VSPM MADHURIBAI DESHMUKH COLLAGE OF NURSIN EDUCATION
NAGPUR
SEMINAR
ON
CARDIAC REHABILITATION
SUBMITTED TO,
Mrs. Lata Sukare
Professor
VSPM MDINE,
Nagpur
SUBMITTED BY,
Ms. Pranali Waodhane
MSc Nursing 1st year
VSPM MDINE,
Nagpur
SUBMITTED ON.
GENERAL OBJECTIVE:
At the end of the seminar the student will be able to gain depth of knowledge regarding cardiac
rehabilitation and it will apply in the clinical area.
SPECIFIC OBJECTIVE:
At the end of the seminar the student will able to:
1. define cardiac rehabilitation
2. enlist the objectives of cardiac rehabilitation
3. enumerate purposes of cardiac rehabilitation
4. discuss purposes of cardiac rehabilitation
5. enlist of cardiac rehabilitation team
6. explain phases of cardiac rehabilitation
7. discuss areas of cardiac rehabilitation
8. explain role of nurse in cardiac rehabilitation
OUTLINE:
1. Introduction
2. Definition
3. Objectives
4. Purpose
5. Rehabilitation team
6. Phases
7. Areas of cardiac rehabilitation
8. Role of nurse in cardiac rehabilitation
9. Research article
10. Summary
11. Conclusion
12. Bibliography
13.
INTRODUCTION:
Cardiac rehabilitation is a comprehensive programme that prepare the patient for full , vital and
productive life within the limitation imposed on him by the cardiac diseases. In other words, it is
the process of restoring and maintaining a patient at his optimal physiological , psychological ,
vocational and social status. Patient moves from a stage of complete dependence to a stage of
independence in his Activity of daily Living ( ADL).Cardiac rehabilitation, also called cardiac
rehab, is a medically supervised program for people who have had a heart attack, heart failure,
heart valve surgery, coronary artery bypass grafting, or percutaneous coronary intervention.
Whether patient had a valve replacement or patient recovering from open-heart surgery,
regaining the level of cardiac fitness that’s right for patient is an ongoing process that takes time,
commitment and medical supervision. The cardiac rehabilitation program at The Hospitals of
Providence is a comprehensive combination of exercise, education and support to help patient
make healthy changes and maintain a full and active lifestyle.
Cardiac rehabilitation aims to reverse limitations experienced by patients who have suffered the
adverse pathophysiologic and psychological consequences of cardiac events.Cardiac
rehabilitation involves adopting heart-healthy lifestyle changes to address risk factors for
cardiovascular disease. To help patient adopt lifestyle changes, this program includes exercise
training, education on heart-healthy living, and counseling to reduce stress and help patient
return to an active life. Cardiac rehabilitation can improve patient health and quality of life,
reduce the need for medicines to treat heart or chest pain, decrease the chance patient will go
back to a hospital or emergency room for a heart problem, prevent future heart problems, and
even help patient live longer.
Cardiac rehabilitation is provided in an outpatient clinic or in a hospital rehab center. The cardiac
rehabilitation team includes doctors, nurses, exercise specialists, physical and occupational
therapists, dietitians or nutritionists, and mental health specialists. Sometimes a case manager
will help track patient care. Patient cardiac rehab team will design a program to meet patient
needs. Before starting patient program, the rehab team will take patient medical history, do a
physical exam, and perform tests. Possible tests include an electrocardiogram (EKG), cardiac
imaging tests, and a treadmill or stationary bike exercise test. Patient also may have tests to
measure patient cholesterol and blood sugar levels.
During cardiac rehabilitation, patient will learn to exercise safely and increase patient physical
activity. The length of time that patient spend in cardiac rehabilitation depends on patient
condition. Medicare and most insurance plans cover a standard cardiac rehab program that
includes 36 supervised sessions over 12 weeks. Many hospital have initiated rapid recovery
programs for cardiac surgery client that reduce the hospital stay to 4 days. client are initially
cared for in intensive care unit ( ICU) with rapid recovery programs, most of the client’s
recovery take place in the home , with the client and family assuming primary responsibility for
many aspect of care. Discharge planning begins at the time of the admission, activity
progression in the post operative period is accelerated , and client and family education
continues on a daily basis throughout hospitalization.
DEFINITION:
Cardiac rehabilitation — also called cardiac rehab — is a customized outpatient program of
exercise and education. Cardiac rehabilitation is designed to help you recover from a heart
attack, other forms of heart disease or surgery to treat heart disease.
OBJECTIVE :
The identification of the patients at risk for a cardiac event's recurrence (ie, risk stratification) is
central to formulating an appropriate medical, rehabilitative, and surgical strategy to prevent
such a recurrence. Patients who are at low or moderate risk typically undergo early rehabilitation.
The major goals of a cardiac rehabilitation program are:
Curtail the pathophysiologic and psychosocial effects of heart disease
Limit the risk for reinfarction or sudden death
Relieve cardiac symptoms
Retard or reverse atherosclerosis by instituting programs for exercise training, education,
counseling, and risk factor alteration
Reintegrate heart disease patients into successful functional status in their families and in
society
PURPOSES:
1) To improve the quality of life. This is achieved by:
Progressive physical activity and exercise programme
Education of the patient and his family concerning the cause ,prevention and
treatment of coronary heart diseases.
Helping the patient to accept the limitation imposed on him by illness and
helping him to make adjustments to the changes demanded by his occupational
goals and lifestyle.
Maintain of psycho-social integrity.
2) To improve the life expectancy of the patient . This is achieved by:
Identification and modification of coronary artery diseases risk factors.
Optimizing the medical / surgical treatment.
Prevention of further attacks.
REHABILITATION TEAM:
1. The physician.
2. The nurse in ICCU, wards and clinic.
3. Physical and occupational therapist.
4. Medical social workers.
5. Clinical psychologist.
6. Vocational and rehabilitation counselor.
7. Dietitian.
8. Family members.
PHASES:
I] Phase 1 (In Hospital) Rehabilitation programs:
Most CABG client participate in cardiac rehabilitation following surgery Phase 1 begins
immediately after the client returns from surgery. The following are the goals of phase 1
inpatient rehabilitation:
To prevent the negative effect of prolonged bed rest.
To assess the client’s physiologic response to exercise.
To manage the psychological issues related to recovery from the CABG surgery.
To educate the client and family concerning recovery and the adoption of risk reduction
behavior.
While in ICU the client is turned every 2 hours during the first several hours after the
surgery .One extubated , the client gets up in a chair and ambulates in the room .After
transfer to the intermediate care unit , the client continues to walk three or four times a
day, increasing the distance walked each time.
Assess the client’s blood pressure,heart rate, ECG, and oxygen saturation before, during
and after activity. Systolic blood pressure should not increase more than 20 mm Hg or
decrease more than 10 to 15 mm Hg after exercise. Heart rate should not increase more
than 20 beats /min above resting , and no significant dysrhythmias should occur. Activity
levels will be reduced if the client have adverse physiologic responses ( e.g .,
tachycardia , dysrhythmias , pain ) to exercise . Client are seated for all meals. Research
has demonstrated that the early mobilization improves cardiac functions and benefits the
client psychologically.
Education for a healthier lifestyle is an important part of each phase of cardiac
rehabilitation.The emphasis in phase 1 is on the identification and modification of
reversible risk factors to prevent further deleterious cardiac events.
Self care :
Before hospital discharge , instruct the client and family ( or significant others) about
medication actions and side effect , dietary restriction , physical activity restriction and
progressions , and incisional care. Because it is not always possible to anticipate all the problems
clients may encounter the first few days at home , instruct the client whom to call when there is
an emergency or when there are question or concerns . If possible , introduce the clients to the
home health nurse who will be supervising home care .Following discharge , the home health
care nurse provides additional educations and counseling and assess the client for
complication .In addition , instruct the client on how to assess response to exercise and activity.
Before discharge , a low – level symptoms- limited exercise test may be performed to evaluate
the client’s ability to perform activities of daily living ( ADL) and exercise. The test result are
used to prescribe a safe and effective exercise programm for the first few week at home and
serve as a basis for the initial exercise prescription in phase 2.
II] Phase 2 ( outpatient Exercise Training) Rehabilitation Programs:
Out patient( phase 2) exercise training usually takes place in a facility that provide continuous
ECG monitoring , emergency equipment and medically supervised exercise. Outpatient treatment
usually begins 10 to 14 days after discharge and require physician referral.
The following are the goals of phase 2:
To restore the client to a desirable exercise capacity appropriate to their health status , life
style and occupation.
To provide additional education and support to the client and the family for adoption of
risk –reduction behavior.
To meet the psychological needs of clients and families , restore confidence , and
minimize anxiety and depression .
To promote early identification of medical problems through closes observation and
monitoring of clients during exercise.
To assist client in returning to occupational and leisure activities.
Exercises therapy is conducted three times weekly for 2 to 3 months .the duration of the
aerobic exercise session ranges from 20 to 40 minutes at an intensity of 70% to 85% of
the baseline exercise heart rate . during each exercise session , blood pressure , heart rate ,
respiratory rate , and ECG are monitored before , during and after exercise .Activity
levels are increased gradually , based on the client responses. A nutritionist may counsel
client about proper diet , and psychologist or social worker may counsel clients about
stress management and adoption of other risk prevention behavior.
At the end of the program , client are given a symptoms –limited exercise test and are
reevaluated. Decisions regarding progression to a phase 3 or home program are based on
the client’s results of the stress test , ability to monitor his or her response to exercise , the
client’s stability , and psychological or emotional status. Periodic evaluations are
scheduled so that activity progressions and cardiopulmonary function can be assessed.
III] Phase 3 ( Community) Rehabilitation Programs:
Phase 3 programs are conducted in community settings , such as a “Y” or a health club.
The following are the goals of phase 3:
To maintain and , if possible , increased , increased exercise capacity.
To institute long term follow up of risk reduction behavior changes.
To encourage clients to take responsibility for continuing life style changes.
Exercise consist of walking , jogging , weight training, and recreational games. Clients
are usually not monitored while exercising , although some facilitates obtain exercise
ECGs on a monthly basis. Client are responsible for monitoring their own heart rate
response to exercise , although blood pressure can be taken by program personnel if
indicated.
HOME EXERCISE REHABILITATION PROGRAMS:
For CABG client a home exercise program is usually prescribed in conjunction with or
in place of the outpatient program.Client are given detailed exercise instruction and are
told to keep a long of heart rates, perceived exertion rates, exercise parameter , and any
problems that occur during the home . Cardiac rehabilitation staff members or the client’s
physicians should analyze the data and adjust the home exercise program if
necessary .Once clients reach their optimal level of functional capacity , they are
instructed to continue to exercise at least three time weekly so that cardiopulmonary
exercise capacity can be maintained.
AREAS OF REHABILITATION:
1. Progressive physical activity.
2. Education of patient and his family.
3. Return to gainful employment or retirement.
4. Modification of coronary risk factors and prevention of further heart attacks.
5. Achievement of normal or near normal life –style.
6. Follow -up care
ROLE OF NURSE IN CARDIAC REHABILITATION:
In cardiac rehabilitation, a team of health professionals provides education and support to help
the patient make new, healthy habits.
1. Quit smoking:
Quitting smoking is the best thing to reduce the risk of future problems. Medicines
and counselling can help for quit for good.
2. Reduce angina (chest pain or discomfort):
Education and counselling can help learn how to reduce episodes of angina (such as chest
pain or discomfort). Angina occurs during activities that make the heart work harder, such as
climbing stairs, having sex, eating a large meal, having emotional stress, or being exposed to
cold. Other symptoms of angina include shortness of breath, nausea, and a cold, sweaty feeling.
Angina is often relieved by rest and medicines.
3. Stay at a healthy weight:
Education combined with exercise, diet, and support can help to stay at a healthy weight or lose
weight if they need to. If the person need to lose weight, try not to feel overwhelmed. Set small,
attainable goals, and then get help to keep reaching those goals. Losing even a small amount of
weight can improve your overall health and reduce your risk for further heart problems.
4. Lower high blood pressure:
The patient will receive tips on lowering high blood pressure through methods such as the
dietary approaches to stop hypertension (DASH) diet. When combined with exercise and stress
management, dietary changes can help lower the patient blood pressure.
5. Improve cholesterol:
The patient will get help improving the cholesterol through lifestyle changes and possibly
medicine. The lifestyle changes include diet, exercise, weight loss, and other changes like
quitting tobacco use. Cardiac rehabilitation team can also check on how the patient are doing
with taking cholesterol medicine. The patient will want to eat a heart-healthy diet even if they are
taking cholesterol-lowering medicine. The medicine will be more effective if you have healthy
eating and exercise habits.
6. Improve emotional well-being:
The education and support will receive in a cardiac rehabilitation program can help the person
feel better about yourself in your everyday life. Seeking help for depression, along with
managing any anxiety and anger they may have, can help to stay healthy.
RESEARCH ARTICAL
Abdulrahman AI Quait , Patrick Doherty ( 2016)
Although cardiac rehabilitation (CR) is a proven intervention in reducing cardiovascular
mortality and morbidity there is concern that CR programme delivery may not yield comparable
outcomes across age groups. This study sought to determine if the outcomes achieved after
completing CR were influenced by age in patients with coronary heart disease. Patients were
stratified into 2 age groups: young (18–65 years) and elderly (>65 years). Pre-CR and post-CR
assessments were used to compute changes in 9 CR outcomes (body mass index (BMI), waist
size, hyperlipidaemia, hypertension, smoking, walking fitness, physical activity, anxiety and
depression). Pearson's χ2 test was used to examine the association between the age groups and
outcome. Data was extracted from the UK National Audit from July 2010 to June 2015. A total
of 203 012 young patients (55.1±7.9 years, 78% male) and 262 813 elderly patients (76.1±6.9
years, 63.9% male) were analysed. Young patients had a better ratio of improvement across a
wide range of risk factors in particular smoking cessation (OR=3.3, p<0.001) while elderly
patients had a better ratio of improvement in body shape risk factors BMI (OR=1.3, p<0.001),
waist size in women (OR=1.3, p=0.016). Age is a significant predictor of outcomes following
CR. While elderly patients achieve better outcomes in body shape risk factors, younger patients
clearly achieve better outcomes across a wider range of risk factors in particular smoking
cessation.
SUMMARY
Today we have discussed about cardiac rehabilitation, its introduction, definition, objectives,
purpose, rehabilitation team, phases, areas of cardiac rehabilitation, role of nurse in cardiac
rehabilitation.
CONCLUSION
Cardiac rehabilitation/secondary prevention programs have proven to be instrumental at reducing
morbidity and mortality and enhancing the physical and emotional well-being in individuals with
CHD. Tremendous progress has been made since the inception of modern cardiac rehabilitation
in the 1970s. Despite significant advances in the care of patients with CHD, challenges remain.
A substantial percentage of eligible patients are not referred to or do not enroll in cardiac
rehabilitation programs, particularly women, ethnic minorities, and individuals with
comorbidities. The changing demographics of cardiovascular disease also present challenges to
CR/SP program utilization. Alternatives to current employed cardiac rehabilitation treatment
strategies need to be considered and tested with the goal developing interventions that will result
in improved outcomes for program participants. As has been the case historically, it is imperative
the delivery of cardiac rehabilitation services continues to evolve in response to results derived
from clinical research.
BIBILOGRAPHY
1. Sister Nancy, reference manual on coronary care nursing, Kumar publishing house, 2007,
page 135-136
2. Joyce M Black, textbook of medical surgical nursing, 7th edition, page no 1644-1652
3. http://www.heart.org/HEARTORG/Conditions/More/CardiacRehab/What-is-Cardiac-
Rehabilitation_UCM_307049_Article.jsp#.WL6BfG-GM2w
4. https://www.nhlbi.nih.gov/health/health-topics/topics/rehab
5. https://www.thehospitalsofprovidence.com/our-services/heart/cardiac-rehab
