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cardiopulm jd > Exericse Guidelines For CV Disease > Flashcards

Exericse Guidelines For CV Disease Flashcards

1
Q

Goal of cardiac rehab is to enable patients to _________ within imposed limitations

A

Resume active and productive lives

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2
Q

Objectives of cardiac rehab include

A

Restore optimal physiologic, psychosocial, and vocational status

Prevent progression or reversal of disease

Reduction of risk of SD or reinfarction

Alleviation of symptoms

Patients become responsible and autonomous for their medical treatment and lifestyle changes

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3
Q

Candidates for cardiac rehab (13)

A 
MI
CABG
PTCA/Stents
Stable angina pectoris
Silent ischemia
Valve replacement
High risk for CHD
Congenital heart defects
CHF
Cardiac arrhythmias
Transplants (heart and lung)
Secondary and tertiary prevention
PAD
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4
Q

Components of CV Rehab include multidisciplinary approaches including:

A 
Medical treatment
Nutritional counseling
Smoking cessation
Risk stratification
Stress management
Hypertension management
Control of diabetes or dyslipidemia
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5
Q

How many cardiac rehab phases are there?

A

4

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6
Q

Phase I of cardiac rehab is the _____ phase

A

Inpatient

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7
Q

How long does phase I cardiac rehab last?

A

Lasts about 3 days until discharge

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8
Q

What is the goal of phase I?

A

NO physiological effects of bed rest

NO cardiac cripples

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9
Q

What exercise can you do in phase I?

A

Low level functional activities
PROM to AROM
Walking and stairs

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10
Q

Phase II of cardiac rehab is the ______ phase

A

Out patient

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11
Q

How long does phase II last?

A

3 months duration

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12
Q

What is the goal of phase II?

A

Increase the functional and CV efficiency of the patient

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13
Q

How is phase II monitored?

A

Telemetry (ECG)

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14
Q

What is phase III otherwise known as?

A

Supervised phase

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15
Q

How long does phase III last?

A

4-6 months duration

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16
Q

What is the goal of phase III?

A

To decrease supervision of exercise program and to promote self regulation of SAID program

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17
Q

Phase III is monitored how?

A

Heart rate. NO telemetry

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18
Q

Phase IV is otherwise known as

A

Unsupervised phase

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19
Q

What is the duration of phase IV?

A

Lifetime in duration

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20
Q

What is the goal of phase IV?

A

Maintain the lifestyle changes acquired in cardiac rehab

Client exercises on their own

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21
Q

True or false (Benefit of exercise?) reduces long term mortality?

A

True

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22
Q

True or false (Benefit of exercise?) May retard the atherosclerotic process?

A

True

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23
Q

True or false (Benefit of exercise?) negative changes in lipid profiles

A

False- positive

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24
Q

True or false (Benefit of exercise?) Decrease cellular sensitivity to insulin?

A

False- increases

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25
Q

True or false (Benefit of exercise?) Modification of TABP

A

True

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26
Q

True or false (Benefit of exercise?) Decrease platelet adhesiveness

A

True

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27
Q

True or false (Benefit of exercise?) Enhanced fibrinolysis

A

True

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28
Q

True or false (Benefit of exercise?) Decreased PNS outflow

A

False- increase

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29
Q

True or false (Benefit of exercise?) Little change in central, but significant change in peripheral parameters?

A

True

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30
Q

True or false (Benefit of exercise?) Decrease in ECG abnormalities?

A

True

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31
Q

True or false (Benefit of exercise?) Decrease in RHR, submax HR, SBP, RPP, and MVO2 demands

A

True

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32
Q

True or false (Benefit of exercise?) Can develop collaterals

A

True

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33
Q

True or false (Benefit of exercise?) Improves psychosocial functioning

A

True

34
Q 
Percentages for increase in VO2 max:
\_\_\_\_ for MI
\_\_\_\_ for CABG
\_\_\_\_ for AP
\_\_\_\_ for severe LVD
A

11-56%
14-66%
32-56%
20%

35
Q

___% of the beneficial effects are still unknown for exercise – many call some of these vascular conditioning effects

A

65%

36
Q

Exercise and diet are superior to _________

A

Percutaneous coronary intervention

37
Q

True or false (Benefit of exercise?) Exercise promotes vascular stability?

A

True

38
Q

True or false (Benefit of exercise?) Improves vascular wall inflammation and endothelial dysfunction

A

True

39
Q

True or false (Benefit of exercise?) Exercise in tertiary prevention decreases mortality

A

False- secondary

40
Q

15 contraindications/precautions

A 
Unstable angina
Unstable dysrhythmias
Unresolved CHF
Uncontrolled HTN
Uncontrolled atrial or ventricular dysrhythmias
Uncontrolled diabetes
Serious heart block
PE
Cardiogenic shock
Severe physical or emotional impairment
Moderate to severe aortic stenosis
Active pericarditis or myocarditis
Pulmonary HTN

GH below 7 - check with MD
RHR >100

41
Q

Do not exercise a patient if there RHR is greater than…

A

100

42
Q

What phase of cardiac rehab is inpatient phase/early mobilization?

A

Phase I

43
Q

What phase of cardiac rehab is post discharge (low level activities, monitor pt, tell them to get a HR monitor?)

A

Phase 1.5

44
Q

What phase is supervised outpatient?

A

Phase 2

45
Q

What phase is lifetime maintenance?

A

Phase 3

46
Q

In phase I of early mobilization, what should you be doing in evaluation?

A

Get clearance from MD

Look at contraindications to phase I

47
Q

In early mobilization (phase 1), what should the frequency be?

A

5-7 days per week (ideally daily)

48
Q

In early mobilization (phase 1), what should the duration be?

A

15 min twice a day

49
Q

In early mobilization (phase 1), what should the intensity be?

A

20 BAR for MI

30 BAR for CABG

50
Q

In early mobilization (phase 1), develop criteria for _____

A

Exercise termination

51
Q

In phases II-III, what should be done during evaluation?

A

Cardiac stress test
Lab studies (SMA12, lipid profile, CBC, electrolytes)
PFT if pulm involvement

52
Q

In phases II-III, what should the frequency be?

A

3-5x per week

Weekend/evening walks are encouraged

53
Q

In phases II-III, what should the duration be?

A

20-45 min of aerobic exericse

Phase specific for total length of time

54
Q

In phases II-III, what should the intensity be?

A

THR= target heart rate
50-70% Karvonen for phase II
70-80% Karvonen for phase III

55
Q

What is the Karvonen formula?

A

[(MHR-RHR) x _____%] + RHR

56
Q

In phases II-III, the intensity is usually increased monthly by __% to a max of 80%

A

5% to 80%

57
Q

In phases II-III, when should you repeat the stress test?

A

At the end of phase II

58
Q

MHR =

A

Peak HR off of stress test

59
Q

In phases II-III, what should the intensity be?

A

An objective target is used and not a RPE value

60
Q

What is RPE

A

Rate of perceived exertion (Borg Scale

61
Q

RPE of 6=

A

No exertion

62
Q

RPE of 11=

A

Light

63
Q

RPE of 13=

A

Somewhat hard

64
Q

RPE of 15=

A

Hard (heavy)

65
Q

RPE of 17=

A

Very hard

66
Q

RPE of 20=

A

Max exertion

67
Q

In phases II-III, what does intermittent training consist of

A

Rest periods of less than one minute between modalities (exercise devices)
Alternating leg and arm activities

68
Q

RPE can only be used in conjunction with the ___

A

THR

69
Q

In phases II-III, with intermittent training- warm up first for about 5 minutes using what kind of exercise?

A

Low level walking

70
Q

In phases II-III, in intermittent training, during the cooldown, it consists of

A

Low level walking then stretching at the end

71
Q

NY Heart Association: Class I

And max met level

A

Patients with cardiac disease but resulting in no limitation of PA
Ordinary physical activity does not cause fatigue, palpitation, dyspnea or angina pain

MAX MET level is 6.5 METS

72
Q

NY Heart Association: Class II

A

Can still do ADLs, not everything, need to be monitored

73
Q

NY Heart Association: Class III

A

Not doing very well- may be waiting for heart or lung transplant

74
Q

NY Heart Association: Class IV

A

Usually not doing well at all- hospice, home care

75
Q

Resistance training has no evidence of the following:

A 
CHF
Uncontrolled dysrhythmias
Severe valve disease
Uncontrolled HTN - SBP > 160 DBP > 100
Unstable symptoms
76
Q

Resistance training after a MI or CABG is minimum ____ weeks including at least __ weeks in a supervised program

A

5 weeks

4 weeks

77
Q

Resistance training after a PTCA is minimum ____ weeks including at least __ weeks in a supervised program

A

3 weeks

2 weeks

78
Q

Out of cardiac arrest, MI, or fatality, which one has the greatest chance of occurring during exercise ?

A

Cardiac arrest

79
Q

What do you want to monitor during exercise?

A 
VO2 max
Lipid profile
Vital signs- RHR, RBP
ECG changes
Psychosocial
80
Q

When stress testing for cardiac, what needs to be done (5)

A

1) determination of human max capacity for physical work
2) detection of confirmation of ischemic heart disease in individuals who are apparently healthy
3) assessment of treatment procedures for patients with ischemic heart disease
4) eval of cardiac dysarrhythmias
5) Rx for exercise

81
Q

Contraindications for exercise prescription?

A

Arm bike- typically increases BP
Aquatic therapy- too hot for pts
Sternal precautions- no more than 5 lbs pick up
Diabetes

cardiopulm jd (12 decks)

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