Cardiac Rehab Phase I (ICU) Flashcards
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What are the main ICU considerations for PTs managing cardiac patients?
→ 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
What does the Richmond Agitation and Sedation Scale (RASS) assess?
→ Levels of consciousness, agitation, and sedation
→ Scores +4 to -3 require Confusion Assessment Method (CAM-ICU)
→ Scores -4 to -5 indicate deep sedation/unresponsiveness
What are the 4 features of Confusion Assessment Method in ICU (CAM-ICU)?
→ Acute onset
→ Inattention
→ Level of consciousness
→ Organization of thought
Describe common symptoms and goals for patients with heart failure.
→ Symptoms: Dyspnea, fatigue, edema, reduced functional status
→ Goals: Trend toward ‘yellow/green zones,’ monitor exercise tolerance
What is a Left Ventricular Assist Device (LVAD) and its purpose?
→ 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)
What are the LVAD exercise guidelines?
→ Aerobic exercise is safe
→ Use RPE scale (11-13)
→ Educate on exercise intolerance and device alarms
How is Peripheral Artery Disease (PAD) assessed?
→ Ankle-Brachial Index (ABI) indicates claudication
→ Walking assessment (treadmill, 6MWT)
→ Medical management: antiplatelet, statins, glucose control, revascularization
How does diabetes affect cardiovascular health?
→ Elevated blood glucose damages vessels, heart, and kidneys
→ Leads to atherosclerosis, the main cause of morbidity in T2DM
→ Exercise considerations: fatigue, polyuria, dizziness
What are special considerations for patients post-heart transplant?
→ No sympathetic/parasympathetic input to the heart
→ Longer warm-up/cool-down needed
→ Resting HR: 95-115 bpm, Peak HR: ~150 bpm
What are the functions of a pacemaker?
→ Pacing, sensing, and rate-responsiveness
→ Increases pacing rate in response to physical activity
→ Monitor heart rate and exercise response
Describe precautions for pacemaker patients.
→ Restrict vigorous upper extremity activity for 1 month post-implantation
→ Use RPE or SBP if HR pacing is inadequate
How does an Implantable Cardioverter-Defibrillator (ICD) work?
→ 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
What are general dysrhythmia considerations in acute care?
→ Monitor EKG, know device settings and exercise testing results
→ Document HR, BP, and symptom response
What are the functions of an arterial line?
→ Continuous BP monitoring, frequent ABG sampling
→ Administers drugs, monitors MAP (acceptable: 70-110 mmHg)
What are the mobility precautions for arterial lines?
→ Avoid weight bearing on radial entry sites
→ Mobilize safely with femoral entries to prevent decline, avoid WB radial entry
Describe central venous access methods.
→ Central line: through jugular/subclavian to vena cava, monitors central venous pressure
→ PICC line: arm vein to superior vena cava, no mobility restrictions
What is a Pulmonary Artery Catheter used for?
→ Measures CVP, right atrial pressure, left atrial pressure
→ Determines oxygen saturation and vascular resistance
What are the precautions for patients with a Pulmonary Artery Catheter?
→ Ensure accurate values and transducer leveling
→ Monitor normal hemodynamic values before mobilization
Describe an Intraaortic Balloon Pump (IABP).
→ Supports hemodynamics, safe for ambulation
→ Avoid hip flexion with femoral insertion
What are key considerations for mechanical ventilation in acute rehab?
→ Ensures adequate gas exchange, often requires sedation
→ Prolonged use leads to weakness and impaired function
What is the focus during weaning from a ventilator?
→ Gradual return to spontaneous breathing
→ Monitor respiratory status and patient response
Describe Extracorporeal Membrane Oxygenation (ECMO) considerations.
→ Know hospital mobility parameters
→ Assess hemodynamic stability and cannula location
What symptoms indicate respiratory distress during activity?
→ Dyspnea, chest discomfort, dizziness
→ Discontinue if DBP ≥ 110 mmHg, SBP > 210 mmHg
What are the parameters for a modified CR program?
→ Large infarction, stable after 2-3 days
→ Resting tachycardia (≥ 100 bpm), angina with activity
What are the signs of acute MI complications during exercise?
→ Premature ventricular complexes, progressive heart block
→ Angina or undue fatigue
Describe the use of the 6MWT in Phase I cardiac rehab.
→ Assesses functional capacity, HR, and BP response
→ Tracks improvement in exercise tolerance
What are the heart failure zones for patient management?
→ Green: No symptoms
→ Yellow: Worsening symptoms, adjust treatment
→ Red: Severe symptoms, emergency intervention
How is exercise intensity modified for acute cardiac patients?
→ Use RPE, target lower ranges for safety
→ Monitor HR, BP, and patient symptoms closely
What are the precautions for venous access devices during mobilization?
→ Follow hospital protocols, ensure safe handling
→ Central lines: assess for catheter integrity
What are the EKG flags during Phase I cardiac rehab?
→ Significant ventricular or atrial dysrhythmias
→ Second or third-degree heart block
What safety measures are needed for patients with Swan-Ganz catheters?
→ Ensure catheter position is secure
→ Monitor hemodynamic status continuously
What is the acceptable MAP range for cardiac patients in acute care?
→ 70-110 mmHg, < 60 mmHg indicates inadequate tissue perfusion
How should exercise sessions be adapted for acute cardiac patients?
→ Shorter durations (10 minutes), more frequent sessions
→ Monitor vital signs before, during, and after
What are the discharge criteria for acute cardiac rehab?
→ Improved exercise tolerance, stable hemodynamics
→ Clear understanding of home exercise guidelines
