In patient physio protocols

1. CARDIAC REHAB
• AACPR –CR as the application of rehabilitative service
To improve and maintain patients physiological, psychosocial
&vocational functioning at an optimal level
• US dept of Health & Human services
It is comprehensive long term program involving medical
evaluation, ex’s prescription, cardiac risk modification, education,
counseling to limit the physiological &psychological adverse
effects of cardiac illness
Goals
• To prevent &reverse atherosclerosis
• Reduce M. ischemia &risk of infraction/sudden death
• Maximize CV functions &capacity
• Maximize ex’s tolerance &ADL performance
• To establish –pt controlled and safe activities &work
• To control risk factors for CHD
• To improve Quality of life
CR-3 phases
Prevention- Acute care (medical& surgical) - rehabilitation
• Phase 1 ;inpatient from hospital admission to hospital
discharge
• Phase 2; outpatient ,training phase including aerobic
conditioning
• Phase 3 ; maintains phase pt’s monitoring of aerobic ex’s
program risk re-education and activity modifications

2. Contraindication of ex’s
• Unstable angina
• Resting SBP>200&DBP>100mmH
• Significant fall of SBP 20 mmHg
• Aortic stenos is
• Uncontrolled atrial& ventricular dysarrythmias
• ; ; tachycardia >100bpm
• Symptomatic CHF
• 3* Heart block
• Active myocarditis&pericarditis
• Recent embolism&thromophlebitis
• Resting ST displacement >3 mm
General
Acute systemic illness &fever
Uncontrolled DM
Orthopedic problem
Precaution &termination EX’S
1. fatigue
2. failure of monitoring equipment
3. light headache ,confusion, ataxia, pallor, cynosis, dyspnea
4. peripheral circulatory insufficiency
5. onset of angina with ex’s
6. symptomatic supraventricular tachycardia
7. ST displacement 3 mm
8. ex’s induced left BBB
9. onset of 2*/3* AVblock
10. Ron T phenomena
11. ex’s hypotension>20 mmHg drop SBP
12. excessive SBP>220&DBP> 110 mmHg
13. bradycardia with workload

3. Phase 1 rehab
Primarily for recovering MI, CABG; PTCA, valve surgery,
cardiac transplant, stable angina &CAD risk factors
Ex’s program
• program starts usually by patient has stabilized after
stabilized infracted or bypass surgery
• program combines with low level ex’s and education
generally lasts 3 to 6 days
• Low level ex’s during hospital stay ,safe ,feasible ,beneficial
,physical activity reduce risk of thrombi, maintain muscle
tone ,orthostatic hypotension &Rom stability
• To begin the program –evaluate medical history clinical
status from patient chart
• Intensity of the program-stepwise fashion emphasis the
ROM with series active, passive& resisted ex’s in supine,
sitting& upright positions
• Passive ex’s contraindicated MI
• Most of the ex’s conducted at the bed side with central
monitoring
• CABG&PTCA rehabilitee more aggressively becoz no/little
damage of myocardium
• Ex’s program consist of 1-11 steps
• Patients progressed 1 or 2 steps each day
PARAMETERS
• MODE of activity ; supervised monitoring progressive step
wise aerobic ex’s (breathing ex’s ,pedal ex’s , climbing stairs
,Rom etc}
• Intersity ;RHR+20 bpm, MET ;2 to 4
• Duration ; 5 to 10 mintues ;progressed 20 to 30 minutes
• Frequency; low level ex’s 2 times per day
• Guidelines; Mayo clinic inpatient CR physical activity
program

4. Ex’s testing
• A low level testing prior discharge for assessing patient
progress
• To determine appropriate home ex’s
• To begin assessing patients risk &prognosis
• Testing conducted with the following end point
• 20-30 beats above RHR
• Max HR of 120 to 140
• MET 4-6 /70-75% age est. MHR
• Patient with beta blocker on RPE of hard end point
• Testing performed 3 days-3 weeks after discharge
• Poorly responded patients progressed cautiously
Psychosocial testing
• Significant component, influence learning compliance
• Life style modification
Personnel
• Physician
• Cardiac rehab nurse
• Physiotherapist
• Psychologist
• Dietitian
Benefits
• Behavioral modification
• Extent of knowledge
• Reliability &validity of self administer questionnaires
• Long term commitment