Cardiac Rehabilitation and Diabetes Management

Course Information

• Course Code and Name: HEY413E REHABILITATION NURSING
• Course Week: 14
• Course Day and Time: Tuesday (12:00 to 13:50)
• Course Credit/ACTS: 2
• Examination Type: Mcqs
• Instructor's Name & Surname: Dr. Hina Zahoor
• E-mail & Phone: [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
• AYESIS Link: https://persis.gelisim.edu.tr/Default.aspx

Weekly Learning Outcomes

• Understand the importance of oncology rehabilitation in the cancer care continuum.
• 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.

Course Policies

• Attendance is mandatory for all scheduled lectures.
• Be responsible: come to class on time.
• Be disciplined: avoid talking to friends in the class.
• Mobiles are not allowed in the 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 the Today Lesson

• Oncological Rehabilitation Nursing 1&2

Daily Flow

• 12.00-12.50 / 1st Hour: Indication Phases
• 13.00-13.50/ 2nd Hour: Settings For Oncology Rehabilitation, Rehabilitation process, Types Of Cancer Rehabilitation Professionals

Oncology Rehabilitation Nursing 1&2

• Oncology rehabilitation is an area with the potential to reduce cancer-related morbidity and healthcare costs.
• Often used interchangeably with cancer rehabilitation. Oncology rehabilitation focuses on managing and improving impairments and functional limitations experienced by individuals with cancer due to the disease itself or the side effects of the treatment they receive.
• The Rehabilitation 2030 call to action, launched by the World Health Organization in 2017, aimed to advance global access to rehabilitation for non-communicable diseases.

Indications

• Pain
• Fatigue
• Chemotherapy-Induced Peripheral Neuropathy (CIPN)
• Spasticity
• Cognitive deficits
• Psychosocial problems
• Sexual dysfunction
• Urinary dysfunction
• Swallowing impairment
• Chemotherapy Side Effects and Syndromes
• Symptoms of Lymphoedema
• Radiation Side Effects and Syndromes
• Paraneoplastic Syndrome
• Cardiovascular Disease
• Amputations
• Functional Limitations

Four Phases of Oncology Rehabilitation

• Preventative rehabilitation phase: Also called prehabilitation in cancer care. It encompasses the time between the onset of cancer diagnosis and the beginning of oncological treatment. Interventions during this time include patient education and therapies aimed at decreasing the impact of expected disability from oncological care. It is often beneficial to undergo rehabilitation before starting cancer treatment..
• Restorative rehabilitation: Focuses on restoring the cured or controlled patients who have residual impairments that cause disability to their previous level of function.
• Supportive rehabilitation: Provides care to maximize functionality as individuals experience declines due to progressive or stable cancer.
• Palliative phase: Emphasis on comfort and function during the terminal stage of cancer. While not limited to end-of-life care, this phase emphasizes symptom and function management in advanced stages.

Settings For Oncology Rehabilitation

• Post-acute care (includes inpatient rehabilitation facilities, skilled nursing facilities, home health care agencies, and long-term care hospitals).
• Outpatient therapy (involves patient visits at a therapy center for focused rehabilitation intervention).

Advantages Of Cancer Rehabilitation

• Function: Rehabilitation programs improve cancer patients' physical abilities. Cancer often reduces strength, mobility, and functionality.
• Quality of life: Programs enhance quality of life for cancer patients by addressing challenges during and after treatment and providing effective pain management techniques.
• Boosted Energy and Endurance: Cancer treatments are often physically and emotionally exhausting and procedures like chemotherapy can reduce energy and endurance. Rehabilitation programs can boost energy levels, help with emotional resilience, and enable patients to engage in activities they enjoy.
• Emotional and Mental Support: Support addresses challenges of cancer treatment, going beyond physical recovery to emotional well-being and encourages resilience and a positive outlook.
• Improved Body Image and Self-confidence: Cancer treatments can cause psychological distress and rehabilitation programs address body image concerns to rebuild self-esteem during the recovery journey.
• Enhanced Survivorship: Focus on cancer survivorship and provide coping strategies for managing challenges and empower patients for a positive outlook after treatment.
• Nurturing Community: Enables individuals to connect with peers, foster solidarity and mutual support, and encourages emotional healing and creates a supportive recovery environment.

How Do You Rehabilitate Cancer Patients?

• Assessment: Comprehensive evaluation of patient's physical, functional, emotional status (strength, range of motion, balance, mobility, psychological well-being, quality of life).
• Development of a rehabilitation plan: Tailored plan that addresses patient's needs and goals (including rehabilitation services, modifications or accommodations).
• Implementation of the rehabilitation plan: Physical therapy, occupational therapy, speech therapy, psychological counseling.
• Monitoring and adjustment of the rehabilitation plan: Close monitoring of patient progress and necessary adjustments.
• Discharge planning and follow-up care: Development of a discharge plan and follow-up care ensures continued progress and achievement of goals.

Assessment Tools

• Health-related quality of life and/or quality of life questionnaires.
• Functional Assessment of Cancer Therapy questionnaires.
• Activities of daily living and instrumental activities of daily living assessments.
• Fatigue assessments.
• Functional mobility assessments.
• Exercise and behavior assessments.
• Cognitive function assessments (neuropsychological tests).
• Communication and sexual function assessments.
• Return to work assessments.

Types of Cancer Rehabilitation Professionals

• Physicians
• Physical Therapists
• Occupational Therapists
• Speech Therapists
• Psychologists
• Social Workers
• Nurses

Cardiac Rehabilitation Nursing

• Cardiac rehabilitation is a complex intervention for patients diagnosed with heart disease. It includes health education to reduce cardiovascular risk, physical activity, and stress management.
• Cardiac rehab has 3 equally important parts: exercise, counselling and training; education for heart-healthy living; and counselling to reduce stress.
• Core components: patient assessment, exercise training, physical activity counselling, tobacco cessation, nutritional counselling, weight management, aggressive coronary/risk-factor management, and psychosocial counselling.
• Rehabilitation programs generally span three months and involve 2 or 3 sessions per week (typically 36 sessions over a 12-week period).
• Dietary recommendations for cardiac patients reduce saturated fat intake, cholesterol intake,and increase polyunsaturated/monounsaturated fats and increase fiber intake.

Pulmonary Rehabilitation Nursing

• Pulmonary rehabilitation (PR) is a multidisciplinary approach designed to improve physical and emotional well-being in patients with chronic respiratory diseases.
• The program involves supervised exercises, education, support, and behavioral intervention to improve patient function in daily life and enhance their quality of life.
• Indications for PR (Pulmonary Rehabilitation) include COPD, ILD, cystic fibrosis, pulmonary hypertension, severe asthma, and post-transplant/surgical recovery (e.g., pneumonectomy).
• Benefits of PR include improved exercise capacity, reduced shortness of breath, improved health-related quality of life, reduced hospitalizations, and reduced anxiety.
• Goals of PR are to improve exercise capacity, quality of life, decrease symptoms like dyspnea, prevent hospital readmissions, and enhance well-being and self-management.
• Components of a PR program may include exercise training, inspiratory muscle training, psychosocial counselling, nutritional evaluation and counselling, and education on medication use.
• Nursing assessment in PR includes a thorough health history and clinical assessment, monitoring vital signs, assessing physical function, and evaluating psychological status.
• Key nursing interventions in PR may involve breathing techniques, exercise programs, patient education (e.g., medication, energy conservation), psychosocial support, and nutritional support.

Neurological Rehabilitation Nursing-1

• Neurological rehabilitation is a therapeutic approach, aimed at improving function and well-being for patients with neurological conditions.
• The goal is restoring health, independence, and functionality as effectively as possible.
• Phases may include: long-term acute care hospital (LTACH) for patients requiring intense clinician supervision; acute rehab, patients in this phase participate in 3 hours of skilled therapy per day, with a goal of transitioning to home therapy or subacute rehabilitation. This phase involves shorter stays than the other phases; subacute rehab, in skilled nursing facilities, for patients are stable but not independent enough for typical home settings; and long-term care facilities for patients needing more support for day-to-day activities.
• Different therapeutic approaches, such as Bobath, Carr, and Shepherd techniques, and gait re-education techniques can be used to target various needs and impairments.

Neurological Rehabilitation Nursing-2

• Targeted exercise programs for neurological recovery address specific neurological conditions by tailoring workouts and using adaptive equipment.
• Adaptive tools aid to facilitate independence, and increase patient engagement in rehabilitation which can be more interactive using technology like augmented reality.
• Conditions that can benefit from neuro rehabilitation include traumatic brain injuries, spinal cord problems, and Parkinson's disease - working to restore health, independence, and functionality.

Take-Home Topics for Review

• Indication
• Phases of Oncology Rehabilitation
• Settings for Oncology Rehabilitation
• Rehabilitation process
• Types of Cancer Rehabilitation Professionals
• Other relevant topics (e.g., legal considerations)

Questions and Suggestions

• Questions are welcomed.

Recommended Daily Studies

• McPherson, K, Gibson, and 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

• Include all relevant references.