Transcript What to Expect from your Student Practicum - 38-412

Cardiac Rehabilitation
Deborah Sullivan MS, ANP-BC
Cardiovascular Prevention and Rehabilitation Department
Lahey Clinic Medical Center
41 Mall Road
Burlington, MA 01805
Deborah.sullivan@lahey .org
781 744-2460
What is Cardiac Rehabilitation
• Medically supervised program
• Optimize a cardiac patient’s
– physical
– psychological
– social functioning
– stabilizing, slowing, or even reversing the progression
of the underlying atherosclerotic processes
– reducing death and disability
AACVPR.org
Myocardial infarction (heart attack)
Coronary artery bypass graft surgery (CABG)
Current stable angina pectoris
Heart valve repair or replacement
Percutaneous transluminal coronary angioplasty (PTCA)/
or coronary stenting
• Heart or heart-lung transplant
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• Heart Failure and those with ventricular assist devices
• Coronary artery disease equivalents such as diabetes or
peripheral artery disease
• Patients with diabetes
• Peripheral arterial disease
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Cardiac rehabilitation is tailored to meet the patient’s
individual needs and goals.
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Utilizes a multidisciplinary team
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The Centers for Medicare and Medicaid Services (CMS)
defines core components :
– Prescribed exercise
– Cardiac risk factor modification
– Psychosocial Assessment
– Medical Nutrition Therapy
– Outcomes Assessment
– ITP (Individual Treatment Plan)
Three phases
 Phase I: during hospitalization,
 Phase II: a supervised ambulatory outpatient
program lasting 3-6 months,
 2-4 weeks post event
 Adjustment period
 Telemetry monitored
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Phase III: lifetime maintenance stage
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No such thing as a typical day!!
 Treat your practicum like a job
▪ Choose the cardiac rehab setting because you want to
be there!!
▪ Dress appropriately, be on time, be prepared, be well
rested, stay home if your sick
▪ You will need your own stethoscope on your first day of
your clinical experience (Littmann stethoscope is about
$70.00)
▪ Hospital orientation, confidentiality statement,
orientation check list
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Fast paced environment, multi-tasking
Monday, Wednesday, Friday
 Early start at 7AM
 Exercise classes run until about 6-7PM
 Formal Education –monthly symposium
 Team meeting
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Tuesday, Thursday
 Phase II or III programs
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Entrance evaluation
 Review the patients information/discharge
summary (medical jargon)
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History
Physical assessment
Lab results
Procedures
Diagnostic Tests (i.e. echo, cardiac cath, x-ray, PFTs)
Musculoskeletal assessment
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Entrance Evaluation (at Lahey)
 Pharmacist
 Nurse
 Social Worker
 Dietician
 Exercise Tolerance Test
 METs
 Calculation of max (ETT) and sub max METs
 Patient education
 Design the patients exercise prescription
▪ Karvonen reserve formula based on the results of the
ETT and MET level achieved (establish a THR)
▪ ACSM guidelines
▪ Borg Scale
▪ Patient considerations
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7 very, very light
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9 very light
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11 fairly light
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13 somewhat hard
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15 hard
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17 very hard
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19 very, very hard
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Data entry to evaluate outcomes
Assist with establishing plans of care
Interactions with patients
 Education (shoes, hydration, environmental
factors, etc.)
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Exercise leadership (free weights/resistance
training)
Stretching and relaxation
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Be familiar with emergency equipment and plan
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Prescreening prior to beginning exercise; Assess for pain or
discomfort (0-10 scale)
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Check resting blood pressure, heart rate and rhythm
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Guidance on warm-up exercises, proper body mechanics,
safety precautions
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Assist patients on exercise equipment, obtain exercise BP,
HR, RPE, watts, METs, time, symptoms
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Document information, communicate with team
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Commonly used medications in cardiac rehab
patients
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Beta Blockers
Calcium Channel blockers
Statins
Nitrates
Diuretics
ACE Inhibitors/ARBS
Anti-platelets
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Fish Oil Supplements & Benefits of Omega-3 Fatty
Acids
 By Timothy Duffy, UMass Lowell Exercise Physiology
Student
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The Importance of Resistance Training in Cardiac
and Pulmonary Rehabilitation Settings
 By Erin Foley, Student , UMass Lowell Exercise
Physiology
 Published in the MACVPR Newsletter (macvpr.org)
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Guidelines for Cardiac Rehabilitation and Secondary
Prevention Programs, 4th Edition
Cardiac Resource Manual
Guidelines for Pulmonary Rehabilitation Programs, 4th
Edition
ACSM's Guidelines for Exercise Testing and Prescription,
Eighth Edition
macvpr.org
aacvpr.org
pcna.net
Thank you!!