Cardiac Surgery and Rehabilitation Quiz

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Questions and Answers

Which of the following is NOT a typical benefit of a MID-CAB procedure?

Lower risk than with heart-lung machine

Shorter length of hospital stay

Reduced risk of infection (correct)

No sternotomy resulting in less functional impairment

According to the provided information, what is a key indication for a MID-CAB procedure?

Severe aortic valve stenosis requiring replacement

One to two blocked arteries on the anterior surface of the heart (correct)

A history of deep vein thrombosis

Three or more blocked arteries on the posterior of the heart

Which of the following is a risk factor for sternal dehiscence?

Healthy BMI

Younger age

Non-smoker

Diabetes (correct)

A physical therapist is reviewing a patient chart post cardiac surgery. Which of these findings should they be looking for?

The method of surgery used, and any unusual events Signup and view all the answers

Which of these techniques should a Physical Therapist use as part of their examination of a cardiac patient? (Select all that apply)

Observation of skin color/perfusion Signup and view all the answers

Which medication strategy is primarily aimed at reducing the workload of the heart by decreasing its pumping force?

Medications that lower heart rate and/or contractility Signup and view all the answers

During a Percutaneous Transluminal Coronary Angioplasty (PTCA), what is the primary mechanism by which blood flow is restored in an occluded artery?

Compression of the plaque using a balloon-tipped catheter Signup and view all the answers

What is a common reason for the use of a stent during a PTCA procedure?

To prevent re-occlusion of the vessel after the procedure Signup and view all the answers

In a Coronary Artery Bypass Graft (CABG) procedure, which of the following describes the main action of the harvested vessel?

It provides an alternate route for blood flow around the occlusion Signup and view all the answers

Which of the following is NOT a vessel that is typically used for grafting in a CABG procedure?

Ulnar artery Signup and view all the answers

During palpation for sternal instability, which digits are used to palpate between the sternal halves?

2nd, 3rd, and 4th digits Signup and view all the answers

Which of the following movements is NOT typically used to assess sternal instability during palpation?

Ankle Dorsiflexion Signup and view all the answers

According to the sternal instability scale, a 'moderately separated sternum' corresponds to which grade?

2 Signup and view all the answers

What is the weight restriction for pushing, pulling, lifting, or carrying during the initial 8 weeks after a sternotomy, according to standard sternal precautions?

Less than 5-10 pounds Signup and view all the answers

According to standard sternal precautions, what is the limitation for bilateral shoulder elevation?

Bilateral shoulder elevation past 90 degrees Signup and view all the answers

What is the 'tube' concept for movements with modified sternal precautions intended to achieve?

It encourages movements in a safe, contained range Signup and view all the answers

Why should bilateral movements of the arms in the horizontal level be performed only within pain-free zones in initial 10 days after sternotomy?

To prevent wound dehiscence Signup and view all the answers

How long is driving typically restricted after a sternotomy, based on standard sternal precautions?

8 weeks Signup and view all the answers

What is the recommended duration for patients to keep their upper arms close to the body after surgery?

6-8 weeks Signup and view all the answers

Which item should patients with a BMI≥35 wear to protect the sternum?

Supportive vest Signup and view all the answers

What should patients do when coughing and sneezing during the recovery period?

Hug a pillow over the surgical incision Signup and view all the answers

What type of vest should patients who cough frequently wear?

Sternal vest that supports the thorax Signup and view all the answers

What is the recommended type of bra for patients with large breasts post-surgery?

A supportive front-fastening bra Signup and view all the answers

What is the primary outcome measured during the 2-minute step test?

Number of times the right knee reaches the designated height Signup and view all the answers

For men aged 70-74, what is considered below average performance in the 2-minute step test?

< 80 Signup and view all the answers

Which of the following is NOT listed as a pro of the 2-minute step test?

High correlation to VO2 max Signup and view all the answers

What does the SF-36 questionnaire assess?

Physical functioning and quality of life Signup and view all the answers

According to the women's results, what is the above average threshold for women aged 80-84 in the 2-minute step test?

<blockquote> 91 </blockquote> Signup and view all the answers

Which of the following is a limitation of the 2-minute step test?

Has inadequate data on responsiveness Signup and view all the answers

What factor is used to determine therapy effectiveness and resource utilization?

The Seattle Angina questionnaire Signup and view all the answers

What must participants do regarding the height of their knees during the 2-minute step test?

Lift knees to a height of about 90 degrees Signup and view all the answers

What does the term 'Independent' (I) mean in the context of documenting level of assist?

Patient can transfer without any help or need for supervision. Signup and view all the answers

Which level of assist requires the clinician to provide 75% support during a transfer?

Maximum Assist (Max A) Signup and view all the answers

What is one primary purpose of Functional Measures?

To assess the impact of medications and/or surgery on function. Signup and view all the answers

Which test measures aerobic capacity in patients with cardiac conditions?

Six Minute Walk Test Signup and view all the answers

What does 'Minimal Assist' (Min A) indicate regarding patient contribution?

Patient performs 75% of the movement, needing minimal help. Signup and view all the answers

What does the term 'Dependent' (D) signify in level of assist documentation?

Patient is unable to participate and needs complete assistance. Signup and view all the answers

What role does risk stratification play in functional measures?

Determining the risk of mortality, re-admissions, and falls. Signup and view all the answers

In the context of functional assessment, what does the 5 Times Sit to Stand Test assess?

Speed and functional strength. Signup and view all the answers

Signup and view all the answers

Study Notes

Patient Positioning

Sit in a new part of the room next to someone you usually don't sit with.

Ischemic Conditions & Med/Surg Management

Medical Management for CAD and MI: Optimize blood pressure with medication, manage weight, increase exercise, lower myocardial oxygen demand with medications that lower heart rate and/or lower contractility, optimize coronary blood flow with blood thinners, cholesterol management, and physical activity optimization.
A more in-depth lecture on pharmacology will follow.

Surgical Interventions for CAD & MI

Percutaneous Transluminal Coronary Angioplasty (PTCA): Balloon angioplasty using a balloon-tipped catheter to compress plaque and restore blood flow in blocked coronary arteries. Can be used with stents.
Stents: Used in conjunction with PTCA, designed to prevent re-stenosis, and often combined with blood thinners.

Surgical Interventions - CABG

Coronary Artery Bypass Graft (CABG): Taking a saphenous vein, internal mammary/internal thoracic artery, or brachial vein to bypass a blockage and restore blood flow to the heart.

Surgical Treatments: Coronary Artery Bypass Graft (CABG)

Harvesting a vessel from the body (e.g., saphenous vein, ulnar artery).
Connecting the harvested vessel from the aorta to the distal area of occlusion.

Mid-CAB: Indications & Contraindications

Indications: Blocked arteries on the anterior surface of the heart.
High risk: High-risk patients for bypass surgery.
Benefits: Absence of sternotomy (open chest incision) reduces functional impairment, shorter hospital stay, and a lower risk compared to heart-lung machines.

Chart Review: Surgery

Necessary elements to review from patient charts:
- Type of surgery performed
- Method of surgery
- Location of vein harvesting
- Any unusual occurrences during the peri-operative or operative period.

PT Examination

Assessment beyond standard examination components:
- Cardiovascular screen (heart auscultation, color/perfusion observation).
- Sternal stability assessment.
- Sternal precautions education.
- Cardiac/Respiratory fitness testing.
- Education on risk factors.
- Referral to cardiac rehabilitation.
- Vital signs and cardiorespiratory response to activity assessment.
- ECG/Telemetry.

Examination Continued: Special Tests CV

Special tests for the cardiovascular system include heart auscultation, capillary refill assessment, peripheral pulse strength assessment, lung auscultation, blood pressure measurement (ortho/hypotension assessments), and sternal stability assessment.

Examination - Sternal Incision

Wound evaluation: Assess color, odor, and discharge from the surgical wound.
Sternal stability: Assess sternal stability.
Risk factors for dehiscence: Older age, smoking, diabetes, overweight/obesity, and poor nutritional status are risk factors for sternal wound dehiscence.

Sternal Instability

Method: Palpate sternal halves during flexion/extension and rotation.
Palpation Technique: Identify grade of motion, any bony gap, and tenderness during movements. Assess during coughing and deep inspiration/expiration.
Assessment of Sternal instability scale: Includes 0(normal), 1(slight increase in motion), 2(moderate increase), and 3 (marked increase in motion).

Sternal Precautions

General Precautions: Avoid pushing, pulling, lifting, or carrying greater than 5-10 pounds for 8 weeks; Avoid bilateral shoulder elevation past 90 degrees; Unilateral shoulder elevation is allowed, and limit reaching behind back; Splint coughing; Avoid driving for 8 weeks.

Modified Sternal Precautions "Move in the Tube"

Alternative to sternal precautions: Pilot program in several institutions.
Patient Positioning: Patients keep their movements within the tube (or green area) in the hospital room to preserve the integrity of the sternum.
Open-Chain Activities: Movement out of the tube (green area) is allowed for activities of daily living (ADLs).

Sternal Precautions – Move in the Tube

Bilateral arm movements: Horizontal, backward, over the shoulder at a pain-free level.
Loaded movements: At a pain-free level.
Upper arms: Close to body for 6-8 weeks.
BMI ≥ 35: Support vest (6-8 weeks).
Coughing & Sneezing: Use pillow pressure to the surgical site to splint the cough for 6-8 weeks.
Chest Support: Sterno vest for full chest circumference or a supportive bra for women.

Keep Your Move in the Tube

Each healthcare institution or surgeon makes the choice of whether to use Traditional Precautions or Move in the Tube precautions.

Ischemic Conditions: Medical & Surgical Management

Video & Movement System: Analyze patient history, systems review, outcome measures, task analysis, movement speed, range of motion, symmetry, smoothness, and symptoms (orthopnea, pain).

Movement System

Evaluate systems contributing to movement (e.g., using the ICF model).
Initial clinical hypothesis
Additional assessments to support or alter the hypothesis

Documentation of Level of Assist

Independent (I): Patient performs the task independently and safely.
Supervision (S): Patient may require supervision to ensure safe performance.
Contact Guard Assist (CGA): Therapist maintains contact with the patient for mobility & balance support.
Minimal Assist (Min A): Patient performs 75% of the task independently; clinician assists 25%.
Moderate Assist (Mod A): Patient performs 50% of the task independently; clinician assists 50%.
Maximum Assist (Max A): Patient performs 25% of the task independently; clinician assists 75%.
Dependent (D): Clinician performs the entire task.

Functional Measures

Assessing functional status.
Impact of medications and/or surgery on function.
Risk stratification for mortality, readmissions, and falls.
Baseline data for home exercise programs.

Aerobic Capacity

6-minute walk test (25 m MCID in MI/CAD).
2-minute marching/step test (time to move).
Functional activities: 5 sit-to-stand repetitions, 30-second sit-to-stand.

Ready, Set, Go!

Stand up straight, mark the wall midway between patella and iliac crest.
March for 2 minutes, and lift knees to 90 degrees.
Count the number of times the right knee touches the marked level.

Men's and Women's Results

Provides age-based averages. Categorizes results as below average, average, or above average.

2-Minute Step Test

Alternative to 6MWT.
Minimal equipment required (tape measure & timer).
Low correlation with VO2.
Insufficient data on reliability and responsiveness.

AM-PAC Inpatient Basic Mobility Short Form

Patient assessment for activities in bed, sitting, and moving.
Standardized scale; 6 items.
Difficulty assessed for each item (Unable, A Little, A Lot, None).
Help needed scores.

QOL (SF-36)

Physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, mental health.

Seattle Angina Questionnaire

Questionnaire to understand activity limitation due to chest discomfort.
Measures frequency of chest discomfort (chest pain, tightness, angina).
Determines the impact on daily activities and lifestyle.

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Description

Test your knowledge on key aspects of cardiac surgery procedures and physical therapy interventions. This quiz covers topics such as MID-CAB procedures, PTCA, and post-operative patient evaluations. Enhance your understanding of cardiac care and rehabilitation practices with these questions.