Cardiac Rehab Phase I (ICU)

Question 1

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Answer 1

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Question 2

What are the main ICU considerations for PTs managing cardiac patients?

Answer 2

→ Continuous monitoring
–> medications, sedation, devices, circulatory assist devices, mechanical ventilation
–> psychological stressors
→ Focus on pulmonary needs first
–> need to improve breathing and effectiveness of gas exchange
→ PT can improve quality of life, physical function, muscle strength, and reduce ICU stay

Question 3

What does the Richmond Agitation and Sedation Scale (RASS) assess?

Answer 3

→ Levels of consciousness, agitation, and sedation

→ Scores +4 to -3 require Confusion Assessment Method (CAM-ICU)

→ Scores -4 to -5 indicate deep sedation/unresponsiveness

Question 4

What are the 4 features of Confusion Assessment Method in ICU (CAM-ICU)?

Answer 4

→ Acute onset

→ Inattention

→ Level of consciousness

→ Organization of thought

Question 5

Describe common symptoms and goals for patients with heart failure.

Answer 5

→ Symptoms: Dyspnea, fatigue, edema, reduced functional status

→ Goals: Trend toward ‘yellow/green zones,’ monitor exercise tolerance

Question 6

What is a Left Ventricular Assist Device (LVAD) and its purpose?

Answer 6

→ Bridge to transplant or destination therapy for heart failure

→ Increases cardiac output (up to 10 L/min)

→ BP monitored using MAP (rest: 70-80 mmHg; exercise: 70-90 mmHg)

Question 7

What are the LVAD exercise guidelines?

Answer 7

→ Aerobic exercise is safe

→ Use RPE scale (11-13)

→ Educate on exercise intolerance and device alarms

Question 8

How is Peripheral Artery Disease (PAD) assessed?

Answer 8

→ Ankle-Brachial Index (ABI) indicates claudication

→ Walking assessment (treadmill, 6MWT)

→ Medical management: antiplatelet, statins, glucose control, revascularization

Question 9

How does diabetes affect cardiovascular health?

Answer 9

→ Elevated blood glucose damages vessels, heart, and kidneys

→ Leads to atherosclerosis, the main cause of morbidity in T2DM

→ Exercise considerations: fatigue, polyuria, dizziness

Question 10

What are special considerations for patients post-heart transplant?

Answer 10

→ No sympathetic/parasympathetic input to the heart

→ Longer warm-up/cool-down needed

→ Resting HR: 95-115 bpm, Peak HR: ~150 bpm

Question 11

What are the functions of a pacemaker?

Answer 11

→ Pacing, sensing, and rate-responsiveness

→ Increases pacing rate in response to physical activity

→ Monitor heart rate and exercise response

Question 12

Describe precautions for pacemaker patients.

Answer 12

→ Restrict vigorous upper extremity activity for 1 month post-implantation

→ Use RPE or SBP if HR pacing is inadequate

Question 13

How does an Implantable Cardioverter-Defibrillator (ICD) work?

Answer 13

→ Detects V-tach/V-fib, delivers shock when threshold is exceeded

→ Max HR set 10-15 bpm below treatment threshold

→ Stress testing helps set appropriate HR levels

Question 14

What are general dysrhythmia considerations in acute care?

Answer 14

→ Monitor EKG, know device settings and exercise testing results

→ Document HR, BP, and symptom response

Question 15

What are the functions of an arterial line?

Answer 15

→ Continuous BP monitoring, frequent ABG sampling

→ Administers drugs, monitors MAP (acceptable: 70-110 mmHg)

Question 16

What are the mobility precautions for arterial lines?

Answer 16

→ Avoid weight bearing on radial entry sites

→ Mobilize safely with femoral entries to prevent decline, avoid WB radial entry

Question 17

Describe central venous access methods.

Answer 17

→ Central line: through jugular/subclavian to vena cava, monitors central venous pressure

→ PICC line: arm vein to superior vena cava, no mobility restrictions

Question 18

What is a Pulmonary Artery Catheter used for?

Answer 18

→ Measures CVP, right atrial pressure, left atrial pressure

→ Determines oxygen saturation and vascular resistance

Question 19

What are the precautions for patients with a Pulmonary Artery Catheter?

Answer 19

→ Ensure accurate values and transducer leveling

→ Monitor normal hemodynamic values before mobilization

Question 20

Describe an Intraaortic Balloon Pump (IABP).

Answer 20

→ Supports hemodynamics, safe for ambulation

→ Avoid hip flexion with femoral insertion

Question 21

What are key considerations for mechanical ventilation in acute rehab?

Answer 21

→ Ensures adequate gas exchange, often requires sedation

→ Prolonged use leads to weakness and impaired function

Question 22

What is the focus during weaning from a ventilator?

Answer 22

→ Gradual return to spontaneous breathing

→ Monitor respiratory status and patient response

Question 23

Describe Extracorporeal Membrane Oxygenation (ECMO) considerations.

Answer 23

→ Know hospital mobility parameters

→ Assess hemodynamic stability and cannula location

Question 24

What symptoms indicate respiratory distress during activity?

Answer 24

→ Dyspnea, chest discomfort, dizziness

→ Discontinue if DBP ≥ 110 mmHg, SBP > 210 mmHg

Question 25

What are the parameters for a modified CR program?

Answer 25

→ Large infarction, stable after 2-3 days

→ Resting tachycardia (≥ 100 bpm), angina with activity

Question 26

What are the signs of acute MI complications during exercise?

Answer 26

→ Premature ventricular complexes, progressive heart block

→ Angina or undue fatigue

Question 27

Describe the use of the 6MWT in Phase I cardiac rehab.

Answer 27

→ Assesses functional capacity, HR, and BP response

→ Tracks improvement in exercise tolerance

Question 28

What are the heart failure zones for patient management?

Answer 28

→ Green: No symptoms

→ Yellow: Worsening symptoms, adjust treatment

→ Red: Severe symptoms, emergency intervention

Question 29

How is exercise intensity modified for acute cardiac patients?

Answer 29

→ Use RPE, target lower ranges for safety

→ Monitor HR, BP, and patient symptoms closely

Question 30

What are the precautions for venous access devices during mobilization?

Answer 30

→ Follow hospital protocols, ensure safe handling

→ Central lines: assess for catheter integrity

Question 31

What are the EKG flags during Phase I cardiac rehab?

Answer 31

→ Significant ventricular or atrial dysrhythmias

→ Second or third-degree heart block

Question 32

What safety measures are needed for patients with Swan-Ganz catheters?

Answer 32

→ Ensure catheter position is secure

→ Monitor hemodynamic status continuously

Question 33

What is the acceptable MAP range for cardiac patients in acute care?

Answer 33

→ 70-110 mmHg, < 60 mmHg indicates inadequate tissue perfusion

Question 34

How should exercise sessions be adapted for acute cardiac patients?

Answer 34

→ Shorter durations (10 minutes), more frequent sessions

→ Monitor vital signs before, during, and after

Question 35

What are the discharge criteria for acute cardiac rehab?

Answer 35

→ Improved exercise tolerance, stable hemodynamics

→ Clear understanding of home exercise guidelines