Rehabilitation Nursing Lesson #3 Cardiopulmonary Rehab Nursing

Objectives Identify energy utilization and energy conservation techniques. Describe factors that influence endurance and fatigue. Define fatigue and list the nursing interventions for prevention of fatigue. Identify outcomes of care for clients involved in cardiac and pulmonary rehabilitation.

Cardiopulmonary Rehab Purpose Decrease the risk of another event Next time may not survive it Focus on Prevention

Cardiopulmonary Rehab Goal To help our clients to get to the highest level of: Wellness Ability to work

Energy Utilization Energy Conservation

Energy Utilization Defined Use FIM scores of ADLs

Energy Utilization Endurance #1 Ability to continue an activity as stress increases: Physically Psychologically #2 Endurance is seen before fatigue #3 Cardiac Stress Test requires Measurements: Apical/radial pulse rate Observe Cardiac rhythm changes Respiratory rate/effort/lung sounds/sputum BP at specific times

Cardiopulmonary Rehab Client and Energy Utilization Look at what they have to offer: CV system Need adequate pump/intact system Respiratory system Adequate intake/outtake of air Metabolic system Adequate hormones

Cardiopulmonary Rehab Client and Energy utilization All energy is used at the cellular level Two Types of Results: #1 Anaerobic Lactic Acid #2 Aerobic Pyruvic Acid

Cardiopulmonary Rehab Client and Energy Utilization What Influences energy requirements: Body size Age Activity Level Environment Presence of illness or injury Medication use Body temperature

Cardiopulmonary Rehab Levels of Patient Activity Basal energy level Add activity increasing calories: Sedentary Moderate Vigorous to strenuous

Cardiopulmonary Rehab Change in activity Sudden reduction changes kilocalorie need. In some cases increases need for calories: CVA TBI Coma Severe illness or disease A slow reduction of activity causes a decreased kilocalorie need over time: COPD

Cardiopulmonary Rehab Energy Conservation Monitor for wasted energy Desire client to rest in two ways: Efficient rest Appropriate rest Rehab interventions used: Save energy Spread energy out overtime period for when really need it

Energy Conservation Nursing Interventions #1 Maintain a correct body position #2 Rest Prescriptions Helps give time to repair Increases endurance for next activity Increases muscle strength Daily rest periods Creating rest periods All about balance!

Energy Conservation What influences Endurance #1 Personal factors Obese Frail Fragile #2 Environmental factors Too hot Too cold #3 Diseases or disorders present Chronic pain #4 Ordered medical treatments Chemo or radiation

Rehab Assessments Patient’s subjective complaints Activity Analysis FIM performance of ADLs Fatigue of used muscle groups Sleep patterns

Positive Effects of daily Exercise Body overall functions better Increase in strength and endurance Many mental health/body benefits observed within one week

Negative Effects of exercise Muscle soreness Muscle imbalance Warning Nursing interventions

Fatigue and Prevention

Fatigue Defined Observed Three Causes: CNS fatigue Neurological Junction fatigue Lactic acid or lactate fatigue

Assess Patterns of fatigue Frequency of occurrence Duration Intensity Aggravating factors? Alleviating factors? Interference with Lifestyle Labwork off? V/S changed? Sleep OK? Sensory or environment problems?

Nursing Interventions Prevention Appropriate planning Stick to the routine Encourage activity at patient’s most energetic times Adjust therapy sessions as needed Avoid excessive activity for patient Assist as required Help patient prioritize Plan rest periods Encourage good nutrition Perform pain management

Cardiac Rehabilitation

Cardiac Rehab Principles Used for clients with cardiac history #1 Client to see care is for long term #2 Client must participate in planned activities #3 Client must assist with prevention of complications #4 Client is treated in three areas: Socially Emotionally Vocational

Three Components Cardiac Rehab #1 Physiologic Med/surgical management Counseled on activity/diet #2 Vocational Assesses ability to return to work and perform adequately under the stress #3 Educational To decrease risks of second event Lifestyle modifications Mandatory to follow medication and exercise regime

Goals of Cardiac Rehab Increase function Decrease activity related symptoms Decrease disability Decrease coronary risk facors

Basic Schedule for Cardiac Rehab PT begins exercises in ICU or CCU All exercises are performed to increase: Stability Endurance Confidence Coping with stress

Four Phases of Cardiac Rehab #1 Inpatient-Acute care #2 Inpatient-Subacute care #3 Full outpatient maintenance Biggest Challenge: Compliance If compliant: Decreases risk of heart arrhythmias Decreases other risk factors Decreases stress, fear and anxiety of second event

Pulmonary Rehabilitation

Pulmonary Rehab Goals Used for COPD patients #1 Decrease dyspnea episodes #2 Increase function and mobility #3 Decrease number of acute care per year #4 Increase ability to perform ADLs/activities #5 Increase management of client/family coping with COPD #6 Promote education

Program Benefits Retrains breathing muscles Educates patients on prevention to decrease O2 use RT stress Decreases complications Stabilizes COPD progression Supports decrease of smoking

Pulmonary Rehab Benefits Offers appropriate therapies to help mobilize secretions Tailored therapeutic exercise Goal Work simplification Diet modification Medical regimen Safety practices of O2 use

Pulmonary Rehab Outcomes Increased tissue perfusion Increased ability to breathe Decreased risk factors Increased activity Decreased anxiety level Big Goal!!!!

Summary Name one thing you learned in this lesson How will you use this in your clinical practice?

References http://www.mritechniciantraining.org/wp-content/uploads/2010/01/heart_attack_symptoms.jpg http://www.buzzle.com/img/articleImages/279279-37622-1.jpg http://www.socialsecurityinsider.com/wp-content/uploads/2008/09/istock_000006824056xsmall.jpg http://www.clipartguide.com/_thumbs/0511-1004-1520-3833.jpg http://www.toronto.drdc-rddc.gc.ca/images/about-apropos/s01-3.jpg http://rpmedia.ask.com/ts?u=/wikipedia/commons/thumb/b/b5/Potatocouch1258.jpg/180px-Potatocouch1258.jpg http://graphics8.nytimes.com/images/2007/10/08/health/exercise.533span.jpg http://photos.demandstudios.com/getty/article/156/146/103419004_XS.jpg http://www.mennell.us/uplImages//Presentation%20slide%20(025),%20coma.bmp http://www.thecaredivision.co.uk/images/page_content/bwdIMG_473acfc7957bb.jpg http://saveyourself.ca/resources/images/old-man-in-pain.jpg http://i.ytimg.com/vi/jUOmOkg8Yao/0.jpg http://www.aafp.org/online/etc/medialib/aafp_org/images/news_folder/aafp_news_now/2007-10/copd-woman.Par.0001.Image.250.gif http://www.tobacco-facts.info/images/20090422-Facial-Burn-720.jpg http://www.rtmagazine.com/issues/images/2012-08/2012-08_01-01.jpg http://i.dailymail.co.uk/i/pix/2012/09/15/article-2203729-0F2A537100000578-246_634x422.jpg http://www.sjo.org/images/Sleep030.jpg http://blogs.smithsonianmag.com/science/files/2012/02/sleeping-man-550.jpg http://www.berkshirehealthcare.org/corporate/images/profiles-in-care/20101207034144.JPG