Treatment Flashcards
How long are typical outpatient cardiac rehab programs
12 weeks
3 Overall goals of cardiac rehab
- Restore optimal function
- Prevent progression of underlying processes
- Reduce risk of sudden death and re-infarction
Exercises to avoid in cardiac rehab
- No valsalva
- Extensive upper body activity
- Isometric/static exercises
FITT prescription for Cardiac rehab
F: 3-5 days per week,
I: 60-80 % of HRR, talk test, RPE (around 4-6),
• Do not use HRR for those on beta blockers or pacemakers
• for pacemakers stay 30 bpm below level that it starts at OR 10-15 bpm below onset of abnormal symptoms or angina
T: work up to 45-60 minutes in 5-10 minute intervals
T: whole body dynamic movement
Should include 5-10 min warmup and cool down
What is the equation for HRR
(HR max-resting HR) x intensity % + resting HR
What do beta blockers do?
What are they used for?
- Decrease: pulse, myocardial contraction force, myocardial O2, conduction velocity between SA and AV node
USES: CAD, angina pectoris, hypertension, irregular heart rhythms
Important consideration when using Beta blockers?
blunted response to HR and BP, decreased resting BP and with exercise, postural hypotension, dose and time related, decreased ischemia with exercise, increased exercise capacity in people with angina
USE RPE! Not age predicted hr range
Ensure gradual warm up and cool down
What does nitrate and nitroglycerin do?
Uses?
Relaxes smooth muscle in blood vessels, increases blood flow and decreases workload & O2 supply of heart muscles
USES: treat angina, CHF, acute MI
Important considerations when taking nitrate and nitroglycerin?
Increased resting HR and possible exercise heart rate
Decreased resting BP and maybe exercising BP, may cause postural hypotension with postural changes,
Increased exercise capacity with angina pts
ensure warm up and cool down: nitro doses 3-5 minutes apart
What needs to be said to those using nitro
storage, expiration date, cool dry space, prime before taking first dose: sit down, take dose, wait 5 minx3 then go to hospital or return at lower rate
what does ACE stand for? (in ACE inhibitors?)
angiotensin converting enzyme
What do ACE inhibitors do?
Uses?
block conversion of angiotensin I to II
prevents vasoconstriction
Decrease peripheral resistance
Increase urine output
USES: HTN, CHF and CVD, MI, kidney function in diabetics
Important considerations when taking ACE inhibitors
Increase exercise tolerance in clients with CHF
Decreased resting and exercising BP
gradual warm up and cool down
What do anticholesterol agents do?
Two types?
Decrease mortality in heart disease patients even if cholesterol is normal,
Decrease cholesterol levels (especially LDL) and triglycerides
Niacin and statins
Important consideration if taking niacin?
postural hypotension, need gradual warm up and cool down),
Side effects of statin?
Muscle aches and joint stiffness
What do antiplatelet agents do?
Uses?
Decrease platelet aggregation at site of tissue damage
USES: reduces risk of MI, TIA, brain attacks or ischemic strokes
Are there effects of antiplatelet angents on pulse or BP
What are the contraindications to exercise with these drugs
No
None
Important considerations when taking antiplatelet agens
caution with bruising, or increased bleed
What are the indications for oxygen therapy?
- SaO2 less than 90% or PaO2 less than 80 mm Hg
- Decrease work of breathing
- acute MI or to decrease myocardial work
- short term post-surgery for recovery
- RT for O2 greater than 40%, acute respiratory distress, transport with O2, and artificial airway (trach)
What are the 3 main systems for oxygen therapy?
LOW FLOW SYSTEM: supplemental O2 to tidal volume
- nasal prongs (6 L max), simple mask, partial rebreathing, and non-rebreathing mask
HIGH FLOW: enough O2 to supply the entire tidal volume
- venturi face mask, face tent, tracheostomy mask
1 L/MIN = 24 % O2 * goes up by 4% every L increase
What is the purpose of incentive spirometry
patients with atelectasis; provides visual input/incentive goal (NO evidence use of IS to prevent post-op complications)
What is the method and contraindications to incentive spirometry
METHOD: Sustained inspiratory effort ~3 sec, relaxed expiration; attempting to achieve max inspiration to TLC
CONTRAINDICATIONS:
- cognitive impairment
- patients unable to deep breathe effectively due to pain
- diaphragmatic dysfunction, or opiate analgesia
- Patients unable to generate adequate inspiration with a vital capacity <10 mL/kg or an inspiratory capacity <33% of predicted normal
What is the purpose of inspiratory muscle training
retrain muscles of inspiration (diaphragm, external intercostals, etc.) in populations needing it (evidence support for COPD, CHF, endurance athletes, SCI)
What is needed in order to conduct inspiratory muscle training
Reliable measure of max inspiratory pressure + max expiratory pressure (pulmonary tests); can use a resistive trainer, threshold trainer (COPD, CHF, athletes), or normocapnic hypernea (athletes, SCI)
Prescription for inspiratory muscle training
Start w/ 5 min, progress over 2-3 weeks to 2x15 min or 1x30 min sessions, 4-5 days/week, begin at 20-30% MIP and progress to 50% MIP as tolerated, fit individuals can progress to 70% carefully
What must you monitor when doing inspiratory muscle training
vitals for signs of cardioresp distress
Contraindications to inspiratory muscle training
Acute respiratory failure cognitive impairment (cannot keep it clean)
What is shunting
normal perfusion but no ventilation (alveoli is collapsed and the capillary is expanded)
What is dead space unit?
normal ventilation with poor perfusion (capillary is completely collapsed and the alveoli is enlarged)
What is silent unit?
no ventilation or perfusion (both are collapsed)
What is normal ventilation?
Greatest in dependent regions
What is abnormal ventilationi
Best in non-diseased areas
What is the effect of mechanical vent on ventilation
Air follows path of least resistance, usually best in non- dependent region
What is normal perfusion
Greatest in dependent regions
What is abnormal perfusion
Unless restricted will flow to gravity dependent regions
What is the effect of mechanical vent on perfusion
Increased pressure can restrict blood flow to non- dependent regions
Treatment principle in normal VQ matching
Lower regions of lungs have greatest surface area therefore best VQ matching in upright lung
Treatment principle in abnormal VQ matching
Generally place the affected area in non- dependent position to increase VQ matching (bad lung up)
