Cardiac rehabilitation

A successful rehabilitation begins with the moment the client enters the coronary care unit for emergency care & continues for months and even years after discharge from the health care facility. The overall goal of rehabilitation is to help the client live as full vital and productive a life as possible while remaining within the limits of the heart’s ability to respond to increase in the activity and stress.

Definition

Cardiac rehabilitation is a comprehensive long term program that involves periodic medical evaluation, prescribed exercises & education & counselling about cardiac risk factor modification.

Cardiac rehabilitation is a multifactorial program that begins when the client is still hospitalized and continues throughout recovery.

Six important sub goals of rehabilitation process

1.Developing a program of progressive physical activity2.Educating the client and significant others about the cause, prevention and treatment of CHD3.Helping the client to accept the limitations imposed by illness4.Aiding the client in adjusting to changes in occupational goals5. Lessening the exposure to risk factors6. Changing the psychosocial factors, adversely affecting recovery from CHD

Cardiac rehabilitation- 4 phases

Phase I - Inpatient phasePhase II - Immediate outpatientPhase III - Intermediate outpatientPhase IV - Maintenance outpatient

Phase I - Inpatient phase Begins with the admission to the coronary care unit. After an MI, Complete bed rest for the 1st day. Use bedside commode for bowel movements.Diet : 2gm sodium diet If nauseated, provide a clear liquid diet until nausea subsidesExercise A coronary care nurse or physiotherapist should start passive exercises. As the client regains strength, have the client sit for brief periods on the side of the bed and dangle the feet

Phase II - Immediate outpatient phase

Discharge to home by the end of two weeks if no complications arise.Sexual intercourse (4 - 8 weeks) when the client is able to climb 2 flights of stairs.Resumption of job: At the end of 8 or 9 weeks if asymptomatic and if the job is not tiring.Graded ambulation, By 8th and 10th week – Complete physical examination including ECG, Exercise stress test, lipid profile and CXR.

Phase III – Intermediate outpatient phase

The extended outpatient phase of cardiac rehabilitation lasts from 4-6 months. Exercise sections continue to be supervised and clients are taught how to monitor their exercise intensity by taking their pulse or if in a walking programCounting the number of steps they take in a 15 sec interval.Periodic evaluation -To assess client’s endurance & tolerance to the prescribed exercise program.

Phase IV - Maintenance outpatient phase

This phase usually take place in the home

or community & is unsupervised

Rehabilitation after cardiac surgery

After CABG, the patient will be on ET ventilation. Ideally the patient can be weaned from the ventilator after 6 hours if the condition permits. In some cases the ventilation may extend up to 24 hrs.

On the 2nd post operative day, the patient will be extubated & on oxygen mask.After 2-3 hrs, the patient will be allowed to sit up in bed. Respiratory exercises and Incentive spirometry is provided.

Rehabilitation cont..dAmbulation – 2nd day onwards the client can be ambulated - graded ambulation. The client can dangle his / her feet by sitting on the side of the bed.

On the 3rd day, the client is mobilised. The client can be ambulated from the bed and allowed to walk around the bed.

On the 7th day, sutures will be removed & patient will be discharged home.

Discharge instructions

CABG- Usual discharge instructions will be followed, especially graded ambulation.

Valve surgeries Regarding lifelong anticoagulants. Tab Warf according to PT & INR. INR must be kept between 2.5 & 3.5 for MVR, For AVR, INR must be between 2.5 & 3, For DVR - 3 to 3.5. Lowest of the two ranges is preferred. Tab Ecospirin will also be continued.

PPC Concept - 6 elementsIntensive careIntermediate care - Ambulatory for short periods of time Self care – Within the limits of his illness

Longterm care - Rehabilitation, Occupational therapy & Physical therapy - Instruct patients to learn to adjust to their illness & disability. Home care – Extension of certain hospital services. Outpatient care – For ambulatory patients, requiring diagnostic, curative, preventive & rehabilitating services

1st day – Bed rest 2nd day – Ambulation starts, sit up in bed3rd day -- Client can walk around the bed

(shifted from ICCU)4th day -- Walk to the next bed. Slightly increase walking periods to 3 mts in the morning & evening. Stomach must be only half filled.5th day -- Usually patient’s will be discharged if no chest pain occurs with graded ambulation.

Patients after MI (Graded ambulation)

Thank You…

Deepa Merin KuriakoseAssistant Professor

Govt. College of Nursing, Kottayam