Week 2 Flashcards
Cardiac Rehabilitation
The process where patients with cardiac disease, in partnership with a multidisciplinary team of health professionals, are encouraged to support, achieve and maintain optimal physical/psychosocial health
Settings that heart services are provided:
In-patient
Outpatient
Heart Wise exercise
Graded activities
adjusting the level of difficulty depending on what the patient can tolerate
Adapted activities:
adding assistive device or changing environment (if exercise is too hard for patient, need to make it easier)
OT/OTA role in cardiac rehabilitation (Emphasis on functional activities as therapeutic modalities):
Restore independence
Patient education in activity modification
Psychological support
Crucial to monitor vital signs while doing so
Why is activity and occupation important?
Unnecessary restriction of activity will cause harm (pt will get weaker and weaker), should try to have a gradual (amount/intensity of exercise) and safe return
What level of activity should heart patients be working at?
Main goal is to identify activities the patient can work at a moderate pace (moderate activities)
What are 3 ways to ensure the patient is working at a moderate pace for them:
1) Heart rate
2) Talk Test
3) Standardized Measure: Rating of Perceived Exertion Scale (RPE)
What should HR be at when working at a moderate pace?
HR should be 20-40 bpm over resting HR/50 (low end) to 70% (high end) of maximal HR when working at a moderate pace
How to calculate what HR should be when working at a moderate pace
- Calculate maximal HR: 220 – current age
- Calculate 50%-70% of maximal heart rate : 0.5 (50%) X maximal HR/0.7 (70%) X maximal HR
medications can “mask” regular HR so its important to know what medications pt is taking
Talk Test
Light intensity: patient can talk or sing
Moderate: patient is breathing fast, but can still talk/form sentences
Vigorous: laboured breath, can only get a few words out
Standardized Measure: Rating of Perceived Exertion Scale (RPE)
Moderate exertion is 4-6
most commonly used in practice
“0 is a breeze and 10 is a wheeze”
Can be used as a motivator for improvement by moving down levels
Patient is walking and they say their RPE is at a 10, what should you do as an OTA/PTA?
Monitor vital signs (when feeling unwell vs when “stable”
Rest the patient
Ask patient questions
“Grading”:
- change to have patient march while sitting down
- Walk shorter distance
- Slow pace
- Reduce energy needed/less talking during walking
Pacemaker
monitors heartbeat
Activity guidelines following Pacemaker implant surgery
First 24 hours:
- No moving shoulder on the side of the insertion,
- you can bend your elbow and move your arm freely below your shoulder
First two weeks:
- No lifting affected arm overhead,
- you can begin to do most of the regular activities you did before procedure
First four weeks: No lifting anything heavier than 10 pounds and avoid any kind of sports or vigorous activity, you can begin to do all regular activities you did before procedure
First eight weeks: avoid any kind of vigorous activity (like shoveling)
Conventional Sternal Precautions:
Do not push, pull or lift anything heavier than 10 lbs with your arms, including your own weight (transfers, using walker/wheelchair)
Need to follow for 6-8 weeks following surgery
Sternal Considerations:
Avoid excessive twisting
Avoid straining or holding of breath
Careful when reaching behind
Avoid arms above head
Recovery time following sternotomy
Average 4-7 days in hospital following sternotomy, full recovery can take months
Most common symptoms following sternotomy:
Fatigue (energy conservation)
Difficulty sleeping at night (sleep hygiene education such as sleeping on side)
Pain & discomfort at incision (pain monitoring and management, education on precautions and their applications in ADLs)
Lobectomy
removal of one (or more) lobes of the lungs
Pneumonectomy
Removal of an entire lung
Wedge resection
Removes a small portion of a lobe
Segmentectomy
Removes a portion of a lung
AAA
Abdominal Aortic Aneurysm Repair
EVAR
Endovascular aneurysm repair (part of AAA)
Minimally invasive
Open Repair
large incision in the abdomen
(part of AAA)
Things to remember for Abdominal surgeries:
log roll
‘No Valsalva Manoeuvre’ : don’t hold your breath, continue breathing
Watch for lines, tubes, and dressings
Sternotomy:
Can take MONTHS for sternum to heal properly
No lifting, pushing, pulling more than 10 pounds for 6-8 weeks following surgery
No unsupported coughing, sneezing
No driving
Refrain from reaching behind and to sides
Refrain from twisting/turning
Refrain from putting arms above head for long period of time
Top 4 cancers
lung, colorectal, breast, prostate
What are 2 things to consider with Oncology:
1)Pain
Medications
Planning time in advance
Letting pt know its ok to not follow up if not feeling it
2)Possible fractures
Metastatic Fractures
new or impending
Critical illness myopathy
a disease of limb and respiratory muscles, and it is observed during treatment in the intensive care unit
muscles will NOT respond in the same way as someone without CIM – slower, weaker, some damage can be permanent
What 2 things should you check with RN/MRP for?
1) Medically stable
2) Which lines and tubes can de disconnected
What are 3 vitals that you should look at and what ranges they should be at
1) BP – below 180/200
2) HR – above 50, below 100
3) RR – no distress; SpO2 above 90% (at rest)
Difference between Mechanical and External Ventilation
Mechanical: Endotracheal tube, Tracheostomy
External: Supplemental 02
Endotracheal tube, Tracheostomy, which one is temporary and which is permanent?
Endotracheal tube – temporary
Tracheostomy – permanent
You are working with a patient who had a sternotomy performed 2 weeks ago for coronary artery bypass grafting (CABG). With respect to conventional (not modified) sternal precautions, your patient should NOT:
Push up from the chair armrests to stand
Pull open heavy doors
Lift arms above shoulder level for brief periods of time
Walk more than 5 minutes at a time
Carry objects that weigh less than 5 pounds
Push up from the chair armrests to stand
Pull open heavy doors
Lift arms above shoulder level for brief periods of time
Walk more than 5 minutes at a time
Carry objects that weigh less than 5 pounds
Pacemaker activity guidelines are the same as post-sternotomy activity guidelines.
False
A patient who is breathing hard during an activity but is still able to talk while participating is probably doing moderate intensity activity.
True
In which section of a patient’s chart would you document a vital sign measurement?
P: plan
S: subjective
A: analysis
O: objective
O: objective
Full recovery post sternotomy can take months because:
Building strength back takes time
The sternum needs to heal
No physical activity is allowed for at least two months
The precautions cause muscle atrophy
Building strength back takes time
The sternum needs to heal
No physical activity is allowed for at least two months
The precautions cause muscle atrophy
A critical patient in the ICU has too many many monitors, lines and tubes to safely engage in your treatment session.
True
False
False
You are working with a patient, post-op CABG day 4 who is on conventional sternal precautions. How often should you remind your patient of their precautions?
at the start of the session
As often as necessary. I should continually be watching to see if they need to be corrected
never - they should know already
when I’m done the session
As often as necessary. I should continually be watching to see if they need to be corrected
For moderate-intensity exercise using the modified Borg scale, it is recommended that a patient works at a level that feels to be:
between levels 1-3
between levels 7-10
between levels 4-6
between levels 4-6
Exercise is an important part of treatment plan for patients with HIV.
True
False
True
Fatigue is the one of the most frequently experienced symptoms for people with cancer.
True False
True
