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S7- Cardiopulmonary > Week 8- Cardiac Rehabilitation > Flashcards

Week 8- Cardiac Rehabilitation Flashcards

1
Q

PART 1:

A

PART 1:

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2
Q

We should provide a _________ approach to the rehabilitation of patients with heart disease involving education, structured progressive physical activity, lifestyle modifications, and vocational counseling.

A

Multidisciplinary

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3
Q

What patient populations are candidates for cardiac rehab? (7)

A
  • Post MI
  • Post-op cardiac surgeries including transplants
  • Heart disease
  • CHF
  • Post PTCA
  • Elderly
  • Asymptomatic, at risk patients
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4
Q

Who is not a candidate for cardiac rehab? (7)

A
  • Unstable angina
  • HEMODYNAMIC INSTABILITY (SP/DP >200/100, orthostatic fall >20mmHg)
  • Serious arrhythmias
  • Conduction abnormalities
  • Active infections
  • Uncontrolled DM
  • Resting ST segment depression
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5
Q

(T/F) Cardiac rehabilitation is underutilized.

A

True

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6
Q

Cardiac Rehab:

  • Reduces _______
  • ______ the heart
  • Improves cardiac function
  • Might get _______ changes
  • Modifies __________
A
  • reduces BW
  • unloads the heart
  • lifestyle changes
  • risk factors
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7
Q
  • How any cardiac rehabilitation phases are there?

- Which phase is the most involved and which is the least involved?

A
  • 4

- Phase I = most involved, Phase IV = least involved

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8
Q

PART 2: PHASE I (ACUTE) CARDIAC REHAB

A

PART 2: PHASE I (ACUTE) CARDIAC REHAB

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9
Q

What are the goals of Phase I (Acute) Cardiac Rehab? (4)

A
  • Independence in ADLs
  • Counteract bedrest effects (reduce risk of thrombi and pneumonia, maintain tone, reduce OH)
  • Medical surveillance during ADL type of activities
  • Education (disease process, CV monitoring, exertional intolerance and energy conservation)
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10
Q

What are some exercise activities to include for Phase I Cardiac Rehab? (5)

A
  • Self care
  • Arm/Leg AROM
  • Very light weights
  • Independent transfers
  • Bedside sitting to ambulation to stairs
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11
Q

Patients in Phase I are monitored, what does this mean?

A

Monitoring vitals through EKG while exercising, making sure no S/Sx before progressing exercise.

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12
Q

What are the (3) instances in Phase I in which we stop treatment?

A
  • Unusual HR increase
  • Inappropriate BP response (>220/110 OR 10mmHg drop in DBP with exercise)
  • Presence of symptoms
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13
Q

Phase I Intensity Parameters:

  • > ___BPM or >___-___BPM increase
  • _________
A
  • <120BPM or >20-30BPM increase

- symptoms

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14
Q

What MET level is required for discharge of Phase I? Why?

A

-3-5 METs by discharge because this is what is required to complete ADLs

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15
Q

PART 3: PHASE II (SUBACUTE) CARDIAC REHAB

A

PART 3: PHASE II (SUBACUTE) CARDIAC REHAB

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16
Q

What are the goals of Phase II (Subacute) Cardiac Rehab? (6)

A
  • Improved exercise tolerance
  • Patient education
  • Risk factor reduction/secondary prevention
  • Return to work
  • Promote psychological, behavioral, and educational improvement
  • 9-10 METS (3.0mph for 30m)
17
Q

How long does Phase II last?

A

8-12 weeks

18
Q

Are patients in Phase II monitored like those in Phase I?

A

Yes, difference is that you are monitored outside of the hospital.

19
Q

How do we find the HRmax of patients in Phase II?

A

207-(0.7*age)

20
Q

What is the Karvonen method for defining a target heart rate range (THR) for patients in Phase II?

A

(HRR*training %) + resting HR

21
Q

In Phase II, keep HR below levels that elicit what (5) things?

A
  1. ) S/Sx
  2. ) Dyspnea
  3. ) Plateauing/decreasing SBP
  4. ) EKG abnormalities
  5. ) Arrhythmias >6/min
22
Q

What would be an acceptable RPE training range for patients in Phase II (endurance vs strength)?

A
  • ENDURANCE = 11-13 RPE

- STRENGTH = 15-17 RPE

23
Q

What are some things that might indicate an abnormal response to exercise in Phase II patients?

A
  • > 240/110 BP, >20 SBP drop
  • Unusual HR response
  • S/Sx (angina, dyspnea, excessive fatigue, mental confusion/dizziness, claudication, pallor, cold sweat, ataxia, pulmonary rales)
  • ECG abnormalities
24
Q

Phase II Resistance Training:

  • Should we perform resistance training in Phase II?
  • __ weeks post PCTA/stent, __ weeks post MI, __ weeks post CABG
  • ___-___% 1RM, 8-10 reps 2-3x/week
A
  • Yes (large muscle groups, control weights, breathe during effort)
  • 2 weeks post PCTA/stent, 5 weeks post MI, 8 weeks post CABG
  • 30-50% 1RM
25
Q

Should patients in Phase II be encourages in Valsalva maneuvers while performing resistance exercises?

A

NO

26
Q

What MET level is required for discharge of Phase II?

A

9-10 METs (3.0mph for 30m)

27
Q

PART 4: PHASE III (TRAINING) AND PHASE IV (MAINTENANCE) CARDIAC REHAB

A

PART 4: PHASE III (TRAINING) AND PHASE IV (MAINTENANCE) CARDIAC REHAB

28
Q

What is the main difference between Phase II and III of cardiac rehab?

A

Patient is more self monitoring in Phase III and HEP.

29
Q

How long does Phase III usually last?

A

3-6m

30
Q

Phase III Exercise Parameters:

  • ___-___% of HRR on treadmill test
  • __-__ sessions/week
  • > ___m per session
A
  • 50-80% HRR
  • 3-4 sessions
  • > 45m
31
Q

What are (4) important things to note about Phase IV?

A
  • HEP
  • Self monitoring
  • Environmental concerns
  • Adherence
32
Q

In what stages is EKG monitoring NOT performed?

A

Stage III and IV

33
Q

PART 5:

A

PART 5:

34
Q

What are some reasons referrals to cardiac rehab programs reman low? (4)

A
  • Lack of centralized method for referral
  • Inadequate communication among treatment teams, patients, and CR facilities
  • Unfamiliarity with CR among potential referring physicians
  • Limited access, competing responsibilities, and perceived inconvenience for the patient
35
Q

What are some patient barriers to their participation in cardiac rehab programs? (8)

A
  • Poor functional status
  • Higher BMI
  • Tobacco use
  • Depression
  • Long distance to CR facilities
  • Low health literacy
  • High costs
  • Inflexible work hours
36
Q

What is the most powerful predictor of participation in a cardiac rehab program?

A

The most powerful predictor was the STRENGTH OF THE PRIMARY PHYSICIANS RECOMMENDATION.

37
Q
  • Is home based cardiac rehab effective?

- What are the obvious problems with home-based vs clinic-based cardiac rehab?

A
  • Yes, low-mod strength evidence stating HBCR and CBCR have similar effects.
  • Safety and monitoring
38
Q

HBCR Advantages. (5)

A
  • More convenient for patient
  • Individually tailored
  • Patient friendly scheduled and access
  • Greater privacy
  • Put in home routine
39
Q

HBCR Disadvantages. (7)

A

-More trust in patient’s ability
-Lack of reimbursement INS
-Less social support
-Less intensive training
-Heavier patient self reliance
-Less face to face monitoring and
communication
-Safety for higher risk patients

S7- Cardiopulmonary (24 decks)

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