PET3932 – Section 2QUIZ 3 STUDY GUIDE Cardiac Rehabilitation: the process by which persons with cardiovascular disease are restored to and maintained at their optimal physiological, psychological, social, vocational, and emotional status. Important aspects:  Phase (4 phases; in-patient or out-patient?) Length (number of days; how long is the phase?) Supervision (what is the ratio of doctor/nurse/PA to patient?) Goal (what should be the outcome of that specific phase?) To sum this up: how do you reach a “quality of life”? Phases of cardiac rehabilitation Phase I: in-patient cardiac rehab Length: 2-4 days → this is a short phase in order to reduce the cost (in-patient care, which isin a hospital, costs a stupid amount of money) → patient can do these things at home once you teach them & they are comfortable - 2 to 3 times a day, the patient should do some ROM (range of motion) exercises, then they can work up to being able to walk around the hospital- Start out doing 5 minutes of activity a day Supervision: one-one-one → usually done by the nurse or staff that originally worked with the patient when they went through their MI or onset of CVD b/c they are most familiar with the patient’s situation Goal: (p.236) (there are more goals listed later, but these are what Dr. Kasper considered tobe the most important goals)- Offset the deleterious physiologic and psychological effects of bed rest. - Evaluate and begin to enable patients to safely return to activities of daily living (ADLs) within the limits imposed by their CVD.Phase II: out-patient cardiac rehab (has to be physician-referred)Start Phase II 2 – 4 weeks after phase I → can do small activities during this time (nothing more than moderate activity though)Length: 12 weeks (36 sessions)-Each session is usually 20 minutes long-Largely depends on how well they’re recovering → if they’re doing awesome, obviously you don’t have to keep putting them through Phase II rehabSupervision: 1 employee – to – 5 patients ratio (employee: nurse, RN, exercise specialist)-Patient should have an EKG hooked up to them, and have their BP & RPE takenGoal: it’s basically the definition of cardiac rehabilitation → patient has restored & maintained their optimal physical, psychological, etc. statusExercise tests need to be done in order to give a prognosis → now the amount and type of medicine can be decided on for the patient-An exercise program can also be developed based on the results of the exercise test-The exercise test should be sign/symptom limited → now you can tell the patient what ADLs they can do when they’re back at home (if they’re showing signs/symptoms when they are picking up 5 pound weights, then obviously they shouldn’t be pushing a lawn mower)Any kind of resistance training done during rehab needs to be approved by a doctor“Cardiac cripple” – a person that thinks they can’t do ADLs at home b/c they’re not in the Ex Rx facility/situation despite the fact that they are physically capable. Phase III: out-patient cardiac rehabLength: forever (patient can use the types of exercises & tips given to them for the rest of their life) → ** however, Dr. Kasper said that essentially no patients actually get to phase III… only about 12.5/100 people even finish phase IISupervision: 1 employee – to – 12 (15) patients-Can be at any gym with employees around; most exercises can be done on their ownRecommends doing in a gym instead of at home just in case any symptoms reoccurGoal: maintain their optimal statusDifference between Phase II and Phase III: the amount of supervision/monitoring of BP and EKG → Phase III has a significant decrease in supervision and does not monitor BP or EKGReason why most people stop their phase III rehab: costs money for sessionsPhase IV: out-patient cardiac rehabLength: foreverSupervision: no personal supervision/not monitored at allGoal: maintain their optimal statusDoesn’t cost money b/c it is not a specific program …they can just go to the gym.SCRIP (The Stanford Coronary Risk Intervention Program)Focused on the effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events.GroupsUsual care (UC) is 47% better in terms of RRStudy showed that you have to change all aspects of life with aggressive control.It’s possible to reduce these diseases, but it’s not realistic b/c people won’t change all the aspects of their lives.Lifestyle Heart TrialIntervention consisted of…10% fat (i.e. vegetarian diet)Aerobic exerciseStress managementSmoking cessationPsychosocial supportControlAH step 2 aerobic exerciseInterventionDiameter stenosis had decreased by 3.1% (control increased by 11.8%)Decreased stenosis, increased perfusionRate of cardiac events lowerShort Form 36 (SF 36)Basically, the insurance companies want to know: can the person do ADLs, go to work, and havesome sort of quality of life; it doesn’t matter if the patient is making small progress on, for example, the amount they can walk on a treadmill.Scales measure physical and mental components of healthPhysical component-Physical function-Role physical-Bodily pain-General healthMental component-Mental health-Role emotional-Social function-vitalityGoals of Cardiac RehabilitationIn-patient rehab program (Phase I) (p.236)Identify patients with significant cardiovascular, physical, or cognitive impairments that may influence the performance of physical activity.Offset the deleterious physiologic and psychological effects of bed rest.Provide additional medical surveillance of patients and their responses to physical activity.Evaluate and begin to enable patients to safely return to activities of daily living (ADL) withinthe limits imposed by their CVD.Prepare the patient and support system at home or in a transitional setting to optimize recovery following acute care hospital discharge.Facilitate physician referral and patient entry into an outpatient cardiac rehabilitation program.Out-patient rehab program (Phase II-IV)(p.240; box 9.4)Develop and assist the patient to implement a safe and effective formal exercise and lifestyle physical activity program.Provide appropriate supervision and monitoring to detect change in clinical