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Sharlene and MB's PT party > Cardiovascular- Acute, Subacute, and post acute cardiac rehab, resistance training, and therex for the complex pt. > Flashcards

Cardiovascular- Acute, Subacute, and post acute cardiac rehab, resistance training, and therex for the complex pt. Flashcards

1
Q

Inpatient (Acute): typical length of stay in hospital for uncomplicated MI

A

3-5 days

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2
Q

Inpatient (Acute): exercise/activity goals

A
  • initiate return of I w/ ADLs, typical 24 hours after pt. is stable, monitor activity tolerance
  • combat neg.effects of bed rest: reduce clot risk, maintain muscle tone and joint mobility, reduce orthostatic hypotension
  • help allay anxiety and depression
  • provide medical surveillance
  • provide pt. and family education
  • promote risk factor modification
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3
Q

Inpatient (Acute): exercise/activity guidelines- program components

A

ADLs
selected UE and LE ther ex
early supervised ambulation

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4
Q

Inpatient (Acute): exercise/activity guidelines- intensity

A

Initial activity (2-3) METs progressing to 5 or less METs

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5
Q

Inpatient (Acute): exercise/activity guidelines- frequency & duration

A

short sessions 2-3 x day

gradually increase duration and decrease frequency

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6
Q

Inpatient (Acute): exercise/activity guidelines- post-MI

A

limited to 70% max HR and/or 5 METs until 6 weeks post-MI

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7
Q

Inpatient (Acute): exercise/activity guidelines- post surgical patients

A
  • typically are progressed more rapidly than post-MI

- lifting activities restricted for usually 6 weeks

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8
Q

Inpatient (Acute): education goals

A
  • understanding of cardiac disease, support risk factor modification
  • self- monitoring procedures, warning signs of exertional intolerance, persistent dyspnea, anginal pain, dizziness
  • energy cost and conservation techniques, fatigue monitoring, general activity guidelines, pacing, and HEP
  • provide emotional support, may need to refer to LSW.
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9
Q

Inpatient (Acute): HEP

A
  • gradual increase of ambulation time, goal is 20-30 min 1-2 x daily at 4-6 weeks post-MI
  • UE and LE ther ex
  • pt. should be able to self- monitor before performing HEP unsupervised
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10
Q

Absolute contraindication for inpatient or outpatient cardiac rehab

A
  • acute MI (w/in 2 days)
  • unstable Angina not previously stabilized by medical therapy
  • uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise
  • acute PE or pulmonary infarction
  • acute myocarditis or pericarditis
  • acute aortic dissection
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11
Q

Relative contraindication for inpatient or outpatient cardiac rehab

A
  • L main coronary stenosis
  • Mod stenotic valvular heart disease
  • Electrolyte abnormalities
  • Severe arterial hypertension
  • Tachyarrhythmias or bradyarrhythmias
  • Hypertrophic cardiomypathy & other forms of outflow obstruction
  • Mental or physical impairment leading to inability to exercise adequately
  • High degree atrioventricular block
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12
Q

Stupid long list of possible effects of cardiac rehab

A
  • Decreased HR (rest or activity), improved HR recovery after exercise
  • Increased Stroke Volume
  • Increased myocardial O2 supply and contractility, myocardial hypertrophy
  • Improved respiratory capacity during exercise
  • Improved fnctional capacity of exercising muscles
  • Reduced body fat, increased lean body mass
  • Decreased serum lipoproteins (cholesterol and stuff)
  • Improved glucose tolerance
  • Improved blood fibronolytic activity and coagulability
  • Improved psychological status
  • decreased angina in CAD patients
  • Reduced total and cardiovascular mortality after MI
  • Decreased symptoms of HF, improved L ventricle functional capacity
  • Improved exercise tolerance and function in patients with cardiac transplantation
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13
Q

Outpatient Cardiac Rehab (sub-acute): eligible patients

A
  • MI, ACS
  • CABG
  • PCI
  • Stable Angina
  • Heart valve repair or replacement
  • Heart or heart/lung transplantation
  • HF and PAD: not covered by insurance but pt. will benefit from supervised exercise program
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14
Q

Outpatient Cardiac Rehab (sub-acute): exercise/activity goals

A
  • Improve functional capacity
  • Progress to return of PLOF
  • Promote risk factor modification/ life style changes
  • Promote energy conservation, taking rest breaks
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15
Q

Outpatient Cardiac Rehab (sub-acute):what should be present in the clinic

A
  • ECG monitoring
  • trained personnel
  • emergency support

Pts. weaned from continuous monitoring to spot checks to self-monitoring

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16
Q

Outpatient Cardiac Rehab (sub-acute): frequency and duration

A

2-3 x week

30-60 min w/ 5- min warm-up and cool down

17
Q

Outpatient Cardiac Rehab (sub-acute): mode of exercise

A
  • walking, cycling, Nu-step, combo of aerobic equipment
  • circuit training
  • strength training
18
Q

Outpatient Cardiac Rehab (sub-acute): suggested exit point

A
  • 9 MET functional capacity

- 5 MET capacity is needed for safe resumption of most daily activities

19
Q

Outpatient Cardiac Rehab (sub-acute): Strength training in Phase 2 programs

A
  • Guidelines: 3 weeks cardiac rehab, 5 weeks post-MI, 8 weeks post-CABG
  • Begin w/ therabands and light weights (1-3 lbs.)
  • Progress to mod loads, 12-15 comfortable reps
20
Q

Outpatient Cardiac Rehab (sub-acute): still provide education?

A

Yup

21
Q

Community Exercise Programs (Post-acute): exercise/activity goals

A
  • improve/maintain functional capacity
  • promote self-regulation of exercises
  • promote life-long commitment to risk-factor modification
22
Q

Community Exercise Programs (Post-acute): locations and eligibility criteria

A
  • YMCA, community centers, clinical facilities

- functional capacity of 5 METs, clinically stable angina, medically controlled arrhythmias

23
Q

Community Exercise Programs (Post-acute): Progression and discharge

A
  • progress from supervised to self-regulation
  • progress to 50-85% functional capacity, 3-4 x week, 45+ min a session
  • regular medical check-ups and ETT generally required
  • discharge typically 6-12 months
24
Q

Resistance Exercise Training: goals

A
  • improve muscle strength and endurance
  • enhance functional independence
  • decrease cardiac demands during daily activities
25
Q

Resistance Exercise Training: patient criteria- post MI

A

permitted if pt. remain under 70% max HR or 5 METs for 6 weeks post-MI, be cautious of valsalva

26
Q

Resistance Exercise Training: patient criteria- cardiac surgery

A

LE resistance training can be initiated immediately, in the absence of peri-operative MI. UE resistance training should be avoided until soft tissue and bony healing has occurred: 6-8 weeks

27
Q

Resistance Exercise Training: patient criteria- Post PTCA

A

min of 3 weeks after procedure and 2 weeks of consistent participation in a supervised CR endurance training program

28
Q

Resistance Exercise Training: patient criteria- no evidence available for people with___

A 
CHF
uncontrolled dysrhythmias
severe valvular disease
uncontrolled hypertension
unstable symptoms
29
Q

Resistance Exercise Training: general prescription

A
  • start w/ low resistance, 10-15 reps, and progress slowly
  • Resistance: 50%+ of 1 rep max, therabands, 1-5lb cuff or hand weights, wall pulleys
  • RPE 11-13, but needs to be correlated to hemodynamic response
  • RPP should not exceed what is used for endurance training
30
Q

Ther Ex Rx for pts. w/ special considerations: HF- criteria

A
  • General: pts. demonstrate sig. ventricular dysfunction, decreased CO, low functional capacities
  • compensated or chronic HF, no signs of acute HF
  • exercise-induced ischemia and arrhythmias poor prognostic indicators
31
Q

Ther Ex Rx for pts. w/ special considerations: HF- monitoring at rest and during activity

A
  • Use RPE in tandem w/ HR, BP, RR, SPO2 to assure good correlation and assessment of exercise tolerance
  • HR response may be impaired (chronic incompetence)
  • At risk for persistent post-exercise vasodilation (and hypotension) w/ later stages of HF
32
Q

Ther Ex Rx for pts. w/ special considerations: HF- exercise prescription

A
  • use low level, gradually progressive aerobic training
  • begin w/ 40-60% functional capacity, increasing as able
  • gradually increase durations, w/ frequent rest periods (interval training)
  • adequate warm-up and cool-down, may need longer than typical 5-10 min
33
Q

Ther Ex Rx for pts. w/ special considerations: HF- other general considerations

A
  • use caution w/ supine or prone exercises due to orthopnea
  • avoid breath holding and valsalva
  • respiratory muscle training, monitor w/ pulse ox
  • emphasize energy conservation and self-monitoring techniques
34
Q

Ther Ex Rx for pts. w/ special considerations: Cardiac Transplant

A

Patients may present w/:

  • exercise intolerance due to extended inactivity and deconditioning
  • side effects from immunosuppressive drug therapy are hyperlipidemia, hypertension, obesity, diabetes, leg cramps.

Sharlene and MB's PT party (35 decks)

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