Cardiac Rehabilitation Nursing Overview

Cardiac Rehabilitation Nursing

• Cardiac rehabilitation is a complex intervention for heart disease patients.
• Components include health education, advice on cardiovascular risk reduction, physical activity, and stress management.
• Rehabilitation programs generally last three months, with sessions two or three times a week (usually 36 sessions over 12 weeks).
• Core components include: patient assessment, exercise training, physical activity counseling, tobacco cessation, nutritional counseling, weight management, aggressive coronary risk-factor management, and psychosocial counseling.
• Dieticians lead practical workshops on healthy eating habits, reading food labels, and cooking demonstrations.
• General dietary recommendations for cardiac patients include reduced saturated fats, cholesterol, increased polyunsaturated and monounsaturated fats, adequate calorie sources (50-60% carbohydrates, 15% protein, and 25-35% fat) and increased fiber intake (20-30g/day).
• Modern cardiac rehabilitation emphasizes moderation and plant-based foods.
• According to the WHO, a waist circumference of 88cm or more in women and 102cm or more in men indicates central obesity. European standards for Turkish society are >80 cm for women and >94 cm for men.
• Body mass index (BMI) > 25 kg/m2 necessitates individualized short and long-term targets.
• High blood pressure is common among cardiac rehabilitation patients. A reduction of systolic blood pressure by 10 mmHg can meaningfully decrease cardiovascular mortality by 20-40%.
• Diastolic blood pressure reduction by 5-6 mmHg has been correlated with a 42% reduction in stroke risk and a 15% reduction in Coronary heart disease
• Blood pressure management is a significant part of cardiac rehab, including education about blood pressure control, medications, side effects, and blood pressure devices.

Pulmonary Rehabilitation (PR)

• Pulmonary rehabilitation is a multidisciplinary approach to improving the physical and emotional well-being of patients with chronic respiratory diseases.
• It involves supervised exercise, education, support, and behavioral intervention.
• The aim is to improve daily functioning and enhance quality of life for patients with chronic lung disease.
• Common conditions for which PR is indicated include: Chronic Obstructive Pulmonary Disease (COPD), Interstitial Lung Disease (ILD), Cystic Fibrosis, Pulmonary Hypertension, Severe Asthma, Post-transplant, Post-surgical recovery (e.g., pneumonectomy), and Pulmonary Fibrosis.

Benefits of Pulmonary Rehabilitation

• Numerous benefits for participants include improved exercise capacity, reduced breathlessness, improved survival, reduced hospitalizations, reduced anxiety and depression, improved health-related quality of life, and improved psychological well-being.

Goals of Pulmonary Rehabilitation

• Improve exercise capacity.
• Enhance quality of life.
• Reduce symptoms (e.g., dyspnea).
• Prevent hospital readmissions.
• Enhance emotional well-being and self-management.

Components of Pulmonary Rehabilitation Programs

• Exercise training
• Inspiratory muscle training
• Psychosocial counseling
• Nutritional evaluation and counseling
• Education, including prescribed drug use

Nursing Assessment in Pulmonary Rehabilitation

• Thorough health history and clinical assessment
• Monitoring vital signs (oxygen saturation, heart rate, blood pressure)
• Assessment of physical function (mobility, muscle strength, endurance)
• Psychological assessment (anxiety, depression, coping strategies)

Key Nursing Interventions in Pulmonary Rehabilitation

• Breathing techniques (diaphragmatic, pursed-lip)
• Exercise programs (low-impact aerobic like walking or cycling)
• Patient education (medication adherence, oxygen, energy conservation, environmental triggers)
• Psychosocial support (emotional support, coping strategies, psychological support if needed)
• Nutritional support (adequate nutrition, weight management, especially for obesity-hypoventilation syndrome)

Barriers to Pulmonary Rehabilitation

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

Pulmonary Rehabilitation in Special Populations

• Older adults (COPD, ILD, Pulmonary Fibrosis) require individualized programs (lower intensity, focus on functional independence, addressing comorbidities, managing polypharmacy)
• Patients with Obesity Hypoventilation Syndrome require a focus on weight management and sleep hygiene, and CPAP/BiPAP for respiratory support

Programme Design (Six-Week Structure)

• National guidelines recommend a six-week PR program with two sessions per week.
• Each session includes supervised exercise and education.
• Patients are expected to undertake home training.
• Programme content includes 12 sessions, seminars, relevant health topics, and individualized plans tailored to each patient.
• Aims to improve physical and psychological conditions, promoting long-term adherence to health-enhancing behaviors.

Goal-Oriented Therapy

• Patients define specific goals (e.g., reduce breathlessness, improve mobility).
• The six-week program is structured around these goals.
• Encourages self-responsibility with clarification of dependence, interdependence, and independence.
• Empowers patients to take responsibility for achieving treatment goals, fostering independence and confidence.

Pulmonary Rehabilitation Programme

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

Advance Care Planning in Pulmonary Rehabilitation (PR)

• Evaluate the physical, emotional, and psychological impact of ongoing treatments.
• Discuss options like ventilation and their implications for quality of life.
• Confirm patient wishes regarding desired place of death.
• Provide compassionate guidance to patients and carers, helping them navigate treatment choices and complex decisions.
• Create a care pathway aligned with the patient's values and goals.
• Ensure dignity, autonomy, and a patient-centered approach to end-of-life care.
• Reduce uncertainty and emotional distress for patients and their families.

Neurological Rehab

• Neurological rehabilitation is the process of engaging in therapy to enhance function and well-being. It's for people with issues affecting nerve systems, improving functionality.

• It aims to restore health, independence and functionality using the most suitable rehab strategies.

• Rehab phases often include: acute rehab (PT, OT, speech therapy, 3 hours daily), subacute rehab (stable but not independent, less intense therapy time), long-term care facility or nursing home (if not able to receive care at home, more supervision required).

• Common conditions requiring Neurological rehab include: Traumatic brain injuries, spinal cord injuries, strokes (hemorrhagic or ischemic), subdural hematoma, transient ischemic attacks (TIAs), bell's palsy, cervical spondylosis, carpal tunnel syndrome, brain/spinal tumors, peripheral neuropathy, muscular dystrophy, myasthenia gravis, Guillain-Barré syndrome, headaches, seizure disorders, dizziness, neuralgia, brain infections like polio, meningitis, brain abscesses, encephalitis, neurodegenerative disorders like multiple sclerosis, Alzheimer's disease, amyotrophic lateral sclerosis (ALS), Parkinson's disease, and Huntington's disease..

Neurological Rehabilitation: Goals

• Prevent complications by identifying conditions early, and helping patients with physical issues recover
• Teach adaptive strategies to enable daily living despite their condition.
• Create strategies to reduce disability.
• Facilitate function in a normal environment, as patients' may need help with everyday life and support after leaving hospitals.

Neurological Rehabilitation: Approaches

• Bobath Approach (Neuro-developmental Treatment): focuses on motor learning and repeating movement patterns under therapist guidance until perfect.
• Carr and Shepherd Approach: functional movements through repeated practice until mastery.
• Gait re-education: addresses gait issues post-injury, with physical therapists identifying and correcting issues in walking.
• Exoskeletons: Emerging tools in gait re-education providing automated exercise without the therapist being involved for much of the exercise..
• Transfer rehabilitation: focuses on teaching transfer techniques (e.g. bed-to-chair).
• Mobility rehabilitation: improves mobility through balance, range of motion, and stretching exercises.
• Contracture management: addresses tight muscles in the lower limbs using strategies like splinting, weight-bearing.
• Adaptive equipment assessment: using specialized equipment or adaptations (e.g. wheelchairs) to enhance movement.

Targeted Exercise Programs for Neurological Recovery

• Functional Movement Training: This practice is crucial to mirror daily life, going beyond traditional exercises and seamlessly integrating back into everyday life, with physical therapists making sure it's appropriate and individually tailored.
• Tailored Workouts: Specifically addresses neurological challenges through customized and individualized exercise programs to target specific conditions and needs.
• Adaptive Equipment Integration: Essential in further enhancing the effectiveness of programs, providing better and optimal support without hindrance for the patients' recovery.
• Assistive Technologies (Augmented Reality Tools, Smart Wearables, Robot-assisted Therapy): Using cutting-edge technology to enhance rehabilitation efficiency by boosting patient participation through interactive and practical approaches.

Oncology Rehabilitation

• Oncology rehabilitation aims to reduce cancer-related morbidity and healthcare costs by managing impairments and improving functional limitations.
• It overlaps with cancer rehabilitation, but focuses on managing and improving the functional limitations.

Oncology Rehabilitation Phases

• Preventative/Prehabilitation: interventions to reduce the impact of expected disability before cancer treatment begins.
• Restorative rehabilitation: focuses on improving function after successful cancer treatment.
• Supportive rehabilitation: focuses on maximizing function during a period of progressive or stable cancer.
• Palliative rehabilitation: prioritizes comfort and function during the terminal stages of cancer.

Oncology Rehabilitation Settings

• Post-acute care facilities (hospitals, skilled nursing facilities, home health care agencies)
• Outpatient therapy centers.

Oncology Rehabilitation Advantages

• Function: programs improve patients' physical abilities, strength and mobility.
• Boosted energy and endurance: treatments can be exhausting, so programs provide intervention methods to boost energy and endurance.
• Emotional and mental support: rehabilitation supports patients emotionally and mentally, beyond physical recovery, addressing challenges during treatment, and fostering positive outlooks.
• Improved body image and self-confidence: Helps patients cope with psychological distress, and improves self-image and confidence.
• Enhanced survivorship: educates on long-term effects and provides strategies for managing survivorship.
• Nurturing community: support groups and shared experiences build a supportive recovery environment.

This quiz covers the essential components of cardiac rehabilitation for heart disease patients. It emphasizes health education, cardiovascular risk reduction, and the importance of physical activity and dietary management. Suitable for nursing professionals and students interested in cardiac care.