Cardiopulm Rehab Flashcards
Is there a growing need for cardiac rehab?
Approximately 66% of heart attack patients do not make a complete recovery
71.5% of 65 year olds with CAD have three or more comorbidities and physical limitations, only 3.8% have none
What are utilization and underutilization trends for cardiac rehab?
Utilization: greater than 2 million are eligible after MI or coronary revasc, on average only 26% of those eligible actually participate
Under utilization: women, non white, elderly, and underinsured are under represented in rehab; initial referral to cardiac rehab essential; barriers include insurance reimbursement, patient motivation, geographic/transportation limitations
What is cardiac rehab?
Comprehensive long term program involving: medical evaluation, prescribed monitored exercise, risk factor modification, education and counseling, multidisciplinary team approach
What are modifiable CAD risk factors?
Tobacco use, lipids, BP, physical inactivity, excess body weight, diabetes, stress
What are non modifiable CAD risk factors?
Age: risk increases as we get older
Gender: men higher risk, risk increases for post menopausal women
Race: African American, native American, Mexican American at higher risk because of higher occurrences of diabetes, HTN, and obesity in these groups
Family history: if either or both of your patients have CAD, your risk for developing CAD is greatly increased
What are characteristic of HTN as modifiable risk factor?
Defined at 140/90
Treatment: antihypertensive therapies, nutrition (sodium intake- decrease to 2500) and exercise
Important to educate patient, check it often, keep records, be consistent
What are characteristics of smoking as a modifiable risk factor?
Single most preventable cause of death in US
Smoking cessation can lower risk by almost 50%
After one year, CAD level of risk equals that of a non smoker
Referral to smoking cessation class is best option
Modifiable risk factor cholesterol (5)
Cholesterol is fatty substance found in human body and in food that come from animals
Drug and nutrition therapies have been indicated to reduce death and disability
Know current research
Changes in diet
Reiteration
What is obesity, why is it a risk factor, how is it treated, and what are associated risk factors with obesity?
Excessive accumulation of fat on body
Why: creates problems with respiration and circulation, added strain on heart by increasing work and blocking arteries
Associated risks: HTN, hyperlipidemia, increased blood glucose, patterns of sedentary lifestyle
Treatment: weight loss, proper nutrition, exercise
What are treatments/tips for patients to control diabetes as a modifiable risk?
Interferes with body’s ability to produce adequate amounts of insulin needed for your body to use sugars and carbs.
Higher risk for CAD
Info for pt: knowledge of disease, dietary mgmt., medication admin, prevention of complications, methods of monitoring blood sugar
Reiteration
OP programs
Why is physical inactivity a modifiable risk factor?
Inactive people are twice as likely to develop heart disease as active people
Numerous systems of body are affected
Inactivity Decreases: HDL levels, collateral circulation and vessel size
Inactivity increases: total cholesterol, glucose intolerance, body weight, BP
T/F: cardiac rehab involves inpatient, outpatient, lifetime
True
What are phases of cardiac rehab?
1: inpatient cardiac rehab
2: monitored outpatient cardiac rehab (initiated 1-3 weeks after event, usually lasts 3-4 mo)
3: maintenance (long term outpatient cardiac rehab)
What are goals of cardiac rehab?
Identify, modify, manage risk factors to reduce disability/morbidity and mortality
Improve functional capacity
Alleviate/lessen activity related symptoms
Educate patients about management of heart disease
Improve quality of life
Program components: initial and ongoing eval typically includes?
Medical history
Risk factor identification and assessment
Functional assessment
Psychological and quality of life indicators
Exercise prescription
What is monitored in sessions of the program?
ECG, HR, BP, signs/symptoms
program components: lifestyle education/counseling sessions target what? and the topics include?
Individual and/or group interactions targeting: risk factor education, intervention, modification; symptom recognition; medication usage; others as indicated by POC
Topics: physical activity, nutrition, lipid management, BP management, smoking cessation, weight management, diabetes management, psychosocial management
What are eligible diagnoses for outpatient rehab?
Stable angina Myocardial infarction Interventional procedure (PCI, PTCA, stent) CABG Valve surgery Heart transplant
What are benefits of cardiac rehab?
Reduced risk of fatal MI
Decreased severity of angina and need for anti angina meds
Decreased hospitalizations
Decreased cost of physician office visits and hospitalizations
Fewer ER visits
What is pulmonary disease?
Pathological limitations of airflow in lungs
Generally not reversible
Lung disease is not only a fatal condition but is chronic in nature, making breathing difficult
Affects 35 million people
CB, emphysema, asthma, COPD
T/F: lung disease death rate continuously increased while the rates of heart disease and cancer dropped
True
Why is pulm rehab important?
When you have chronic lung disease routine activities may cause SOB
For many the SOB affects every aspect of daily living
As a result they may become fearful of physical activity and become less active with increased SOB
What is pulm rehab?
Exercise and lifestyle modification
Supervised by variety of health care professionals and requires physician referral
An outpatient service at hospital or clinic
Meets two to three times a week
What are benefits of participation in pulm rehab?
Improve breathing
Increase endurance and strength
Control symptoms
Management of meds and/or oxygen
Minimize frequency or length of hospital stays
Manage stress, anxiety, and/or depression
Improve one’s energy
What are goals of pulm rehab?
Control and alleviate symptoms Improve activity tolerance Promote self reliance and independence Decreased need for acute responses Improve quality of life
What are components of pulm rehab?
Supervised progressive exercise/activity Functional and ADL training Energy conservation Breathing retraining Stress management Medication education
What diagnoses are covered by medicare for pulm rehab?
COPD
CB
Asthma
Emphysema
What are utilization benefits of pulm rehab?
Decreased severity of dyspnea with functional activities
Decreased hospitalizations
Decreased cost of physician office visits and hospitalizations
Decreased ER visits
What are patient benefits of pulm rehab?
Improved functional capacity Increased knowledge of pulm disease Improved adherence to positive lifestyle changes Better compliance with medical regime Reduce anxiety/panic Increased self esteem and confidence
What are factors to consider for exercise prescription in cardiopulm populations?
Health status Risk factor profile Behavior characteristics Personal goals Exercise preferences Exposure to exercise Changes in health status Expectations of others Genetic potential Ability to comply Your expectations vs theirs Physician input Blend of exercise class
In exercise prescription you may need to make modifications due to…?
Observed individual responses Adaptations to exercise Activities done outside of therapy Differences in exercise modalities Health status Addition/deletion of meds Health status change Work status change
What are considerations for exercise with angina?
Prolonged warm up and cool down: ROM, stretching, low level aerobic activities
Upper body exercises may precipitate angina more readily
What are considerations for exercise in MI?
Warm up should last 5-10 min that consist of: stretching, light aerobic activity
Aerobic activity should last 20-30 min and should be discontinued if signs or symptoms arise
Cool down should last as long as it takes for HR to reach resting level
What is intervention for percutaneous cardiac revasc?
Exercise training can begin almost immediately
Progress more rapidly if no myocardial damage
Watch closely for potential reoccurrence manifested by signs/symptoms of ischemia
What are considerations for exercise in CABG and valve surgeries?
Start lower level and progress at slower rate
Be cautious of sternal precautions, no upper body exercises for 6-8 weeks post surgery
What are considerations for exercise in pulmonary diagnoses?
Be very aware of oxygen saturation throughout
Intermittent bouts are generally used, anywhere to 5-10 minutes with 2-3 minute rest
Upper body exercises are found to be more beneficial due to specificity
What are contraindications for exercise prescription?
Unstable angina
Severe CAD
Serious ventricular arrhythmias
Others that could be aggravated by exercise
T/F: cardiopulm rehab is important because it will give the patient the tools, knowledge, and motivation needed to fight the progression of cardiovascular and pulmonary disease?
True
