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Special Topics

Cardiac Rehabilitation

QuestionAnswer
Arrhythmia -Loss of normal rhythm
Dysrhthmia -Irregular rhythm
Fibrillation -Uncoordinated contractions
Heart Block -Interference with conduction of electrical impulses within the heart
Beta-Blockers -Prevents stimulation of the heart resulting in decreased BP & HR response to activity
Calcium Channel Blocker -Prevents the flow of calcium into smooth muscles so prevents vasoconstriction
Digitalis -Increases strength of the heart's contraction causing a decrease in HR
Angiogram -X-ray photo of blood or lymph vessels
Electrocardiogram -Record of a person's heartbeat
Heart Catheterization -Long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart
Thallium Stress Test - Nuclear imaging test that shows how well blood flows into the heart while you're exercising or at rest
Coronary Artery Bypass Graft (CABG) -Most common form of open heart surgery -Vein grafts from leg -# denotes how many grafts were done
Valve Replacements -Prevents back flow -Aortic -Mitral
Percutaneous Transluminal Coronay Angiopasty -Opens blocked coronary arteries so that blood may flow. Catheter inserted into an artery ; x-rays taken; balloon-tipped catheter is advanced to the heart, and into the narrowed coronary artery, open/close; widening the artery so blood flow improves
Stents -Tubular support placed temporarily inside a blood vessel, canal, or duct to aid healing or relieve an obstruction
MET: Metabolic Equivalent -Cost in terms of O2 consumption and energy expenditure required to do activity -May be used in CR to set intensity of exercises
Aneurysm -Localized, blood-filled balloon-like bulge in the wall of a blood vessel that ruptures -Risk factors: diabetes, obesity, hypertension, tobacco use, alcoholism, increasing age
Angina -Ischemic chest pain caused by decreased blood flow to the heart -Tobacco use, diabetes, high blood pressure, high cholesterol, family history of heart disease, older age, obesity, stress
Arteriosclerosis -Arteriosclerosis is the stiffening or hardening of the artery walls -Risk factor: -High cholesterol -High blood pressure -Smoking -Insulin resistance -Diabetes -Overweight or obesity -Lack of physical activity -Unhealthy diet
Atherosclerosis -Atherosclerosis is the narrowing of the artery because of plaque build-up -Risk factors: -High cholesterol -High blood pressure -Smoking -Insulin resistance -Diabetes -Overweight or obesity -Lack of physical activity -Unhealthy diet
Congestive Heart Failure (CHF) -Chronic condition in which the heart doesn't pump blood as well as it should -Risk factors: -High blood pressure -Heart attack -Coronary artery disease -Sleep apnea -Viruses -Tobacco use -Obese -Congenital heart defects
Embolus vs Thrombus -Thrombus is a blood clot that forms in vein -Embolus is anything that travels through the blood vessels until reaches vessel too small to let it pass; blood flow stopped by embolus
Ischemia -Inadequate blood supply to an organ or part of the body, especially heart muscles
Myocardial Infarction (MI) -Blockage of blood flow to the heart muscle -Risk factors: -Obese -Diabetes -Family history -High cholesterol -High fat diet -Smoking
Pulmonary Edema -Condition that causes excess fluid in the lungs -Risk factors: -History of lung disease (TB) -COPD -Vascular blood disorders
Tachycardia vs Bradycardia -Tachycardia= abnormally rapid HR -Bradycardia= abnormally slow HR
What is the job of the heart -Provide adequate blood to the body -CO= SV x HR -Needs plenty of oxygen
Heart Disease -Acute/chronic cardiac disability resulting from a reduction of blood supply to myocardium w/ associated CAD - MI, Angina, Heart failure, arryhthmias, sudden death, valvular dysfunction
____ is the most prevalent heart disease -CAD= Coronary Artery Disease
____ is the most common cause of CHD and is a primary contributor to CVA and PVD -Atherosclerosis
#1 cause of death in U.S. -CHD
Team Approach -Physician -Exercise professional -Dietitian -Behavior specialist
Goals of Rehab -Prevent harmful effects of prolonged bed rest when a patient has been hospitalized -Develop cardiovascular fitness with emphasis on optimal ability -Identify patients whose psychological response to cardiac disease may need extra support
Pattern 6D -Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure
Phase I of cardiac rehab -In-patient = acute phase -Nursing educates about disease process, prognosis, risk factor mods -Dietician starts pt on strict diet -Therapy evaluates physiological response to self-care & ambulation; provide safeguidelines for activity progression
Phase I cont... -Pts are closely monitored by wired vs. telemetry EKG -Protocols vary from facility to facility-most based on 7-Step MI & 10-Step CABG Programs from Grady Memorial
Phase 1 cont... -ROM exer. and ambulation -Therapy uses BP & HR (before, during, and after rx) to monitor -Open heart pts start sooner and allowed to do more intense workout due to less heart tissue death
Contraindications / Precautions for Exercise -Unusual HR increase or decrease -Elevated BP -Sudden drop in systolic BP - >10 mmHg change either way in diastolic BP
Contraindications cont... -Angina -Dyspnea -Excessive fatigue -Confusion, Dizziness -Severe claudication -Pallor, Cold Sweat, Ataxia -EKG abnormality
Electrocardiogram (ECG or EKG) -Record of the heart's function -Records the electrical impulses that stimulate the heart mm to contract and relax
Depolarization -Electrical stimulation to contract
Repolarization -Reversal of electrical stimulation causing relaxation
EKG monitoring -Usually use a 3 lead set-up via telemetry so pt can move around
P wave -Atrial depolarization
PR segment -Conduction delay allowing mechanical contraction of atria to finish
QRS Complex -Ventricular depolarization + Atrial repolarization
ST segment -Conduction delay allowing completion of ventricular contraction
T wave -Ventricular repolarization
PR, QT, ST Intervals -Denote the time it takes the heart to get from one phase to the next
Abnormal values found for any of the intervals = -Denotes dysfunction
EKG abnormalities -Tachycardia and Bradycardia
Rhythm problems -Many are caused by Ectopic foci -Atrial flutter/fibrillation
PVC's -Bigeminy -Trigeminy -Coupplet -Triplet -Another abnormality is V-tach
Infarctions -T wave inversion -ST segment changes: elevation, depression, downsloping with depression
Phase I Discharge planning -Review of general activity guidelines,HEP, diet, medication, and warning S&S -Possible stress test
Phase II -Out-patient or home-based -Begins as early as 24 hrs post-discharge and lasts 8-12 wks at 2-3 times/wk -Warm-up period= stretching or walking -Circuit interval training period= cardiovascular + light weights -Cool-down period= stretching or walking
Phase II cont... -Monitor HR, BP, body weight, EKG. -May also use Ratings of Perceived Exertion (RPE) -Education classes: CPR, diet, meds, self-monitoring
Delayed entry into Phase II: MI -MI = Not supposed to do aerobic or strength training for 4-6 weeks while heart tissue heals
Delayed entry into Phase I: PTCA -PTCA = Generally wait 2 weeks
Delayed entry into Phase I: CABG -CABG = No aerobic or strength training until incision is healed and blood levels are normal (~6 weeks)
Special considerations during Phase I & II: CHF -CHF = Can only do low level endurance and resistive training. Need respiratory muscle training
Special considerations during Phase I & II: Heart Transplants -Heart Transplants = Heart is “denervated” so cannot use HR alone to set intensity
Special considerations during Phase I & II: Pacemaker/Defibrillator -Pacemaker/Defibrillator = No UE exercises initially
Phase III -Maintenance or Community Program -Goals: Maintain function & Promote long-term fitness and health -6-12 months long, varied supervision level
Phase III cont... -Only a small % of patients continue to this level -Self monitoring primarily – heart watches -May include aerobic dance, weight training, track work, etc. -Advanced education programs
Home-based Cardiac Rehab -Option for Phase II or beyond patient who is “low risk”. -Daily activity logs, weekly check-ins -HH nursing – EKG via telephone -6-12 months
Created by: alovedaytn