Cardiac and Oncology Rehabilitation Quiz

Istanbul Gelisim University - Faculty of Health Sciences

• Istanbul Gelisim University was established in 2008.
• The Faculty of Health Sciences has a 100th anniversary logo.
• The Faculty of Health Sciences phone number is +90 212 422 70 00.
• Website links are included for the university (gelisim.edu.tr) and the faculty (sbf.gelisim.edu.tr).
• Social media icons (Facebook, Twitter, YouTube, Instagram, and location) are present.

Course Details - Nursing

• Course Code and Name: HEY413E REHABILITATION NURSING
• Course Week: 14
• Course Day and Time: Tuesday (12:00 to 13:50)
• Course Credits: 2
• Examination Type: Mcqs
• Instructor: Dr. Hina Zahoor
• Instructor Email: [email protected]
• Instructor's Room: 305
• Office Hours: 9:00 to 5:00
• GBS Link: https://gbs.gelisim.edu.tr/ders-detay-5-160-6267-1
• ALMS Link: https://lms.gelisim.edu.tr/almsp/u/Home/Index
• Avensis Link: https://persis.gelisim.edu.tr/Default.aspx

Weekly Learning Outcomes

• Understand the importance of oncology rehabilitation in cancer care.
• Identify the different settings where oncology rehabilitation occurs.
• Recognize the key phases of the rehabilitation process for cancer patients.
• Understand the roles of various cancer rehabilitation professionals involved in the rehabilitation process.
• Gain knowledge of how oncology rehabilitation contributes to improving the quality of life for cancer survivors.

Attendance and Responsibilities

• Attendance is mandatory for all scheduled lectures.
• Students are expected to be responsible and come to class on time.
• Students should avoid talking to friends in class.
• Mobile phones are not allowed in class.

About the Last Lesson

• Principles of Neurological Rehabilitation
• Cognitive Rehabilitation Strategies: Nurturing Brain Function
• Targeted Exercise Programs for Neurological Recovery
• Assistive Technologies in Neurorehabilitation: Enhancing Independence
• Conditions That Can Be Treated With Neuro Rehab
• Case study

About Today's Lesson

• Oncological Rehabilitation Nursing 1&2

Daily Flow

• 12:00-12:50: Indication Phases (1st Hour)
• 13:00-13:50: Settings For Oncology Rehabilitation, Rehabilitation process, Types Of Cancer Rehabilitation Professionals (2nd Hour)

Oncology Rehabilitation Nursing 1&2

• Oncology rehabilitation aims to reduce cancer-related morbidity and healthcare costs.
• Often used interchangeably with cancer rehabilitation, focusing on managing and improving impairments and functional limitations.

Rehabilitation 2030

• The Rehabilitation 2030 call to action, by the World Health Organization in 2017.
• Aims to advance global access to rehabilitation for non-communicable diseases.

Indications and Side Effects

• Pain
• Fatigue
• Chemotherapy-Induced Peripheral Neuropathy (CIPN)
• Spasticity
• Cognitive deficits
• Psychosocial problems
• Sexual dysfunction
• Urinary dysfunction
• Speech impairment
• Swallowing impairment
• Chemotherapy Side Effects and Syndromes
• Symptoms of Lymphoedema
• Radiation Side Effects and Syndromes
• Paraneoplastic Syndrome
• Cardiovascular Disease
• Amputations
• Functional Limitations
• Side effects like mucositis, alopecia, pulmonary fibrosis, nausea/vomiting, cardiotoxicity, diarrhea, neuropathy, myalgia, renal failure, local reaction, myelosuppression, cystitis, phlebitis, etc

Four Phases of Oncology Rehabilitation

• Preventative (prehabilitation): Interventions before treatment
• Restorative: Restoring function to previous level for cured/controlled patients
• Supportive: Maximizing function for patients with progressing or stable cancer
• Palliative: Comfort and function during the terminal stage of cancer.

Settings for Oncology Rehabilitation

• Post-acute care (inpatient rehabilitation, skilled nursing, home health, long-term care)
• Outpatient therapy (patient visits at a therapy center for focused intervention)

Advantages of Cancer Rehabilitation

• Improved physical function
• Pain management
• Enhanced quality of life
• Increased energy and stamina
• Emotional and psychological support
• Improved body image and self-esteem
• Enhanced survivorship
• Supportive community
• Boosted energy and endurance
• Emotional and mental support
• Improved body image and self-confidence
• Enhanced survivorship
• Nurturing Community

How to Rehabilitate Cancer Patients?

• Assessment: Evaluate patient's physical, functional, and emotional status.
• Develop a rehabilitation plan: Tailor the plan to the patient's needs and goals
• Implement the rehabilitation plan: Implement physical therapy, occupational therapy, speech therapy, psychological counseling etc
• Monitor and adjust the plan
• Discharge planning and follow-up care: Ensure patient continues to progress and achieve their goals.

Assessment Tools

• Health-related quality of life questionnaires: European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, the 36-Item Short Form Survey, and the Functional Assessment of Cancer Therapy
• Activities of daily living and instrumental activities of daily living
• Fatigue
• Functional mobility
• Exercise behavior
• Cognition function
• Communication
• Sexual function
• Return to work

Goals of Cancer Rehabilitation

• Help patients regain physical, emotional, and psychological well-being.
• Improve their quality of life.
• Individualized, patient-centered, and focused on achieving specific goals and objectives.

Types of Cancer Rehabilitation Professionals

• Physicians: Coordinate, monitor progress and manage medical issues
• Physical therapists: Improve mobility, balance, strength, and flexibility
• Occupational therapists: Assist with daily living tasks, provide assistive devices
• Speech therapists: Help with speech, communication, and swallowing
• Psychologists: Deal with emotional and psychological issues, like stress, anxiety, and depression
• Social workers: Support patients and their families

Nurse - People-Centered Integrated Care

• Provides comprehensive care in line with cancer care continuum.
• Ensures optimal communication with patients and the healthcare team.
• Prevention and Early Detection: Cancer prevention efforts.
• Nurse Navigation and Follow-up: Overcome health system barriers.
• Clinical Roles: Physical exams, assessments, chemotherapy, communications
• Supportive and Palliative Care: Address psychosocial needs

Revision

Cardiac Rehabilitation - General

• Cardiac rehabilitation is a complex intervention for patients with heart disease
• Components include health education, advice on cardiovascular risk reduction, physical activity, and stress management

Cardiac Rehabilitation - Components

• Exercise counseling and training
• Education for heart-healthy living
• Counseling to reduce stress

Cardiac Rehabilitation - Organization and Time

• Programs typically span three months, with sessions two or three times per week (typically 36 sessions over a 12-week period)

Cardiac Rehabilitation - Nutrition

• Dieticians provide workshops on healthy eating habits, label reading, general dietary recommendations, reduced saturated fats and cholesterol, increased polyunsaturated/monounsaturated fats, adequate calorie sources, and increased fiber intake

Cardiac Rehabilitation - Weight Management

• Waist circumference >88 cm (women) or >102 cm (men) indicates central obesity.
• BMI >25 kg/m2 requires individualized short and long-term targets based on other risk factors

Cardiac Rehabilitation - Blood Pressure Management

• High blood pressure is common in referred cardiac patients.
• Reducing systolic blood pressure by 10mmHg or diastolic blood pressure by 5-6mmHg reduces cardiovascular and stroke risk.
• Cardiac rehab includes education on blood pressure control, medication impacts, therapeutic life changes, and blood pressure devices.

Cardiac Rehabilitation - Diabetes Management

• High cardiovascular risk profile for patients with diabetes
• Education on diabetes control emphasizes therapeutic education tools for better glycemic control to reduce cardiovascular morbidity and mortality.
• Goal for glycosylated hemoglobin (HbA1c) of <7%

Cardiac Rehabilitation - Psychosocial Issues

• Patients often face psychological and social problems affecting their morbidity and mortality.
• Screening, support for returning to work and daily coping is important aspect of cardiac rehabilitation.

Pulmonary Rehabilitation (PR)

• A multidisciplinary approach for patients with chronic respiratory diseases to improve physical and emotional well-being.
• Supervised exercise, education, support, and behavioral intervention are used to improve lung disease function in daily living and quality of life

Pulmonary Rehabilitation - Indications

• Chronic Obstructive Pulmonary Disease (COPD)
• Interstitial Lung Disease
• Cystic Fibrosis
• Pulmonary Hypertension
• Severe Asthma
• Post-lung transplant
• Post-surgical recovery (e.g., pneumonectomy)
• Pulmonary Fibrosis

Pulmonary Rehabilitation - Benefits

• Improved exercise capacity
• Reduced breathlessness
• Improved survival
• Reduced hospitalizations
• Reduced anxiety and depression
• Improved health-related quality of life
• Improved psychological well-being

Pulmonary Rehabilitation - Role of Nursing

• Thorough health history and clinical assessment
• Monitoring vital signs: Oxygen saturation, heart rate, and blood pressure
• Assessment of physical function: Mobility, muscle strength, and endurance
• Psychological assessment: Anxiety, depression, and coping strategies

Pulmonary Rehabilitation - Key Nursing Interventions

• Breathing Techniques (diaphragmatic and pursed-lip breathing)
• Exercise programs (low-impact aerobics like walking or cycling)
• Patient education (medication, oxygen therapy, energy conservation, triggers)
• Psychosocial Support (coping with chronic illnesses, offering psychological referrals)
• Nutritional support (adequate nutrition, assisting with weight management issues)

Pulmonary Rehabilitation - Barriers

• Physical limitations (low exercise tolerance, dyspnea, fatigue)
• Psychological factors (anxiety, depression)
• Socioeconomic factors (limited healthcare access, financial constraints)
• Cultural factors (lack of understanding or mistrust)

Pulmonary Rehabilitation - Special Populations

• Older adults (COPD, ILD, pulmonary fibrosis): Modify programs for lower intensity, focusing on functional independence, addressing comorbidities (e.g., osteoporosis, cardiovascular disease), and managing polypharmacy.
• Patients with Obesity Hypoventilation Syndrome: Focus on weight management and sleep hygiene, addressing breathing difficulties and assessing CPAP/BiPAP use.

Pulmonary Rehabilitation - Programme Design

• Six-week program, 2 sessions per week
• Sessions incorporate supervised exercises and education; home training also expected
• Include 12 sessions focused on health topics.
• Develop individualized plans based on assessment

Pulmonary Rehabilitation - Goal-Oriented Therapy

• Each patient sets specific goals (e.g., reducing breathlessness, understanding their disease, improving mobility).
• The six-week program is structured around these goals.
• Focus on dependence, interdependence, and independence
• Encourage self-responsibility and empowerment

Pulmonary Rehabilitation - Programme Content

• Relaxation
• Disease education
• Dietary advice
• Benefits advice
• Energy conservation
• Medication advice
• Chest clearance
• Breathing control techniques

Pulmonary Rehabilitation (PR) - Advance Care Planning

• Burden of treatment: Assess physical, emotional, and psychological impact of ongoing treatments.
• Therapies: Discuss ventilation options and their quality of life implications.
• Preferred Place of Death: Understand and document patient wishes.
• Nurses' role: Guided compassion, navigation, and the creation of a care pathway to ensure patient centered end of life care.

Neurological Rehabilitation Nursing - General

• Rehabilitation refers to engaging in therapy to improve function and well-being.
• Aims to help patients with neurological conditions recover or increase functionality within their environment.

Neurological Rehabilitation Nursing - Goals

• Restore health, independence, and functionality as much as possible using best rehabilitation strategies.

Neurological Rehabilitation - Barthel Index

• Measures functional ability and dependency in activities of daily living (ADLs).
• Assesses progress and effectiveness of interventions through 10 basic ADLs. Scoring from 0-20 (total dependency) to 100 (full independence)

Neurological Rehabilitation - Phases of Rehabilitation

• Long-Term Acute Care Hospital (LTACH): First level of critical care after inpatient stays. Needs intense clinician supervision and management
• Acute Rehab: Requires 3 hours of skilled therapies per day. Focus on transitioning to home therapy or subacute rehab.
• Subacute Rehabilitation: Patients are stable but not independent, requiring skilled nursing facilities and less rigorous supervision and care compared to acute rehab patients
• Long-Term Care Facility or Nursing Home: Provides care for those unable to receive care at home. Assist with ADLs

Neurological Rehabilitation - Conditions

• Traumatic Brain injuries
• Spinal cord injuries
• Hemorrhagic/ischemic strokes, hematoma
• Neuromuscular disorders/Bell's Palsy
• Functional disorders: headaches, seizure, etc.
• Brain infections, Encephalitis
• Neurodegenerative diseases
• Alzheimer's, Epilepsy, Huntington's disease

Neurological Rehabilitation - Aims

• Prevent complications
• Teach adaptive strategies
• Facilitate function in a normal environment

Neurological Rehabilitation Approaches

• Bobath Approach (neuro-developmental treatment)
• Carr and Shepherd Approach
• Gait re-education
• Transfer rehabilitation
• Mobility rehabilitation
• Contracture management
• Adaptive equipment

Neurological Rehabilitation - Adaptive Equipment

• Assistive mobility devices (wheelchairs and walkers)
• Smart wearables (monitoring movement and optimizing rehabilitation).
• Augmented Reality tools

Neurological Rehab - Additional Notes

• Quality neuro rehab helps patients to regain mobility with consistent movement.
• This form of rehab can minimize symptoms caused by trauma & neurological conditions in patients recovering.
• Neuro rehab also teaches patients & caregivers how to adapt to changes after receiving the care they need.

Take-Home Topics

• Indication
• Phases
• Settings for Oncology Rehabilitation
• Rehabilitation Process
• Types of Cancer Rehabilitation Professionals

Questions and Suggestions

Recommended Daily Studies

• McPherson, K, Gibson, BE & Leplege, A 2015, Rethinking Rehabilitation: Theory and Practice, CRC Press, NW, Florida.
• Hoeman, SP 2008, Rehabilitation Nursing: Prevention, Intervention and Outcomes, 4th edn, Mosby, St Louis, United States

References (Partial)

• World Health Organization
• Various Journal Articles (specified by numbers) on physical activity, cancer rehabilitation, etc.

About the Next Week

• Final Exam

Important Note

• Private course presentations contents cannot be shared without instructor permission. (Law No. 6698)

Thank You

• Thank you for your attendance.
• Contact information is provided.

Test your knowledge on the significance of blood pressure changes and the role of rehabilitation in cardiac and cancer care. Explore key aspects such as diabetes management and effective rehabilitation settings. This quiz covers essential concepts related to therapeutic education and supportive approaches in rehabilitation.