient a safe, monitored environment for exercise
auscultate heart and lung sounds
measure the patient’s vitals: blood pressure, HR< EKG, O2 saturation (low O2 stresses the heart)
check patient’s subjective symptoms - e.g. fatigue, exertion
speed of HR return to resting levels
phases of cardiac rehab
I -inpatient II -outpatient ECG monitored III -outpatient --> optional ECG monitoring IV -community-based
phase I cardiac rehab
- settings
- patient may begin if…
settings
-cardiac unit, surgical ICU, medical ICU, telemetry unit, transplant unit
MD approval/order
no chest discomfort (8 hours)
no new signs of decompensated HF
no abnormal ECG changes such as ST segment depression
phase I
- goals
- activity
- start with bouts of _____
normal CV response to changes in position and activites of daily living
reach 3-4 MET activity level by discharge
activity - slow progression of activity intensity (increase by 1 MET/day)
start with bouts of 3-5 minutes of activity
phase I
- what can the PT do
- what should the PT avoid
active assistive range of motion for DVT prevention
change position e.g. “dangling” legs over edge of bed, watching for BP changes
-stop if systolic BP drop is >20 mmHg
avoid isometrics
avoid valsalva maneuver
keep activites at 2 METs to start
avoid head down position (pass out)
Phase I education
risk factor modification stress management dietary modifications smoking cessation safe sexual activity cardiac medications what to do in case of symptoms
phase II
- time frame
- _____ performed prior to rehab
- ECG monitoring done how often?
- goals
- patient education on…
supervised outpatient program x 6-8 weeks
exercise test performed prior to rehab
-tested on dosage of medication they will be on during exercise
ECG monitoring every session
goals - increase exercise capacity to 5 METs
-beta blockers decrease HR response to exercise
patient education on HR, exercise, Sx, pacing skills
phase II education
self-monitoring during an exercise period
identify the intensity of their workload
ability to work at the appropriate HR and RPE when exercising away from all of the monitoring equipment of the outpatient facility
