PET3932 – Section 2EXAM 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 ridiculous 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 for Phase I)- 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 60 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 rehabSupervision: 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 takenGoal: it’s basically the definition of cardiac rehabilitation → patient has restored & maintained their optimal physical, psychological, etc. statusExercise tests need to be done in order to give a prognosis → so that 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 → so that 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, but maybe they can do something like wash dishes)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 rehabLength: 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 IISupervision: 1 employee – to – 12 (15) patients-Can be at any exercise facility with employees around; most exercises can be done on their ownRecommends doing in an exercise facility (gym, etc.) instead of at home just in case any symptoms reoccurGoal: maintain their optimal statusDifference 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 EKGReason why most people stop their phase III rehab: costs money for sessionsPhase IV: out-patient cardiac rehabLength: foreverSupervision: no personal supervision/not monitored at allGoal: maintain their optimal statusDoesn’t cost money b/c it is not a specific program …they can just go to the gym alone.SCRIP (The Stanford Coronary Risk Intervention Program)Focused on the effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events.GroupsUsual care (UC) is 47% better in terms of RR (Relative Risk)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 TrialIntervention consisted of…10% fat (i.e. vegetarian diet)Aerobic exerciseStress managementSmoking cessationPsychosocial supportControlAt-Home step 2 aerobic exerciseInterventionDiameter stenosis had decreased by 3.1% (control increased by 11.8%)Decreased stenosis, increased perfusionRate of cardiac events lowerShort Form 36 (SF 36)“Quality of Life” testBasically, 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 healthPhysical component-Physical function-Role physical-Bodily pain-General healthMental component-Mental health-Role emotional-Social function-vitalityGoals of Cardiac RehabilitationIn-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
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