Cardiac Rehabilitation Flashcards
Cardiac Rehabilitation Basics
- Medically supervised
- Lifestyle modification
- Phase 1 Inpatient - 2 Outpatient - 3 Maintanence
- Individualized, typically 3x/week, up to 36 weeks
- Physican referral required
Typical length of stay following uncomplicated cardiac surgery is?
4 days
Goals of Phase 1
Education
* Provide Written information
Exercise
* Monitor: HR, BP, RPE, O2 Sat, Angina Scale and Claudification Scale
Pathways
* Follow and document what was done when
Phase 1 Rehab includes…
- Diet and Nutrition
- Psychological Rehab
- Activity Guidelines
- Risk Stratification
- Education
Exercise - Phase 1
- Goal – 4-5 METS (climb 1 flight of stairs)
-
Walking and ROM programs
– Instruction of self monitoring
– HR
– Exertion levels - RPE (11-13 range)
Symptoms - Functional mobility
- Talk about home (preparation)
Phase 2 Goals
Physician supervision required
- Provide individual exercise programs (ITP); Improve CV fitness and monitor with EKG
- Emphasis on education (modifable risk factors)
- Enhance confidence to return to hobbies and leisure/work
- Group interactions (psychological, behavioral, educational)
Chronic vs Stable HF
Chronic: Left ventricular EF less than 35% and (NYHA) Class II - IV symptoms despite being on optimal heart failure therapy for at least 6 weeks.
Stable: pts who have not had recent (less than or equal to 6 weeks) or planned (less than or equal to 6 months) major cardiovascular hospitalizations or procedures.
Phase 2 Time period and programs
- Start 24-48 hours post discharge
- Duration 1-36 weeks
- Staff ratio of 1:1 to 1:5
Intensive Cardiac Rehab
* Pt. recieves 72 one-hour sessions within 18 weeks
– Up to 6 sessions per day
– Must exercise aerobically everyday of rehab
Phase 2 Exercise Program Guidelines
Warm up
* Stretch (if needed and document limitations)
* Active mmvt
Training session (based off info from GXT or other tests)
* Aerobic
* Resistive
* Flexibility (if needed)
Cool down
Phase 3 goals
- Indep in self monitoring (HR, RPE)
- Compliance with home ex
- Medically stable
- No long need ECG monitoring
Is phase 3 covered by insurance? What programs do patients do here?
- Typically self pay or a 3rd party payer.
- Typically Community Based Program.
- Emergency equipment on premise (AED and protocols)
Angina Scale
Dyspnea Scale
Claudification Scale
What is the acronym for a comprehensive exam for chest pain?
OLD CART
O = onset – sudden vs gradual
L = location – substernal, left side, jaw
D = duration – Cardiogenic chest pain generally 2-20 mins
C = characteristics – pressure, tightness, heaviness vs sharp with inspiration
A = accompanying symptoms – associated with diaphoresis, dyspnea, light-headedness
R = radiation – Does the pain radiate to the arms, neck, jaw or teeth?
T = treatment – relieved by rest, O2, Nitro?
What would make someone high risk (exercise) risk stratification?
- Presence of complex ventricular dysrhythmias during ex testing or recovery
- Presence of angina or Sx(e.g., SOB, light-headedness, at low levels of exertion (less than 5 METs) or during recovery)
- High level of silent ischemia during ex testing or recovery (ST-segment depression greater or equal than 2 mm from baseline)
- Presence of abnormal hemodynamics with ex testing or recovery
What considers someone high risk (non-exercise)?
- Resting EF less than 40%
- History of Cardiac Arrest or Sudden Death
- Complex Dysrhythmias at rest
- Complicated MI or revascularization procedure
- Presence of heart failure
- Presence of S & S or post-event/post-procedure ischemia
- Prescence of clinical depression
When preparing to make an Exercise Presciption, what factors need to be considered?
- Clinical history
- Risk Stratification
- Degree of L Ventricular impairment
- Ischemic or anginal threshold
- Any cognitive or psychological impairment
- Vocational (work) requirements
- Musculoskeletal limitaitons
- Personal health and fitness goals
How many classes are there for cardiac rehab?
6!
Examples of Class 1 exercises
- Sit in bed with assistance
- Self care seated
- Stands at bedside with assist
- Sits in chair 15-30 minutes (2-3x/day)
Examples of Class 2 exercise
- Sits up in bed independently
- Stands independently
- Self care in bathroom - seated
- Walks in rooms and to bathroom (may need assist)
Examples of Class 3 exercise
- Sits and stands independently
- Does own self cares in bathroom - standing
- Walks in hall with assist (50-100 ft)
Examples of Class 4 Exercise
- Own self cares and bathes
- Walks in hall (150-200 ft; 3-4x/day w/ min assist)
Typically d/c at this point
Example of Class 5 exercise
Walks in hall (250-300 ft; 3-4x/day
