Rehabilitation and Cardiac Care Quiz

Course Information

• Course Code: HEY413E REHABILITATION NURSING
• Course Name: REHABILITATION NURSING
• Course Week: 7
• Course Day and Time: Tuesday (12:00 to 13:50)
• Course Credit/ACTS: 2
• Examination Type: Mcqs
• Instructor: Dr. Hina Zahoor
• Instructor's Email: hzahoor@gelisim.edu.tr
• 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

• Discuss the advantages for patients undergoing cardiac rehabilitation.
• Explain the specific objectives aimed to be achieved through rehabilitation.
• Cover which patient populations or conditions are suitable for this type of program.
• Discuss situations or conditions where cardiac rehabilitation may not be appropriate.
• Explain the different stages or steps involved in a comprehensive rehabilitation program.

Notes

• 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

• Psychosocial adaptation
• Stress
• Crisis
• Self-concept
• Elisabeth Kübler-Ross' 5 stages of grief
• Factors that affect an individual's psychosocial responses to diseases
• Aims of psychological support in rehabilitation nursing

About Today's Lesson

• Cardiac Rehabilitation Nursing part 1

Daily Flow

• 12.00-12.50 / 1st Hour: Benefits Of Cardiac Rehabilitation, Goals of Cardiac Rehabilitation, The indications for cardiac rehabilitation
• 13.00-13.50/ 2nd Hour: Contraindications, Phases of Cardiac Rehabilitation

Cardiac Rehabilitation Nursing

• Cardiovascular diseases are among the leading causes of mortality and morbidity worldwide.
• Ischemic heart disease is expected to remain the number one cause of mortality and insufficiency in 2020.
• Cardiac rehabilitation supports those with known cardiovascular disease to achieve and maintain optimal health.
• Cardiac rehab is a medically supervised program designed to improve patient's cardiovascular health if a patient has experienced a heart attack, heart failure, angioplasty, or heart surgery.
• If a client has a heart attack or other heart problem, cardiac rehabilitation is an important part of recovery.
• Cardiac rehab can prevent further progression of disability, improve physical function, and improve quality of life.
• Cardiac rehabilitation is an accepted form of management for people with cardiac disease.

Benefits of Cardiac Rehabilitation

• Strengthening the heart and body after a heart attack.
• Relieving symptoms of heart problems, such as chest pain.
• Building healthier habits, including getting more physical activity, quitting smoking, and eating a heart-healthy diet.
• Approximately half of the mortality reduction achieved through exercise-based cardiac rehabilitation is attributed to reductions in major risk factors (e.g., smoking).
• It improves inflammation, ischemic preconditioning, improves endothelium function, and creates a favorable fibrinolytic balance
• An increase in tolerable metabolic equivalents, 33%, and maximal oxygen consumption by 16% is observed.

Goals of Cardiac Rehabilitation

• Medical: Improve cardiac function, reduce risk of sudden death and re-infarction, relieve symptoms like breathlessness and angina, increase work capacity and prevent progression of underlying disease
• Social: Return to work if appropriate and/or previous level of functional capacity, promote independence in ADLs, activities of daily living
• Psychological: Restore self-confidence, relieve anxiety, and depression, relieve or manage stress
• Behavioral: Quit all forms of smoking, make healthy dietary decisions, be physically active, adhere to medication regimes
• Health Service: directly reduce medical costs, promote early mobilisation and discharge from hospital, reduce cardiac related hospital admission

Phases of Cardiac Rehabilitation

• Phase I: In-hospital patient period
• Phase II: Post-discharge pre-exercise period
• Phase III: Exercise and Education Programme
• Phase IV: Maintenance

General Phases in Cardiac Rehabilitation

• Phase I: Inpatient Program, begins after cardiac event and ends at discharge, includes low-level exercise and education for patient and family.
• Phase II: Outpatient Hospital-based, (≥ 4 weeks after discharge), includes dietitians, social workers, etc, emphasizes monitored exercise, education and lifestyle management.
• Phase III: Community-based, health facilities, maintenance program.
• Phase IV: Community-based, community centre.

Phase I: 1-2 Weeks

• Begins after the patient's recovery period from myocardial infarction, angioplasty, or coronary artery bypass graft surgery, involves medical evaluations, rehabilitation training, exercise programs tailored to daily life transitions, psychological support, and proper diet plans.

Phase II: 2-12 Weeks

• Begins 2-12 weeks after discharge, involves individualized exercise evaluations and programs in the hospital.

Phase III: 3-9 Months

• Diet of the patient throughout their life. Planning of the exercises. Exercises goal is to regulate blood pressure, have proper breathing exchanges, and heart rate reduction.

Phase IV: Lifetime

• Continuation of phase III without ongoing support. Patients apply what they learned in previous phases.

Revision

• No specific details provided

Health Care Services Types

• Preventive care focuses on preventing diseases or conditions before they occur.
• Curative health services treat diseases or medical conditions to cure or manage them.
• Rehabilitative health services restore or improve functional abilities after an illness or injury.
• Includes physical therapy, occupational therapy, speech therapy, and other rehabilitation.
• Medical rehabilitation refers to the process of restoring or improving physical, mental, or cognitive functions lost or impaired by illness, injury, or surgery.
• Social rehabilitation aims to improve functional capabilities and inclusion in society for individuals to find new jobs and professions.

Common Goals of Rehabilitation

• Foster self-care, self-sufficiency
• Encourage maximal independence
• Maintain function
• Prevent complications
• Restore optimum function
• Promote maximum potential
• Emphasize abilities
• Promote adaptation
• Restore acceptable quality of life
• Maintain dignity
• Assist with community reintegration
• Promote optimal wellness

Interdisciplinary Model

• Emphasizes collaboration.
• Holistic approach.
• Patient-centered care.

Collaborative Team Structure

• Team composition includes physicians, physical therapists, occupational therapists, speech-language pathologists, psychologists, social workers, and nutritionists.
• Roles and responsibilities are clearly defined for each member to ensure all aspects of patient rehabilitation are addressed.

Characteristics of Effective Interdisciplinary Team

• Trust
• Mutual understanding
• Respect
• Effective communication
• Coordination of care
• Information/enough knowledge
• Sharing responsibilities

Benefits of working in an effective interdisciplinary team

• Increase the continuity of care.
• Cooperate in achieving the target.
• Solve problems with a common understanding among professionals.
• Know the value of team members.
• Increase patient, family, and healthcare professional satisfaction.

Application areas determined by the Association of Rehabilitation Nurses

• Independent rehabilitation centers
• Hospitals
• Long-term subacute care centers
• Long-term care centers
• Comprehensive outpatient rehabilitation centers
• Special application areas
• Home care
• Clinical and daily rehabilitation programs
• Community and state services
• Schools and universities

Home Rehabilitation

• Patients who cannot leave the home receive rehabilitation therapies in their homes.
• Most common therapies include physiotherapy, occupational therapy, and speech therapy.

Goals of Rehabilitation

• Prevent secondary disability
• Improve body function
• Return patients to their former functioning state.
• Assist patients adapt to a new functioning state.

Objectives of Rehabilitation Nursing

• To restore affected abilities to the highest level of function.
• To prevent further disability/handicap.
• To protect the person's abilities.
• To assist the person

Professional Nurse's Roles

Caregiver Role

• Deliver understanding and support to patients.
• Accept individuals holistically and provide care.
• Focus on caring as a central focus of nursing and health care services.

Decision Maker Role

• Involved in decision-making process for patient treatment.
• Critically assess patient signs to identify potential problems and make appropriate recommendations and actions.
• Involve the patient and family in the care plan and treatment decision-making.

Patient Advocate Role

• Promote what's best for the patient.
• Ensure patient needs are met and rights are protected.
• Create healthy environments through community education and involvement in professional organizations.

Manager Role

• Primarily manages patient care.
• Coordinates other healthcare workers in patient care.
• Manages training activities.
• Manages communication.

Rehabilitative Role

• Provide lost function to the patient as much as possible.
• Support daily life activities.
• Provide psychological support.

Educator Role

• Educate patients, families, communities, colleagues, and other health professionals.
• Focuses on health protection, development, health behaviors, and individual care.

Career Developer Role

• Increase training opportunities for nurses.
• Professionalize nursing.
• Expand working fields including master’s degrees, PhDs, and certificates programs.

Researcher Role

• Search for new information to improve care and service quality.
• Use scientific basics for care and service.
• Contribute to scientific knowledge in nursing through research.
• Carry out this role by conducting research.

Counselor Role

• Focus on helping patients develop new attitudes, feelings, and behaviors about quality of life.
• Physician determines medical diagnosis and treatment.
• Nurses take responsibility for administering physician-specified treatment.

Therapeutic Role

• Physician determines medical diagnosis and treatment.
• Nurses are responsible for the treatment administration and fulfill medical requirements.

Chronic Condition and Disability

• Chronic diseases are slowly progressive, lasting 6 months or longer, caused by multiple risk factors, and often complicate a person's life.
• Leading causes of death in Turkey include circulatory system diseases, benign and malignant tumors, respiratory diseases, endocrine/nutrition/metabolic diseases, and others.
• Chronic diseases have complex and multiple causes, occur across the lifespan, and lead to physical limitations and disability. They are long-term and have a gradual deterioration of health.
• Risk factors include non-modifiable (age, gender, family history, ethnicity, prior stroke or heart attack) and modifiable (unhealthy diet, high blood sugar, smoking, high blood pressure, high cholesterol, physical inactivity, overweight, excessive alcohol, stress).
• Examples of chronic diseases are cardiovascular disease, cancer, chronic respiratory diseases, diabetes, chronic renal disease, arthritis, and musculoskeletal diseases, and mental health problems.
• Disability encompasses impairment, disability, and handicap. Impairment means loss or abnormality of function; disability relates to restrictions in activity; handicap is the disadvantage preventing role fulfillment.
• Disability involves the interaction between individuals with a health condition (e.g., cerebral palsy, Down syndrome, depression) and their personal experiences, with environmental (e.g., negative attitudes, inaccessible facilities, and limited social support).
• Causes and risk factors of disability include malnutrition, occupational hazards (e.g., low safety standards, wheat harvesting), and other factors.
• People with disabilities face barriers to education, employment, social and political life, community participation, and health. Disabling barriers include inadequate policies/standards, negative attitudes/discrimination, lack of service provision, problems with service delivery, inadequate funding, and lack of accessibility.
• Consequences of these barriers include lower educational achievement, lower employment levels, higher poverty rates, and poorer health outcomes.
• A social perspective on disability prioritizes accepting that people with disabilities are complete human beings, respecting their rights, their differences, their life, their dignity, being represented, cooperating for their rights, and ensuring equality of opportunity.
• 97.3% of the long-term care population consists of elderly individuals.
• An increase in the prevalence of disability is reported and is partially associated with aging populations and an increase in chronic health conditions.
• Strategies for monitoring current physical health, increasing physical activity in the elderly, and increasing preventive services (e.g., vaccinations, screening programs for early diagnosis), developing healthy behavior, and implementing fall prevention programs are important considerations.
• Improving oral health and preparing the healthcare workforce for an aging community are important measures to address the concerns of chronic diseases and disabilities.

Rehabilitation for Chronic Conditions

• Goals for rehabilitation include improving physical function (mobility, strength, endurance), managing pain via therapies, enhancing quality of life, and promoting independence.
• Types of rehabilitation interventions include physical therapy (PT), occupational therapy (OT), speech and language therapy, psychological support, and nutritional counseling.
• Key focus areas for different conditions include cardiovascular rehabilitation (emphasizing exercise, education, heart-healthy living, counseling to reduce risk factors), pulmonary rehabilitation (improving lung function, breathing techniques, and education), neurological rehabilitation (improving motor function, communication, cognitive skills), and musculoskeletal rehabilitation (reducing pain, improving muscle control, power, endurance).
• Recent trends in rehabilitation technology include immersive technologies, telehealth, rehabilitation wearables, rehabilitation robotics, and artificial intelligence.