Cardiopulm Rehab

Question 1

Is there a growing need for cardiac rehab?

Answer 1

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

Question 2

What are utilization and underutilization trends for cardiac rehab?

Answer 2

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

Question 3

What is cardiac rehab?

Answer 3

Comprehensive long term program involving: medical evaluation, prescribed monitored exercise, risk factor modification, education and counseling, multidisciplinary team approach

Question 4

What are modifiable CAD risk factors?

Answer 4

Tobacco use, lipids, BP, physical inactivity, excess body weight, diabetes, stress

Question 5

What are non modifiable CAD risk factors?

Answer 5

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

Question 6

What are characteristic of HTN as modifiable risk factor?

Answer 6

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

Question 7

What are characteristics of smoking as a modifiable risk factor?

Answer 7

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

Question 8

Modifiable risk factor cholesterol (5)

Answer 8

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

Question 9

What is obesity, why is it a risk factor, how is it treated, and what are associated risk factors with obesity?

Answer 9

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

Question 10

What are treatments/tips for patients to control diabetes as a modifiable risk?

Answer 10

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

Question 11

Why is physical inactivity a modifiable risk factor?

Answer 11

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

Question 12

T/F: cardiac rehab involves inpatient, outpatient, lifetime

Answer 12

True

Question 13

What are phases of cardiac rehab?

Answer 13

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)

Question 14

What are goals of cardiac rehab?

Answer 14

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

Question 15

Program components: initial and ongoing eval typically includes?

Answer 15

Medical history
Risk factor identification and assessment
Functional assessment
Psychological and quality of life indicators
Exercise prescription

Question 16

What is monitored in sessions of the program?

Answer 16

ECG, HR, BP, signs/symptoms

Question 17

program components: lifestyle education/counseling sessions target what? and the topics include?

Answer 17

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

Question 18

What are eligible diagnoses for outpatient rehab?

Answer 18

Stable angina
Myocardial infarction
Interventional procedure (PCI, PTCA, stent)
CABG
Valve surgery
Heart transplant

Question 19

What are benefits of cardiac rehab?

Answer 19

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

Question 20

What is pulmonary disease?

Answer 20

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

Question 21

T/F: lung disease death rate continuously increased while the rates of heart disease and cancer dropped

Answer 21

True

Question 22

Why is pulm rehab important?

Answer 22

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

Question 23

What is pulm rehab?

Answer 23

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

Question 24

What are benefits of participation in pulm rehab?

Answer 24

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

Question 25

What are goals of pulm rehab?

Answer 25

Control and alleviate symptoms
Improve activity tolerance
Promote self reliance and independence
Decreased need for acute responses
Improve quality of life

Question 26

What are components of pulm rehab?

Answer 26

Supervised progressive exercise/activity
Functional and ADL training
Energy conservation
Breathing retraining
Stress management
Medication education

Question 27

What diagnoses are covered by medicare for pulm rehab?

Answer 27

COPD
CB
Asthma
Emphysema

Question 28

What are utilization benefits of pulm rehab?

Answer 28

Decreased severity of dyspnea with functional activities
Decreased hospitalizations
Decreased cost of physician office visits and hospitalizations
Decreased ER visits

Question 29

What are patient benefits of pulm rehab?

Answer 29

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

Question 30

What are factors to consider for exercise prescription in cardiopulm populations?

Answer 30

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

Question 31

In exercise prescription you may need to make modifications due to…?

Answer 31

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

Question 32

What are considerations for exercise with angina?

Answer 32

Prolonged warm up and cool down: ROM, stretching, low level aerobic activities
Upper body exercises may precipitate angina more readily

Question 33

What are considerations for exercise in MI?

Answer 33

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

Question 34

What is intervention for percutaneous cardiac revasc?

Answer 34

Exercise training can begin almost immediately
Progress more rapidly if no myocardial damage
Watch closely for potential reoccurrence manifested by signs/symptoms of ischemia

Question 35

What are considerations for exercise in CABG and valve surgeries?

Answer 35

Start lower level and progress at slower rate

Be cautious of sternal precautions, no upper body exercises for 6-8 weeks post surgery

Question 36

What are considerations for exercise in pulmonary diagnoses?

Answer 36

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

Question 37

What are contraindications for exercise prescription?

Answer 37

Unstable angina
Severe CAD
Serious ventricular arrhythmias
Others that could be aggravated by exercise

Question 38

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?

Answer 38

True