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NPTE: Cardiac (scorebuilders 2008)

Phase I cardiac rehab program • Consists of pt/family education, self-care eval, continuous monitoring of vitals, low-level exercise: AROM, amb, and self-care. • Ends with: low-level exercise test. • Lasts 3-5 days.
Phase II cardiac rehab program • Lasts 2-12 wks. • Frequency = 2-3x/wk. • Pts. monitored closely and supervised during all activities. • Progress to Phase III when: clinically stable, indep. w/ self-monitoring, don't require ECG monitoring
Phase III cardiac rehab program • Lasts 6-8 wk. • Frequency: 1x/wk • Includes exercise, education, and counseling. • Max symptom-limited exercise test is required.
Phase IV cardiac rehab program • Lasts throughout the pts. lifetime • Requires independence with self-monitoring, stable cardiac status, no contraindications to exercise, at least 5 MET capacity
MET level? • Eating 1
MET level? • Toileting 1-2
MET level? • Driving a car 1-2
MET level? • Dressing 2
MET level? • Walking (2 mph) 2-2.5
MET level? • Bathing 2-3
MET level? • Cooking 2-3
MET level? • Light housework 2-4
MET level? • Light gardening 3-4
MET level? • Showering 3.5-4
MET level? • Sexual intercourse 4-5
MET level? • Dancing 4-5
MET level? • Walking (4 mph) 4.5-5.5
MET level? • Swimming 4-8
MET level? • Shoveling snow 6-7
MET level? • Mowing the lawn 6-7
Hypertension in: • Infant >90/60 mmHg
Hypertension in: • Children >120/80 mmHg
Hypertension in: • Adults - borderline >140-159/90-99 mmHg
Hypertension in: • Adults - moderate >160-179/100-109 mmHg
Hypertension in: • Adults - severe >180/110 mmHg
Hypotension exists if: Systolic pressure <100 mmHg
Pathological Changes in ECG: • Depressed QRS Indicates: heart failure, ischemia, pericardial effusion, obesity, COPD
Pathological Changes in ECG: • Ectopic foci A location where abnormal myocardial depolarization originates. Occurs if the rhythm of the ectopic pacemaker increases, the rhythm of normal pacemakers is inhibited, or if the conduction path from the normal pacemaker to the ectopic foci is blocked.
Pathological Changes in ECG: • Elevated QRS Hypertrophy of myocardium
Pathological Changes in ECG: • Q wave previous myocardial infarction
Pathological Changes in ECG: • ST segment elevation acute myocardial infarction
Pathological Changes in ECG: • Atrial fibrillation hypertension, CHF, CAD, rheumatic heart disease, cor pulmonale, pericarditis, illegal drug use
Pathological Changes in ECG: • Supraventricular tachycardia mitral valve prolapse, core pulmonale, digitalis toxicity, rheumatic heart disease
Pathological Changes in ECG: • Premature atrial contraction intake of caffeine, emotion stress, smoking, pathologies like CAD, electrolyte imbalance, infection, CHF
Pathological Changes in ECG: • Ventricular tachycardia post myocardial infarction, rheumatic heart disease, CAD, cardiomyopathy
Pathological Changes in ECG: • Ventricular fibrillation long-term or severe heart disease, post myocardial infarction, hypercalcemia, hypokalemia, hyperkalemia
Pathological Changes in ECG: • Multifocal ventricular tachycardia hypokalemia, hypomagnesemia, hypothermia, drug-induced through antiarrhythmic medications
Pathological Changes in ECG: • Premature ventricular contractions intake of caffeine, emotional stress, smoking, pathologies like CAD, digitalis toxicity, cardiomyopathy, myocardial infarction
Pathological Changes in ECG: • Complete heart block (3rd degree) infection, electrolyte imbalance, CAD, anteroseptal myocardial infarction, impairment with the AV conduction system
Pathological Changes in ECG: • Asystole failure of all pacemakers to initiate, conduction system failure, acute MI, ventricular rupture
Cardiac markers for MI CK/CK-MB, Trop I, Trop II, Myoglobin, LDH-I
Blood test for CHF BNP, should be below 100 normally
Total cholesterol level <200
Triglyceride levels 10-140
LDL level 60-160
HDL level 29-77
PT level prothrombin time. 10-13. Assesses clotting ability of factor I, ii, v,vii, x. Used with Coumadin
PTT level partial thromboplastin time. 60-70. Assesses clotting ability of all factors except vii, xiii. More sensitive than PT in detecting minor deficiencies. Monitors oral anticoagulants.
Hematocrit Percent of packed RBC in total blood volume. Used to identify abnormal states of hydration. Low = weakness, chills, dyspnea. High = increased risk of thrombus. - Normal: Males = 40-54. Females = 37-47. Newborns = 49-54. Children = 35-49.
Hemoglobin assess for blood loss. Low = hemorrhage. High = polycythemia or dehydration. - Normal: Males = 14-18. Females = 12-16. Newborns = 16.5-19.5. Children = 11.2-16.5
Catheterization: Name what it measures: • Swan-Ganz Pulmonary artery catheterization. Immediate cardiopulmonary pressure measurements: pulmonary artery pressure.
Catheterization: Name what it measures: • Hickman catheter indwelling right atrial catheter: inserts into the right atrium, allows removal of blood samples, administration of medication, and monitoring of central venous pressure.
Normal HCO3 level 22-26 mEq/L • If the HCO3 is below 22, the patient is metabolic acidotic. If the HCO3 is above 26, the patient is metabolic alkalotic.
Normal pCO2 level 35-45mmHg. • Below 35 is resp alkalotic, above 45 is resp acidotic.
Auscultation of: • Aortic valve 2nd intercostal space on right by sternum
Auscultation of: • Pulmonic valve 2nd intercostal space on left by sternum
Auscultation of: • Tricuspid under 4th rib on left by sternum
Auscultation of: • Bicuspid (Mitral) under 5th rib on left midclavicular line.
Created by: liz124714