individuals with cardiovascular and pulmonary disease Flashcards
cardiac rehabilitation is commonly used to
deliver exercise and other lifestyle interventions to individuals with CV disease
pulmonary rehabilitation is often provided for those with
various chronic obstructive pulmonary disease, emphysema, bronchitis
cardiovascular disease
diseases that involve the heart and/or blood vessels
peripheral artery disease
diseases of the arterial blood vessels outside the heart and brain
cerebrovascular disease
diseases of the blood vessels that supply the brain, resulting and stroke
coronary heart disease
disease of the arteries of the heart
acute coronary syndrome
the acute manifestation of coronary heart infarction or sudden death
myocardial ischemia
temporary lack of adequate coronary blood flow relative to myocardial oxygen demands
myocardial ischemia is often manifested as
angina pectoris (chest pain)
myocardial infarction
injury/death of the muscular tissue of the heart
pulmonary disease
diseases that involve the lungs
acute manifestations of pulmonary disease
shortness of breath, difficult or rapid labored breathing, chest tightness, bouts of coughing, wheezing, more frequent colds/flu/pheumonia
inpatient cardiac rehabilitation guidelines
current clinical status assessment
mobilization
identification and provision of information regarding modifiable risk factors and self care
discharge planning with HEP and ADL
refer to outpatient CR
inpatient cardiac rehab. programs
clinical assessments
each sessions should include assessments and documentation of vital signs
supervised daily ambulation
individual education
AACVPR parameters for inpatient cardiac rehabilitation daily ambulation
no new or recurrent chest pain
stable or falling creatine kinase and troponin values
no indication of decompensated heart failure
normal cardiac rhythm and stable electrocardiogram
at hospital discharge, the individual should have
specific instructions regarding strenuous acuities that are permissible and those that should avoid
until evaluated with an exercise test or entry into a clinically supervised outpatient CR program, the upper limit of HR or RPE noted during exercise should not exceed
those levels observed during the inpatient program
(inpatient cardiac rehab) individuals should be counseled to identify
abnormal signs and symptoms suggesting exercise intolerance and the need for medical evaluation
indicts for inpatient and outpatient cardiac rehab
medically stable postmyocardial infarction
stable angina
coronary artery bypass graft
percutaneous transluminal coronary angioplasty
stable heart failure (cardiomyopathy)
heart transplantation
valvular heart disease/surgery
peripheral arterial disease
contraindications for cardiac rehab
unstable angina
uncontrolled hypertension
orthostatic BP drop >20
aortic stenosis
atrial or ventricular arrhythmias
sinus tachycardia
heart failure
adverse responses to inpatient exercise leaning to exercise discontinuation:
diastolic BP >
110
adverse responses to inpatient exercise leaning to exercise discontinuation:
decrease in systolic ____ during exercise with increasing workload
> 10
adverse responses to inpatient exercise leaning to exercise discontinuation:
significant ventricular or partial _____ with or without symptoms
arrhythmias
adverse responses to inpatient exercise leaning to exercise discontinuation:
_____ degree heart block
2nd or 3rd
adverse responses to inpatient exercise leaning to exercise discontinuation:
signs and symptoms of exercise intolerance including
angina, marked dyspnea, ECG changes
FIIT recommendations for cardiac inpatient:
frequency, aerobic and flexibility
2-3 sessions for the first 3 days
minimally once per day, as often as tolerated
FIIT recommendations for cardiac inpatient:
intensity, aerobic and flexibility
seated or standing RHR +20 bpm for individuals with an MI and +30 bpm for individuals recovering from heart surgery
upper limit <120bpm, RPE <13 (6-20 scale)
mild stretch discomfort
FIIT recommendations for cardiac inpatient:
time, aerobic and flexibility
intermittent walk-in 3-5 mins as tolerated, progressively increase
rest period may be slower walk
attempt to achieve 2:1 exercise/rest ratio, progress t 10-15 min continuous walking
all major joints at least 30s per joint
FIIT recommendations for cardiac inpatient:
type, aerobic and flexibility
walking
ROM and dynamic movement. passive stretching
at the time of physical referral or program entry the following assessments should be performed
medical surgical history
physical examination
review of recent CV tests and procedures
current meds
CVD risk factors
routine pre exercise assessment of risk for exercise should be performed
before, during, after each rehab session
FIIT outpatient recommentations:
frequency
aerobic: minimally 3d/week, up to 5d
resistance: 2-3 nonconsecutive
flexibility: 2-3d/wk, daily ideal
FIIT outpatient recommentations:
intensity
aerobic: with test: 40-80% capacity using HRR, VO2
without test: seated to standing HR +20-+30 bpm or RPE 12-16
resistance: 10-15 rep without fatigue, RPE 11-13, 40-60% of 1RM
flexibility: point of feeling tightness and slight discomfort
FIIT outpatient recommendations:
time
aerobic: 20-60 min
resistance: 1-3 sets, 8-10 exercises
flexibility: 10-30s hold for static stretching, >4 repetitions
FIIT outpatient recommentations:
type
aerobic: arm ergometer, combination UE LE cycle ergometer, upright and recumbent cycle, stepper, elliptical, rower, stairs, treadmill
resistance: select equipment that is safe and comfortable
flexibility: static and dynamic stretching focused on the major joints of the limbs and lower back
for individuals with very limited exercise capacities, bouts ____ daily may be considered as a starting point
<10min
if an ischemic threshold has been determined, the exercise intensity should be prescribed at
HR of 10bpm below the HR at which the event was identified
if peak HR is unknown, the RPE method should be used to guide exercise intensity using the following relationships (3)
<12 is light or <40% of HRR
12-13 is somewhat hard or 40-59% of HRR
14-16 is hard or 60-80% of HRR
individuals on a beta blocker may have an ____ response to exercise
attenuated HR
for individuals who have a beta blocker dose change, ____ and establish _____
monitor signs and symptoms, establish a new target for exercise intensity
it is recommended that an exercise test be performed anytime that ____ or ___ warrant
symptoms, clinical changes
individuals on diuretic therapy are at an increased risk for ___, ____, ___ particularly after bouts of exercise
volume depletion, hypokalemia, orthostatic hypotension
outpatient rehab: the aerobic exercise portion of the session should include _______ for maintenance of a healthy body weight and its many other associated health benefits
rhythmic, large muscle group activities with an emphasis on increased caloric expenditure
individuals with known stable CVD and low risk for complications may begin with continuous ECG monitoring and decrease to ____ ECG after ____ sessions or sooner as deemed appropriate
little to no
6-12 sessions
individuals with known CVD and at moderate to high risk for cardiac complications should begin with continuous ECG monitoring and decrease to ____ ECG after ____ sessions and as deemed appropriate
intermittent or no
12 sessions
when considering removing or reducing ECG monitoring the individual should understand
his or her individual exercise level that is safe
cardiac outpatient: exercise prescription procedures can be based on
recommendations of these guidelines and what was accomplished during the inpatient phase and home exercise activities
although a _______ test prior to starting cardiac rehab is ideal in the development of an exercise program, it is not common
symptom-limited graded exercise test (GXT)
in place of GXT, a _____ or other forms of ____ exercise tests can be performed as a measurement of exercise tolerance and capacity
6-MWT, submaximal
use of ___ also can be a practical method for prescribing both aerobic and resistance exercises
RPE
outpatient CR: the individual should be educated on and closely monitored for signs and symptoms of intolerance such as
excessive fatigue, dizziness, light-headedness, chronotropic incompetence, ischemia
