Cardiac Rehabilitation Flashcards
Phases
¬ Phase 1 > Inpatient CPU and ward 5-7 days
¬ Phase 2 > Outpatient supervised program
¬ Phase 3 > Community independent exercise program
Aims
¬ Educate on risk factors and lifestyle changes, management of condition
¬ Improve patients attitude, confidence & functional capacity
¬ Exercise tolerance, improve myocardial efficiency, decrease risk of recurrence
¬ CHANGE BEHAVIOUR
Phase 1
Management
- Gradual mobilisation
- Counselling, support
- Education
- Explanation of medication
- Management of angina
- Discharge planning including referral to cardiac rehab
Phase 1
Considerations
• Area of infarction
o Anterolateral – main pumping area
o Inferior
• Arrhythmias – take caution
• STEMI or NSTEAC Whole wall or tiny bruise
• Cardiac markers Troponin is associated with larger infarction
• Left ventricular failure Fine crackles auscultated in bases
• Resting HR If it is too high
• Respiratory status
• Other co-morbidities
Phase 1
Respiratory Complications Post AMI
¬ Gas exchange alterations o Means PO2 72mmHg (normal is 100mmHg) o Increased closing volumes o Pulmonary interstitial fluid accumulation ♣ Consider BREATHING exercises to help ¬ Narcotics > Decreased RR/TV/no sigh ¬ Nitrates o Increased ratio of dead space to TV o B-Blockers – can cause bronchospasm ¬ Bed Rest > Atelectasis
Phase 1
Components
¬ Full assessment (see considerations)
¬ HR and auscultation
¬ Arrhythmias
¬ Respiratory care
Phase 1
Guidelines/Protocols
Only if stable and NO left ventricular failure:
• No head down tilt
• No resisted exercises
• Avoid upper limb X’s 1st week
• No prolonged coughing
o Humidification > Mucomyst if thick secretions
• Day 1 > breathing X’s, Foot X’s
• Day 2 > add lower limb X’s
• Day 3 > SOOB, stand, walk around bed
NB. All subject to Ax, HR, response to X.
Phase 1
Discharge Home – Week 1
• 5 Week before beginning cardiac rehab o Driving ♣ AMI 2-4 weeks ♣ Cardiac surgery 6 weeks o Sexual activity when can walk 2 flights of stairs
