CV rehab management (PAD/CABG)

Question 1

Claudication pain scale:
0 =
1 =
2 =
3 =
4 =

Answer 1

no pain
1st feeling of pain
pain which exercise should cease
near max pain
worst ever

Question 2

intermittent claudication =
resting claudication =

Answer 2

pain with activity, goes away with rest
does not go away with rest - more advanced

Question 3

in patients with PAD, what level should you exercise to?

Answer 3

tolerable level of pain
2/4 on claudication scale

Question 4

interval training is successful in PAD
- what parameters should be followed?

Answer 4

start with equal intervals 1-5 minutes of exercise to rest
slowly progress to more exercise with shorter rest

Question 5

CABG rehab protocol:
POD 0 =
POD 1 =
POD 2-3 =

Answer 5

0 = EOB in 8 hours, standing in 12 hours
1 = out of bed in chair for breakfast, short transfers/ambulation
2-3 = progressive mobility & ambulation

Question 6

what day should CABG patients be transferring out of CVICU?

Answer 6

POD 2-3

Question 7

how long do sternal precautions apply s/p sternotomy?

Answer 7

8-12 weeks

Question 8

what are typical sternal precautions?

Answer 8

no pushing/pulling
no lifting > 5-10 lbs –> milkjug
avoid shoulder flex/abd > 90 deg
limited use of BUE w/ bed mobility & transfers

Question 9

what are the updated sternal precautions?

Answer 9

keep your move in your tube
– allows pts to perform previously contraindicated movements with BUEs

Question 10

how do we know what sternal precaution rule to follow? what does the literature say?

Answer 10

follow surgeon’s instructions
new literature showing lack of sufficient stress on sternum may hinder healing and promote disuse atrophy

Question 11

CABG management things to think about:
– bed mobility
– transfers
– ambulation
– stairs
– functional endurance
– balance
– education

Answer 11

– rolling vs. trunk shift, bed features.. we don’t have them at home
– maintain precautions, appropriate DME
– activity pacing, monitor symptoms
– use railings but maintain precautions
– think physiologically
– fall reduction strategies
– pain management, edema control, DME

Question 12

CABG materials
– incentive spirometer
– heart pillow
– platform walker
– walkers?
– equipment for home

Answer 12

– taking deep breaths
– hug to chest to avoid breaking sternal precautions
– maintains sternal precautions
– do they break precautions?
– tub transfer bench, shower chair, commode

Question 13

mobilize or don’t?
– external pacer
– transvenous pacemaker

Answer 13

– yes
– no

Question 14

if a true chest tube is placed in the pleural space, the two options are:
– wall suction
– water seal

Answer 14

– connected to wall suction. continuous negative pressure, pulls air and fluid out quicker –> used early on
– one way valve - air can exit but not enter. no suction needed, often used once lungs have started to heal

Question 15

considerations for chest tubes:
– atrium must stay _____ and ____ the level of the pt
– be aware of where the tube ___
– check output ______
– check the ____ for type of suction & whether pt can come off it for mobility
– bubbling indicates _____
– what if chest tube comes out?

Answer 15

– upright ; below
– is placed to patient
– pre and post mobility
– EMR
– air leak
– immediately plug in chest wall

Question 16

considerations for pulmonary artery catheter (PAC):
– are there restrictions for mobility?

Answer 16

– no, but facility and patient dependent. lots of attachments & heavy

Question 17

central venous catheter:
– restrictions for mobility?

Answer 17

no, even if femoral

Question 18

arterial line:
– restrictions for mobility?

Answer 18

no, even if femoral

Question 19

extubation of lines:
– no mobility for _____ post extubation
– hold mobility for _____ following central line removal

Answer 19

– 2-4
– 2

Question 20

pacemaker precautions:

Answer 20

no driving
no pushing/pulling on operative side
no lifting > 5-10 lbs
no shoulder flexion/abduction > 90 deg

** sternal precautions

Question 21

24-48 hours after pacemaker placement pt should use ______ for comfort

Answer 21

sling

Question 22

therapy implications following pacemaker placement:

Answer 22

use unaffected side for ADLs, overhead reaching, holding onto railings/grab bars, DME

Question 23

what are some things that will help following abdominal surgeries?

Answer 23

abdominal binder for comfort
log rolling, semi-Fowlers position
no lifting > 5-10 lbs

Question 24

vascular surgery post-op precautions:
– peripheral revascularizations may have _____ surgical incisions
– access to femoral artery can create ____ incision
– monitor for:
– vascular surgery puts pt at risk for:

Answer 24

– extensive
– deep
– bleeding or hematoma
– blood loss, compartment syndrome, neuropraxia

Question 25

therapy precautions post-op vascular surgery:
– pain from incisions can limit ____
– regaining _____ and ______ ROM is the most challenging
– WB status typically
– if there are non healing wounds to WB surfaces, WB status is _____

Answer 25

– ROM
– neutral DF and knee extension
– WBAT
– NWB

Question 26

heart transplant medications:

Answer 26

steroids - prednisone
statins
anticoagulants/antiplatelets - reduce activity that could cause bleeding… fall risk prevention!!

Question 27

what nerve is severed during heart transplant?

Answer 27

vagus nerve

Question 28

if the heart has no vagus nerve, how is heart rate controlled?

Answer 28

hormone circulation –> HR response to exercise is much slower

Question 29

what is very important to do when performing exercise with post-heart transplant patients?

Answer 29

warm up and cool down

Question 30

heart rate effects post heart transplant:
– resting HR
– ___(higher/lower)___ HRR
– BP

Answer 30

– higher resting HR (90-110)
– lower
– higher resting BP but at risk for orthostatic hypotension

Question 31

early PT goals post heart transplant:
– optimize ____ and ____ to wean off supplemental O2
– increase ____ and _____ in BUEs
– improved ______ via ADLs and low intensity exercise

Answer 31

– pulmonary hygiene and chest wall mechanics
– strength and ROM
– exercise tolerance (1-4 METs)

Question 32

after heart transplant, since the heart is denervated, _____, _____, _____, and ____ should be monitored to gage intensity

Answer 32

BP, ventilatory thresholds, RPE, and symptoms

Question 33

if you want to adjust intensity of exercise post heart transplant, what should you observe closely?

Answer 33

sweating, color changes, mentation

Question 34

how long should the patient follow sternal precautions post heart transplant?

Answer 34

8-12 weeks

Question 35

goal for exercise following heart transplant?

Answer 35

15-60 minutes aerobic exercise
4-6 days/week

Question 36

if no complications following heart transplant, when should the patient begin cardiac rehab?

Answer 36

~ 6 weeks post op

Question 37

following heart transplant, what should resistance training focus on?

Answer 37

large proximal muscles with efforts to prevent OP and steroid myopathy

Question 38

patients post heart transplant have a _____% __(higher/lower)__ VO2 max than age matched norms

Answer 38

40-50% lower