PET3932 Section 2 EXAM 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 is in 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 to be 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 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 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 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 exercise facility with employees around most exercises can be done on their own Recommends doing in an exercise facility gym etc 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 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 Groups Usual care UC is 47 higher 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 Trial Intervention consisted of 10 fat i e vegetarian diet Aerobic exercise Stress management Smoking cessation Psychosocial support Control At Home 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 Quality of Life test Basically the insurance companies want to know can the person do ADLs go to work and have some 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 within the 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 status Provide ongoing surveillance data to the patient s health care providers in order to enhance Return the patient to vocational and recreational activities or modify these activities based medical management on the patient s clinical status Provide patient and spouse partner