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Cardio Pulmonary > Cardiac Rehabilitation > Flashcards

Cardiac Rehabilitation Flashcards

1
Q

what is cardiac rehabilitaiton?

A

a multidisciplinary approach to the rehabilitation of pts w/heart disease

involves:

  • education
  • structured, progressive physical activity
  • lifestyle modification
  • vocational counseling
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2
Q

Candidacy for Cardiac Rehabilitation

A
  1. Post MIs
  2. Post cardiac surgery, including transplants
  3. Heart disease
  4. CHF
  5. Post PTCA
  6. Elderly
  7. Asymptomatic, at-risk patients
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3
Q

Who is not a candidate for Cardiac Rehab?

A
  1. Unstable Angina
  2. hemodynamic instability
  3. Serious arrhythmias
  4. Conduction abnormalities (2nd and 3rd degree blocks)
  5. active infections
  6. uncontrolled diabetes
  7. resting ST segment depression
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4
Q

what constitutes hemodynamic instability?

A

SP > 200

DP > 100

orthostatic fall > 20 mmHg

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5
Q

does cardiac rehab work?

A

YES!

  1. reduces body weight
  2. unloads the heart
  3. improves cardiac function
  4. might get changes in lifestyle
  5. modifies risk factors
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6
Q

List and briefly describe the 4 phases of cardiac rehab

A
  1. Phase I → acute/inpatient phase
    1. immediately upon becoming medically stable
    2. monitored
  2. Phase II → subacute/rehab/ conditioning phase
    1. immediately upon D/C
    2. monitored
  3. Phase III → training/intensive rehab
    1. outpatient
  4. Phase IV → maintenance
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7
Q

what is a standard outcome measure for Phase II Cardiac Rehab?

A

6-min walk test

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8
Q

what occurs in the initial assessment in Phase I cardiac rehab?

A
  1. Hx
  2. family interview
  3. Physical exam
  4. How well can pt perform ADLs
  5. ROM, Strength, Gait
  6. Sternal precautions
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9
Q

how is exercise tolerance determined in Phase I cardiac rehab?

A
  1. monitor BP 3-5 min
  2. pt is slowly walked 25-30 ft and a rest break is taken
  3. if no unusual HR, BP, or ECG reading observed then the walk is repeated and over time lengthened according to pt’s subjective feelings as well as vitals
  4. activity is progressed as long as pt tolerates the exercise
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10
Q

Describe treatment within Phase I cardiac rehab

A
  1. start slowly
  2. use short duration sessions, multiple times per day
  3. warm up/cool down
  4. intensity
    1. <120 bpm or <20-30 bpm increase over resting
    2. symptom monitor
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11
Q

when would you stop treatment in Phase I Cardiac Rehab?

A
  1. unusual HR increase
  2. inappropriate BP response
    1. SP >210
    2. DP> 110
    3. 10 mmHg or more drop in DP w/exercise → stop exercise
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12
Q

what symptoms call for a cessation of exercise in Phase I Cardiac Rehab?

A
  1. angina
  2. dyspnea
  3. excessive fatigue
  4. mental confusion or dizziness
  5. pallor, cyanosis, cold sweat
  6. EKG abnormalities
  7. arrhythmias
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13
Q

Goals for Phase I cardiac rehab

A
  1. initiate return to IADLs
  2. counteract the deleterious effects of bed rest, reduce risk of thrombi and pneumonia, maintain muscle tone, reduce OH
  3. provide medical surveillance during ADL types of activities
  4. pt/family edu
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14
Q

activities to consider for phase I cardiac rehab

A
  1. self care
  2. arm and leg AROM
  3. very light weights
  4. independent transfers
  5. bedside sitting to ambulation to stairs
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15
Q

how many METS should be attainable by D/C from Phase I cardiac rehab?

A

3-5 METS

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16
Q

ADLs = ______ METS

A

about 5 METS

17
Q

length of Phase II cardiac rehab

A

8-12 weeks

18
Q

goals of Phase II cardiac rehab

A
  1. improved exercise tolerance
  2. pt edu
  3. risk factor reduction/secondary prevention
  4. return to work
  5. promote psychological, behavioral and educational improvement
  6. 9-10 METs or 3.0 mph for 30 min
19
Q

how is intensity determined in Phase II cardiac rehab?

A

via a fraction of HR reserve

HRmax = 207 - ((0.7) * age))

20
Q

things to consider when establishing intensity in phase II cardiac rehab

A
  1. keep HR below levels that:
    1. elicit symptoms/signs limited
    2. cause dyspnea
    3. elicit a plateauing or decreasing SBP
      1. 240 or 110
    4. elicit ECG abnormalities
    5. elicit arrhythmias of >6 min
    6. use RPE
21
Q

Abnormal responses to exercise in Phase II Cardiac Rehab

A
  1. SBP > 240, DBP> 110
  2. Systolic hypotension >20 bpm drop
  3. unusual HR response
  4. symptom provocation
    1. anginal response
    2. undue dyspnea
    3. excessive fatigue
    4. mental confusion/dizziness
    5. severe leg claudication
  5. signs
    1. pallor
    2. cold sweat
    3. ataxia
    4. pulmonary rales
  6. ECG abnormalities
22
Q

can you preform resistance training in phase II cardiac rehab?

A

YES but with reservations

  • onset:
    • 5 weeks post MI
    • 8 weeks post CABG
    • 2 weeks post PTCA and stent
  • 30-50% of 1 rep max
  • 8-10 reps, 2-3x/wk with a day of rest in between
  • large muscle groups
  • control weights
  • breathe/exhale during effort
23
Q

Mode, Intensity, Duration, and Frequency of resistance training in Phase II cardiac rehab

A
  1. Mode → hand weights and/or machines
  2. Intensity
    1. RPE → 11-13
    2. no straining, no pain
  3. Duration
    1. 10-12 reps/set
    2. 1-2 sets
  4. Frequency
    1. 2-3x per week
24
Q

Resistance considerations for Phase II Cardiac Rehab

A
  1. complete a smooth, controlled, and full ROM w/each activity
  2. balance your exercise between complementary muscle groups
  3. core strengthening
  4. avoid gripping the weight handles tightly
25
Q

When is Phase III cardiac rehab occuring?

A

3-6 months post event

26
Q

what is included in phase III cardiac rehab?

A
  1. HEP
  2. community exercise programs (like YMCA)
  3. pts may or may not be seen once/week
  4. no ECG monitoring
  5. self monitoring
27
Q

goals of Phase III Cardiac Rehab

A
  • achieve 50-80% of HRR on treadmill test (moderate activity)
  • 3-4 sessions/week
  • >45 min per session
28
Q

what is included in Phase IV Cardiac Rehab?

A
  1. HEP
  2. self-monitoring
  3. environmental concerns
  4. adherence
29
Q

considerations for exercising after a stent placement

A
  • avoid vigorous exercise and heavy lifting for a short time after stent procedure
  • an early symptom-limited exercise stress test (1 day post-op) did NOT increase the incidence of clinical stent thrombosis or access site complications
30
Q

why do referrals to cardiac rehab remain low?

A
  1. lack of centralized method for referral
  2. inadequate communication among treatment teams, pts, and CR facilities
  3. unfamiliarity with CR among potential referring physicians
  4. limited access, competing responsibilities, and perceived inconvenience for the pt

Cardio Pulmonary (21 decks)

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