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
