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Rehab Stage I - III Flashcards

1
Q

What is the principle of cardiovascular rehabilitation?

A

To enable the patient to regain full physical, psychological and social status and to promote secondary prevention in order to optimise long-term prognosis.

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2
Q

List some well-documented benefits of cardiovascular rehabilitation.

A
  • Improved survival
  • Reduced hospital admission
  • Reduced angina
  • Improved lipid profiles
  • Reduced blood pressure
  • Reduced smoking levels
  • Improved functional capacity
  • Improved compliance with lifestyle modifications
  • Reduced anxiety and depression
  • Increased confidence and well-being
  • Improved return to work and leisure activities
  • Improved health education of families and friends
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3
Q

Who are eligible patients for cardiovascular rehabilitation?

A

Patients who have had:
* An acute cardiac event (e.g. myocardial infarction)
* Revascularisation (e.g. CABG, PCI)
* Heart failure
* An implanted cardioverter defibrillator
* Peripheral arterial disease
* Stable angina
* Valve surgery
* Heart transplantation
* Congenital heart disease
* A ventricular assist device

These conditions represent a range of cardiac issues that can benefit from rehabilitation.

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4
Q

What patient groups are currently prioritized in cardiovascular rehabilitation programmes?

A

Post-myocardial infarction and post-revascularisation procedures patients

These groups are the most common participants in rehabilitation programmes.

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5
Q

What is the goal of cardiovascular rehabilitation practitioners regarding access to rehabilitation programmes?

A

To secure funding to reduce inequalities of access

This aims to include more patient groups in core rehabilitation programmes over time.

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6
Q

What should all team members involved in cardiovascular rehabilitation be proficient in?

A

Basic life support and the use of an automated external defibrillator

This is necessary for patient safety.

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7
Q

What does Phase I of the rehabilitation process cover?

A

The acute phase of illness such as
1. A new diagnosis eg acute coronary syndrome
2. A worstening eg agina now requires revascularisation
3. Acute exacerbation in condition eg heart failure

This phase occurs after events

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8
Q

What areas are assessed during the inpatient phase of cardiovascular rehabilitation?

A

Physical, psychological, and social needs

This assessment informs the rehabilitation process.

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9
Q

What types of information and advice are provided to patients during Phase I?

A

Diagnosis and treatment, management of chest pain, psychological support, risk factor modification, prescribed medication, early mobilisation, feelings and relationships, work, driving, and local Phase II provisions

This helps patients transition back to normal life.

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10
Q

What is the average length of hospital stay following an acute event or surgery?

A

Five days

For uncomplicated heart attack patients who have undergone revascularisation, it may be as little as two to four days.

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11
Q

What conditions must a patient meet before discharge from the hospital?

A
  1. Must be Clinically stable
  2. able to carry out self-care,
  3. able to walk short distances

Self-care includes activities such as washing and dressing.

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12
Q

What is Phase II of the rehabilitation process and what should it consist of?

A

Early discharge phase
Should consist of:
1. Exercise and Lifestyle Advice
2. Goal setting
3. Risk Factor Modification
4. Relaxation
5. Stress management & pyschological counselling
6. Occupational counselling

This phase covers the time after discharge back to the care of the GP.

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13
Q

What type of advice is given to patients during the early post-discharge period?

A

Advice about a gradual return to normal activities

This includes a graduated walking programme.

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14
Q

What methods can be used to provide Phase II post-discharge support?

A
  • Telephone calls by health professionals
  • Visits by a cardiac specialist nurse
  • Visits by community staff nurses or district nurses
  • The Heart Manual
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15
Q

What is The Heart Manual?

A

A resource for patients recovering from MI with editions for different conditions

It includes workbook-style home programmes or digital versions covering health education, exercise, and stress management.

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16
Q

When does core rehabilitation (Phase III) typically begin in the UK?

A

Any time from two weeks after the event

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17
Q

How often should patients participate in a structured exercise program during core rehabilitation?

A

At least two to three times a week

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18
Q

What is the primary goal of cardiovascular rehabilitation?

A

To increase physical fitness

Requires documented evidence of regular review, goal setting, and exercise progression.

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19
Q

How long should the documented interaction between the patient and the multidisciplinary team last?

A

A minimum of 8 weeks

According to BACPR EPG, 2nd Edition, Nov 2020.

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20
Q

What is the initial focus when starting cardiovascular rehabilitation?

A

Exploring patients’ understanding of their condition and perceived control

This sets the foundation for rehabilitation.

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21
Q

Who is involved in the priority and goal-setting process in cardiovascular rehabilitation?

A

The patient, their significant other, and the rehabilitation professional.

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22
Q

What options do patients have for support in behavior change during rehabilitation?

A

Hospital-based CR team, leisure services, mobile tech, wearable devices.

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23
Q

What does an individual assessment in cardiovascular rehabilitation typically include?

A
  1. Current clinical status,
  2. Cardiac history
  3. Medication compliance
  4. Investigation results
  5. Psychological status
  6. Risk stratification
  7. Functional capacity assessment
  8. Physical limitations arising from sedentary lifestyle
  9. Calculation of training heart rates.
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24
Q

What is the purpose of risk stratification in cardiovascular rehabilitation?

A

To assess the risk of further cardiac events during exercise.

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25
What factors increase the risk of further cardiac events during exercise?
The amount of damage to the myocardium and its function.
26
What are examples of submaximal functional tests used in rehabilitation?
* 6-minute walk test * Cycle ergometer test * Chester step test
27
What is the role of exercise tolerance tests (ETT) in cardiovascular rehabilitation?
To provide a basis for safe and effective exercise prescription.
28
What diagnosis indicates the heart myocardium is damaged and is a complication that increases risk during exercise?
Heart failure ## Footnote Heart failure leads to inadequate cardiac output.
29
What does post event/procedure angina /ischaemia indicate?
Increased risk of arrhythmias and reduced blood supply to the myocardium ## Footnote It may suggest that treatment is not yet optimal.
30
What is the definition of reduced Left Ventricular Function (LVF)?
Indication that the myocardium is struggling to maintain cardiac output ## Footnote EF <50% is considered reduced.
31
What EF percentage indicates poor LVF?
EF <35% ## Footnote This is considered severely impaired LVF.
32
What EF percentage indicates moderate LVF?
EF 35-49% ## Footnote Moderate LVF suggests some level of impairment.
33
What does ongoing angina indicate?
Residual disease and ischaemia ## Footnote Ongoing symptoms may require monitoring and medication.
34
What are some ongoing angina symptoms?
* Light headedness * Dyspnoea at low workload ## Footnote Silent ischaemia can also be indicated by ST depression on ECG.
35
Who is considered at high risk for serious arrhythmias?
Anyone with a history of serious ventricular arrhythmias ## Footnote This includes those with ventricular tachycardia or fibrillation.
36
How would the exercise prescription differ for anyone with ventricular arrythmias (tachycardia or fibrillation)
Intensity should be low. Increase very gradually.
37
What is the worry for patience with complex ventricular arrhythmias at rest or exercise; has had a history of cardiac arrest or has an implanted ICD?
They could be at risk of cardiac arrest or MI
38
What is recommended for patients with a history of ventricular fibrillation?
Implanted ICD ## Footnote This device helps prevent VF recurrence in high-risk patients.
39
What does a maximal functional capacity less than 7 METS indicate?
Heart is not coping with exercise intensity ## Footnote This can be determined through submaximal as well as ETT test.
40
What is a potential issue with clinically significant treated depression?
Medications can be arrhythmogenic ## Footnote SSRIs are preferred due to fewer side effects.
41
What is the drug of choice for cardiac clients with depression?
SSRIs ## Footnote Examples include fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram.
42
Which SSRI is the drug of choice post MI?
Sertraline ## Footnote It is preferred due to its safety profile in cardiac patients.
43
Why should citalopram be used with caution in CVD patients?
Associated with dose-related arrhythmias ## Footnote This can pose additional risks for patients with cardiovascular disease.
44
What does silent ischaemia refer to?
ST depression on ECG during exercise or in recovery ## Footnote Silent ischaemia may not present with noticeable symptoms.
45
What defines a high level of silent ischaemia during exercise testing?
ST segment depression >2 mm from baseline
46
What are some symptoms that indicate high risk during exercise participation?
Angina, shortness of breath, light-headedness, or dizziness occurring at low levels of exertion (<5 METS) or during recovery
47
What is the significance of chronotropic incompetence during exercise testing?
It indicates abnormal hemodynamics and places the patient at high risk
48
What are the key indicators of abnormal hemodynamics during exercise testing that would be a characteristic of a patient being at highest risk for exercise participation?
Chronotropic incompetence or flat/decreasing systolic BP with increasing workloads or recovery ie severe post exercise hypotension.
49
What CAD risk factors are used to predict the liklihood of coronory disease progression but are not used when assessing the risk of an adverse event during exercise?
Smoking, high fat diet
50
What is the primary purpose of risk stratification in exercise programmes?
To determine 1. exercise intensity 2. level of monitoring 3. level of supervision. This enhances programme safety
51
What should patients be screened for before each exercise session?
1. Changes in medication 2. symptoms 3. home exercise activity 4. problems and concerns ## Footnote Screening helps ensure patient safety and readiness for exercise.
52
What would exclude a patient from participating in the core rehab exercise session (Tip: there are 9 of these).
1. Fever or systemic illness 2. Unresolved unstable angina 3. BP 180/110 or worse 4. P 100 or worse 5. Uncontrolled atrial or ventricular arrhythmia 6. Symptomatic hypotension 7. Unstable heart failure 8. Recurrent or new breathlessness, fatigue or ankle oedema 9. Recurrent or new palpitations, dizziness or lethargy
53
What is a sign that a condition is deemed unstable or uncontrolled?
Evidence of new or worsening symptoms within the previous month ## Footnote Medication changes within the previous month also indicate instability.
54
What should be done if a patient presents with certain signs or symptoms before the next rehabilitation session?
Medical review should be undertaken ## Footnote This ensures patient safety and proper management of their condition.
55
What should induction sessions for new patients include?
Explanation of aims, exercises, safe target heart-rate ranges, warm-up and cool-down importance, monitoring ## Footnote Induction also includes practice in performing exercises safely and effectively.
56
What might many patients find intimidating when starting an exercise programme?
The idea of taking exercise ## Footnote Gentle encouragement may be needed for participation.
57
What should an induction involve?
1. Aims 2. Equipment and Techniques 3. How to monitor intensity (what level to work at during each section of the programme). RPE scale. 4. Importance of warm up and cool down 5. Practice at performing exercises 6. Understanding trackers, pulse taking
58
What is the recommended approach for patients categorized as low risk in terms of supervision?
Less continuous supervision than high-risk counterparts ## Footnote Low-risk patients can safely engage with less monitoring.
59
What should patients be set up with from the outset of Core rehab (Phase I)?
A home-based exercise programme ## Footnote Supervised sessions alone may not meet the recommended exercise frequency.
60
What is the recommended frequency for exercise in Phase II?
2-3 times per week
61
What percentage of Heart Rate Reserve (HRR) should be targeted during aerobic endurance training?
40-70% HRR
62
What intensity on the Borg or RPE scales should they Phase III training aim for?
Borge = 11-14 RPE = 2-4
63
What is the recommended duration for conditioning in Phase II?
20-30 minutes
64
What type of exercise is best?
AET Aerobic Endurance Training
65
What is a key consideration regarding patient attitudes during exercise in Phase II?
Patients may be fearful, anxious, cavalier, or aggressive
66
What is the ultimate goal of the conditioning component in Phase II?
Achieve a minimum of 20 minutes continuous cardiovascular exercise ## Footnote May not have achieved this coming in to stage iV
67
What approach is recommended for patients who are too deconditioned to achieve 20 minutes of continuous exercise?
Interval training with periods of active recovery
68
What are the two types of monitoring used to assess exercise safety and effectiveness?
Subjective and objective monitoring
69
What are some subjective signs of over-exertion to monitor?
* Excessive shortness of breath * Sweating * Angina * Fatigue * Loss of coordinated movement
70
What are some objective measures for monitoring exercise?
* Blood pressure * Heart rate * MET level achieved
71
What is one aim of the exercise component in Phase II?
To foster patient independence in exercising ## Footnote Wean from objective toward subjective (RPE scales)
72
What is the ideal staff-patient ratio during exercise sessions in Phase II?
Five patients to one trained professional
73
What should be the humidity and temperature maintained during exercise sessions?
* Humidity: 65% * Temperature: 65 to 72°F (18-22°C) ## Footnote Check room size is adequate too (no bumping hazards)
74
What is essential for patient safety during exercise sessions?
Ensuring all clients are asymptomatic and within 10 bpm of pre-exercise heart rate before leaving
75
Fill in the blank: The conditioning component in Phase II aims for a minimum of _______ minutes of continuous cardiovascular exercise.
20
76
What three things protect patients best in the event of an emergency?
1. Staff know Emergency procedures 2. There is a defibrillator on site 3. Access to a telephone
77
What is the minimum recommended frequency for exercise training in home-based exercise?
Three times a week ## Footnote This frequency is essential for gaining maximal benefit from the training.
78
What is the recommended home exercise program for patients?
Twice per week similar exercises and up to 30 minutes of walking on remaining days ## Footnote Walking should be at an appropriate speed and symptom-free.
79
What should unsupervised exercise always be within?
Prescribed target heart-rate range and a rating of perceived exertion of 11-14 on the Borg RPE scale or 2 - 4 on the Borg CR10 scale ## Footnote These guidelines ensure safety and effectiveness during exercise.
80
How can compliance with home-based activity be improved?
By recording it in an exercise log ## Footnote This allows for verification of frequency, duration, intensity, and monitoring of RPE scores.
81
What is the aim of education sessions in core rehab (Phase I)?
To facilitate the patient's understanding of their illness and treatments ## Footnote This education supports behavior change and empowers patients.
82
What topics should education sessions cover?
* Heart disease and investigations * Risk factors for CAD * Effects and benefits of exercise * Healthy heart diet * Medication * Relaxation * Stress management ## Footnote These topics are crucial for patient awareness and recovery.
83
What psychological conditions are common in patients with coronary artery disease?
Anxiety, depression, and psychological distress ## Footnote These conditions can significantly affect recovery and outcomes.
84
How much does depression increase cardiac mortality post-myocardial infarction?
Three to four-fold increase ## Footnote This highlights the importance of addressing mental health in cardiac rehabilitation.
85
What tool is commonly used for psychological assessment in cardiovascular rehabilitation?
Hospital Anxiety and Depression Scale (HADS) ## Footnote This tool helps screen patients for anxiety and depression levels.
86
Give examples of psychological interventions used in cardiovascular rehabilitation?
* Cognitive behavioural techniques * Motivational interviewing * individual counselling * relaxation * solution-focused therapy * stress management
87
True or False: All cardiovascular rehabilitation patients ideally benefit from access to psychological support.
True. ## Footnote Evidence shows psychological interventions can improve outcomes.
88
What is assessed prior to discharge from core rehab (Phase III)?
Whether all rehabilitation goals have been met. ## Footnote This includes assessing psychological stability and risk stratification.
89
Fill in the blank: Patients should be able to _______ independently, safely, and effectively according to an individual exercise prescription.
exercise. ## Footnote This is a key objective for discharge.
90
How must a patient be able to monitor themselves prior to discharge from PIII?
1. Take pulse 2. Rate Percieved Exertion 3. When to take GTN spray
91
What must rehabilitation staff ensure before discharging a patient to the GP?
1. The patient can demonstrate knowledge of their condition, understand what lifestyle changes need to continue and is medically stable 2. The patient can plan their goals, demonstrate compliance with home based activities and is psychologically stable and adjusted to the cardiac event. ## Footnote This includes meeting specific criteria related to functional capacity.
92
What is the recommended functional capacity for long-term exercise prescription (moving to Phase IV)?
Approximately 5 METS, i.e. walking comfortably at 4 mph. ## Footnote Patients with lower functional capacity should still be accommodated.
93
What are some issues considered during post-assessment for long-term management planning?
* Who will monitor risk factors * Details of medical follow-up * Local venues/resources for exercise * Advice on long-term exercise prescription * Support for behavior change * Coping with relapses * Local support group information eg weight management * Importance of social support ## Footnote This helps in maintaining lifestyle changes after rehabilitation.
94
What factors can affect the progress of patients in rehabilitation?
Fitness level, psychological distress, and co-pathologies
95
What is a critical step before a patient moves to long-term exercise sessions?
Writing a discharge communication to the patient's GP
96
What percentage of people drop out of exercise programs within the first 6 months?
50%
97
What should cardiovascular rehabilitation providers from core rehab and long-term exercise do?
Work closely to address local needs and maintain long-term exercise behavior
98
What form should be completed and given to each patient upon discharge from core rehab?
BACPR transfer form

BACPR (11 decks)

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