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Cardio Pulm > Cardiac Rehab: Post MI & CABG > Flashcards

Cardiac Rehab: Post MI & CABG Flashcards

1
Q

Phase I

A

-‘in hospital’ acute stage: constantly changing
-begin as soon as vitals & angina are stable
(2-3 days or 5 days after MI)

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2
Q

Contraindications for cardiac rehab

A
  • unstable angina
  • MI or extension of infarction in past 2 days
  • HTN (resting SBP>200, DBP >110)
  • Hypotension (SBP <80)
  • Hemodynamic instability
  • uncompensated CHF
  • uncontrolled HTN
  • Serious arrhytmias
  • dissecting aortic aneurysm
  • unstable psychological condition
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3
Q

Cardiac rehab

A

-process to restore & maintain individual with coronary problems to optimal physiological, sociological, psychological, educational, vocational status

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4
Q

Indications for inpatient &/or outpatient cardiac rehab

A
  • Acute post MI (w/n 12 months)
  • Stable angina
  • post CABG
  • post valve repair/replacement
  • post PTCA/stent
  • post heart/lung transplant
  • CHF (w/n guidelines)
  • at risk for CAD
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5
Q

cardiac rehab program phases

A
  • Phase I
  • Phase IB
  • Phase II
  • Phase III
  • Phase IV
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6
Q

Post Surgery vs. Post MI

A
  • surgery:
  • -heal faster
  • -shorter hospital stay
  • -UE & trunk stretching
  • -Cough/breathing ex’s important
  • -restricted lifting 6 weeks
  • MI:
  • -slower recovery
  • -longer hospital stay
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7
Q

Lifting Restrictions

Surgery & MI

A

restricted for 6 weeks:

  • Surgery: 8-10#
  • MI: 15-20#
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8
Q

Phase I Goals

A
  • screen for complications
  • prevent deconditioning
  • prevent pneumonia
  • edu pt/family
  • measure effectiveness of meds
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9
Q

Phase I Ex’s

A

-Resting HR, BP, EKG, SO2, lung Auscultation

-warm up, ambulate, aerobic ex’s
MONITOR VITALS

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10
Q

Phase II Ex’s Intensity

A
  • RPE </= 120
  • or RHR + 20 (MI)/ RHR + 30 (surgical)
  • 1-2 METS
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11
Q

Phase I PT Session

A
  • edu
  • ROM
  • breathing ex’s
  • Self-care
  • monitored walking
  • stairs (2 flights=same METS required for sex)
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12
Q

Phase I

ex’s frequency

A
  • days 1-3=3-4x/day

- day 4+=2x/day

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13
Q

Phase I ex’s time

A
  • intermittant (3-5 min bouts)
  • total daily time 20 min
  • Goal: 10-15 min (then increase ex’s intensity)
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14
Q

Phase I

mod/term ex’s

A
  • RPE >/=13
  • HTN
  • Hypotension
  • decr PP to <20mmHg
  • unusual incr HR
  • PVC couplet or 3+ PVC in row
  • PVC w/ R-onT phenomenon
  • Onset of 2* or 3* heart block
  • 1+ angina/3+ angina?
  • 3+ claudication
  • fatigue
  • dizziness
  • pallor
  • cold sweat
  • ataxia
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15
Q

Phase I begins:

A
  • as soon as vitals & angina stable
  • uncomplicated MI=2-3 days post
  • complicated MI=5 days post
  • begin at 1-2 METS
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16
Q

Phase I Discharge Planning

A
  • Sx to monitor
  • Ex’s Rx
  • Dietary guidelines
  • meds
  • referral to outpt phase II
  • ideally involves LLGXT
17
Q

Phase IB

A

-done in home with goal to get ready for phase II

18
Q

Phase II goals

A
  • monitor cardiovascular response to mild-mod workload & communicate w/ docs
  • return to prior activities
  • condition heart & respiratory systems
  • help pt cope with psychological stresses
  • develop lifestyle ex’s habit modificaiton
  • edu to pt/fam on 2* prevention
19
Q

Phase II

A
  • ‘out of hospital’
  • begin soon after discharge from hospital
  • must be w/n 6 months for insurance to cover
  • in hospital or satellite setting
20
Q

Phase II session components

A
  • warm up
  • stretch
  • endurance conditioning
  • cool down
21
Q

Phase II ex’s goals
I:
T:

A
  • up to 9 METS

- 20-30 min continuous ex’s then increase intensity

22
Q

Phase II resistance ex’s time frame

A
  • 5 weeks post MI
  • 8 weeks post CABG
  • 2 weeks post PTCA
23
Q

Phase II Ex’s

A
  • SUPERVISED
  • monitor vitals
  • about 36 visits
  • 3 days/week + home ex’s
24
Q

Phase II Ex’s Intensity

A

If SLGXT Prior:

  • 10 bpm lower than anginal threshold
  • 80% last ex’s test (HR)
  • incr HR 10 bpm after 2-3 weeks

If no SLGXT Prior:

  • RPE 11-13
  • THR=60-70% PMHR
  • Karvonen (HRR): 40-60 % HRR
  • by 3-6 months burn 1,000 KCal/week
25
Q

Phase II criteria for resistance ex’s

A
  • mod-good L ventricle function

- ex’s capacity >5 METS w/o angina or ST segment depression

26
Q

Phase II Resistance Ex’s Guidelines

A
  • start w/ low weight (RPE 11-14)
  • 1 set of 10-15 reps
  • incr 2-3 #/week arms
  • incr 5-10#/week legs
  • RPP not > RPP during aerobic
  • Full ROM
  • No valsalva
  • Exhale during exertion
27
Q

Phase II Contraindications for Resistance Ex’s

A
  • symptomatic CHF
  • uncontrolled arrhythmias
  • severe valvular disease
  • unstable Sx
  • uncontrolled HTN
28
Q

What questions to rule out Angina?

A
  • what are the Sx?
  • where is it located?
  • What’s the effect of palp?
  • deep breath/cough?
  • body position/ROM?
  • cardiovascular Ex’s?
  • rest?
  • NTG?
29
Q

Phase III

A
  • out of hospital
  • not covered by insurance
  • purpose: fitness, endurance, incr knowledge & independence
30
Q

Phase III Ex’s

A
  • incr time from 30 to 40-60 min
  • check p GXT periodically
  • call in their EKG
  • discharge in 6-12 months

Cardio Pulm (27 decks)

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