Critical Cardio, Shock, Sepsis Past Paper PDF

SHOCK, SEPSIS, & CRITICAL CARDIO 1 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  LEARNING OBJECTIVES Explain the pathophysiology for perfusion. Explore ep...

SHOCK, SEPSIS, & CRITICAL CARDIO 1 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  LEARNING OBJECTIVES Explain the pathophysiology for perfusion. Explore epidemiological and etiological risk factors that contribute to critically ill clients experiencing altered perfusion. Describe the impact of altered perfusion on a critically ill client’s overall health. Differentiate the clinical presentation of critically ill clients experiencing altered perfusion. Explore the role of the nurse when caring for critically ill clients experiencing altered perfusion. Apply nursing process through use of the clinical judgment functions while providing care to critically ill clients experiencing altered perfusion. 2 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  SHOCK. IS SHOCK, IS SHOCK. Shock Life-threatening syndrome Circulatory system unable to supply adequate oxygen to tissues to meet metabolic demand  Oxygen Delivery Oxygen delivery (DO2)- Amount of O2 Determined through evaluation of CO and arterial O2 delivered to the content tissues Oxygen utilization & Measured via blood sample Oxygen consumption Normal VO2 are between 60% and 75% (VO2)- reflect the If this is low it means the tissues are extracting more relationship between O2 than they should be oxygen delivery and Can also mean the pt is having a hard time increasing extraction at tissue O2 in response to stressors such as fever or pain level. 4 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Cardiac output- blood ejected every minute LET’S REVIEW CARDIAC Preload- Blood in OUTPUT… ventricles at end of diastole Afterload- The resistance to flow that the ventricle must overcome to eject the blood Contractility- Force of the mechanical contraction.  Hypovolemic- not enough blood volume. Can happen with burns! (happens at 25-35% loss) Cardiogenic- Inadequate pumping of heart muscle (Usually an MI) C L A S S I F I C AT I O N S O F SHOCK Distributive-Consequence of disease causing poor vascular tone (D/t sepsis, anaphylaxis etc) Obstructive-Mechanical barrier to ventricular filling (ie cardiac tamponade, tension pneumothorax, or PE)  Notice! Neurogenic is ONLY one with bradycardia. Note narrow pulse pressure for cardiogenic. Shock is shock is shock BUT look for the differences to help differentiate. System Sepsis Anaphylactic Neurogenic Toxic Hypovolemic Obstructive Cardiogenic Neuro Fever CV Tachycardia Tachycardia Bradycardia Tachycardia Tachycardia Tachycardia Tachycardia Hypotension Hypotension Hypotension Hypotension Hypotension Hypotension Hypotension Anxiety JVD Arrhythmias Restlessness then Cyanosis Narrow pulse deteriorating pressure Respiratory Bronchospasm Tachypnea Asymmetrical Crackles d/t venous Laryngeal edema Orthostatic hypotension breathing pattern congestion Wheezing Absent breath Stridor sounds in 1 lung field SQ emphysema Urinary oliguria Integumentar Flushed dry warm Flushed dry warm Flushed dry warm Flushed dry warm Cold clammy skin Cold clammy skin Cold clammy skin y skin skin skin skin Itchy skin Hives Digestive Swelling of the tongue Possible hematemesis Hemoptysis Bloody stool Abdominal distention 7 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Neural compensation- Hypotension triggers catecholamine (epi and nor-epi) release which increases P and BP through vasoconstriction Endocrine compensation –The S TAG E S O F SHOCK – kidneys release renin which C O M P E N S AT O R leads to angiotensin II Y conversion (a vasoconstrictor). ADH is released. Hyperglycemia occurs. Chemical compensation- Chemoreceptors in the aorta sense hypoxia and trigger tachypnea and hyperventilation Resp alkalosis.  Failure of compensatory mechanisms…Houston. We have a problem. Extensive shunting of blood to vital organs S TA G E S O F S H O C K – PROGRESSIVE Profound hypoperfusion Worsening metabolic acidosis Respiratory acidosis  Prolonged inadequate blood supply to cells Cell death, loss of aerobic metabolism S TA G E S O F S H O C K – R E F RA C T O RY Multisystem organ failure Death is imminent. Client is comatose **Shock is IRREVERSIBLE at this stage.  An 88-year-old client is on a medical-surgical unit being treated with IV antibiotics for a urinary tract infection. The client has been stable, however, the client recently developed restlessness, so the DISCUSSION nurse asked the AP to obtain the QUESTION (1 OF 2) client’s vital signs. The vital signs were: Temp 102 (orally), Pulse 136 (regular rate and rhythm), RR 24, BP 82/52, O2 sat 88%. What phase of shock is this client most likely exhibiting? What data supports your answer? 11 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  ASSESSMENT Central Nervous System Restlessness (initial) Confusion (initial) Irritability (initial) May lead to- Lethargy (prolonged) Coma (prolonged)  Cardiovascular Hypotension Narrow pulse pressure- common in compensatory stage d/t vasoconstriction Tachycardia, THEN ASSESSMENT bradycardia Skin color- Cool, mottled, or cyanotic if blood being shunted. OR warm and flushed in distributive. Peripheral pulses- thready Capillary refill- sluggish  Respiratory Tachypnea A B G’s- Most accurate ASSESSMENT readings Pulse oximetry (Note: Poor peripheral circulation can cause inaccurate readings)  Renal Oliguria first, THEN anuria ASSESSMENT Then, Increased creatinine S/S of acute renal failure  Gastrointestinal Hypoactive bowel sounds- why? Nausea Vomiting ASSESSMENT The GI tract is sensitive to poor perfusion. The cell damage can allow intestinal bacteria to escape to the rest of the body causing sepsis. *Can lead to MODS  PATHOPHYSIOLOGY: DISTRIBUTIVE SHOCK Decreased SVR and Perfusion 4 Subcategories of distributive shock- Remember poor vascular tone! Septic shock Occurs as a result of the release of inflammatory cytokines which cause damage to the internal layer of blood vessels and initiates clotting mechanisms. Anaphylactic shock Occurs in response to severe hypersensitivity to an allergen (food, medication, bee sting etc.) mediated by IgE increasing vascular permeability and vasodilation and a decreased SVR.. Neurogenic shock Occurs due to autonomic dysregulation caused by a spinal cord injury above the level of T6. Toxic shock Involves infection from Staphylococcus aureus causing excessive activation of cytokines and inflammatory cells. 17 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  DISTRIBUTIVE SHOCK: ETIOLOGY Anaphylactic Sepsis Exposure to an allergen Pancreatitis Toxic Burns Soft tissue infection Infection Postsurgical infection Neurogenic Obstructive Spinal cord trauma Tension Pneumothorax Guillain-Barre injury High levels of PEEP Cerebral hemorrhage Cardiac tamponade Hypovolemic Pulmonary Embolism Hemorrhage Cardiac mass Traumatic blood loss Aortic dissection Upper/lower GI Bleed Cardiogenic Ruptured aneurysm Acute MI Postpartum bleed Aortic dissection Anticoagulants Cardiac arrhythmia Non-hemorrhagic excessive diuresis Medication overdose Burns RV failure GI Fluid loss Metabolic acidosis Electrolyte imbalance Pulmonary embolism 18 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  SHOCK: TREATMENTS & THERAPIES Treatment is focused on supportive care and treating the cause IV Fluids- at least 30ml/kg for 1st three hours Mechanical Ventilation Hemodynamic monitoring: Pulmonary artery catheter; central venous pressure; arterial line IV antibiotics- WITHIN FIRST HOUR OF SEPSIS S/S Norepinephrine IV to manage Mean Arterial Pressure Blood and blood products Mechanical circulatory support: Intra-aortic balloon pump; left ventricular assist device; extracorporeal membrane oxygenation; cardiac transplant Nutrition- parenteral or enteral Hemodynamic monitoring IM epi= 1st line tx for anaphylactic shock. Then IV crystalloids, steroids, antihistamines 19 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  CARDIAC TAMPONADE: PATHOPHYSIOLOGY Simple Nursing Cardiac Tamponade: https://www.youtube.com/watch?v=4VCBrwU yLqQ An accumulation of fluid around the heart 3 Phases Phase 1: accumulated fluid in the pericardial space, ventricles harden and cannot relax Phase 2: CO is decreased due to SVP not filling the heart Phase 3: Decreased CO to the point of circulatory failure 20 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  CARDIAC TAMPONADE: ETIOLOGY Central line placement Kidney failure Malignancies Leukemia Infection Heart failure Complications from MI Radiation to the chest Aortic dissection Previous high-risk surgery Aortic aneurysm Hypoparathyroidism 21 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  CARDIAC TAMPONADE: IMPACT ON OVERALL HEALTH Anxiety Restlessness Difficulty breathing Heart failure Edema Bleeding Shock  Needs to be treated IMMEDIATLEY or death will occur 22 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  CARDIAC TAMPONADE: CLINICAL PRESENTATION Becks Triad Hypotension Jugular vein distention Muffled heart sounds 23 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Pathophysiology Deregulated host response to infection Excessive release of proinflammatory cytokines SEPSIS/SEPTIC SHOCK Vasodilation (CONTINUED_1) Decreased vasomotor tone Increased capillary permeability 24 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  SIRS+INFECTION=SEPSIS - Caused by either tissue injury or infection - Sepsis= systemic inflammatory response from INFECTION - The criteria for sepsis include having at least 2 SIRS criteria components and having a known infection with positive cultures. https://www.semanticscholar.org/paper/Systemic-inflammatory-response-syndrome-(SIRS)%3A-and- Matsuda-Hattori/9cfd3618033ca4062e12e09ee74d2b187588b49b 25 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Clinical Manifestations Early stage (Hot stage) Tachycardia Bounding pulses Fever Possibly normal BP SEPSIS/SEPTIC SHOCK (CONTINUED_2) Late stage (Cold stage) Cool, pale skin Weak, thready pulses Tachycardia Hypotension 26 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  SEPSIS/SEPTIC SHOCK (CONTINUED_3) Medical management Prevention is the best way! Hand washing is always #1 Aseptic technique for procedures 27 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Bundle of Care- Surviving Sepsis Campaign Hour 1 Activities that need to be completed within 1 hour SEPSIS/SEPTIC SHOCK after identifying sepsis (CONTINUED_4) Treatment may not be completed in 1 hour Treatment should begin immediately 28 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Medical management – Bundle of Care Blood work Serum lactate Blood cultures X2 SEPSIS/SEPTIC SHOCK (CONTINUED_5) Complete blood count Coagulation studies Liver function tests Arterial blood gas 29 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Medical management – Bundle of Care Antibiotics SEPSIS/SEPTIC SHOCK (CONTINUED_6) Administered within 1 hour upon arrival 30 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Medical management – Bundle of Care Aggressive fluid resuscitation decreases mortality SEPSIS/SEPTIC SHOCK (CONTINUED_7) Vasopressors if needed Norepi for sepsis Crystalloid solution (ie NS or LR) 31 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Medical management Corticosteroid therapy possibly but low-dose steroids have not been shown to be helpful. Last line. Ongoing monitoring Remember we are giving a ton of SEPSIS/SEPTIC SHOCK (CONTINUED_8) fluids- what are we assessing? What happens if we assess that our interventions have been successful? 32 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  COMPLICATIONS: DISSEMINATED INTERVASCUL AR COAGUL ATION (DIC): PATHOPHYSIOLOGY A condition in which the blood clots throughout the body, blocking small blood vessels, leading to organ failure (www.nhlbi.nih.gov.) 33 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  DIC: RISK FACTORS Pregnancy complications Blood infections Cancer Blood transfusion reaction Liver dysfunction Shock- Most commonly caused by sepsis/septic shock Trauma Burns  Reversing the effects of DIC is difficult  Mortality is high 34 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  DIC: CLINICAL PRESENTATION  First they CLOT, then they BLEED Bleeding (in second phase) around wounds, at surgical sites, and venipuncture sites Hypovolemia Hypotension Decreased CO and LOC Ecchymosis Hematoma Petechiae Tissue necrosis (Fingers,toes, tip of nose) Dyspnea Epistaxis Conjunctival bleeding 35 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  DIC: LAB AND DIAGNOSTIC TESTING PT/PTT (increased) D-Dimer (increased) Fibrinogen (decreased) Platelet count (decreased) 36 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  DIC: THE NURSING PROCESS/CONSIDERATIONS Assess change in LOC Observe respiratory rate rhythm and depth Obtain ABGs Note blood sputum or blood in urine or stool Perform a skin assessment observing for bruising Detect changes in oxygenation Ensure patent IV access Keep client comfortable Vigilantly assess sites after blood draws and line placements due to bleeding Treat the cause of the DIC Assess lung sounds 37 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  DIC: TREATMENTS AND THERAPIES Fresh frozen plasma Platelet replacement Whole blood Anticoagulants SOMETIMES but not routinely IV Fluids Balanced crystalloids such as LR 38 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  C OM P L IC AT ION S : M ULT I P L E OR GAN DY S F U N C T I ON S Y N D R OM E (M OD S ): PAT H OP H Y S IOLOGY An extreme response after injury, sepsis or burns that leads to the constant release of immune mediators in the blood causing altered organ function and failure. Constant release of immune mediators results in oxidation stress causing an imbalance of antioxidants and free radicals. Decreased cellular oxygenation convert cells to anerobic metabolism which leads to lactic acidosis. The increase in metabolic acidosis leads to multiple organ dysfunction syndrome. MODS causes the break down of muscle tissue and vital organs. 39 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  MODS: RISK FACTORS Chronic disease Pre-existing organ dysfunction Immunosuppressive therapy Extreme age Malnutrition Cancer Trauma Alcoholism Severe Trauma Sepsis- apoptosis is accelerated in sepsis 40 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  MODS: IMPACT ON OVERALL HEALTH Infection is the leading cause of MODS after trauma Emergency situation High mortality (40% to 50%): Death rate increases as the number of involved organs increase Prolonged recovery can cause damaging effects to the aging adult 41 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  MODS: CLINICAL PRESENTATION Respiratory- Lungs affected FIRST (ARDS) Hepatic Dyspnea leading to respiratory failure (client requires Increased bilirubin level intubation and mechanical ventilation) Gastrointestinal Infiltrates on chest X-Ray Cardiovascular Nausea Vomiting blood Tachycardia Integumentary Decreased blood pressure Impaired wound healing Arrhythmia Decreased cardiac output Central Nervous System Renal Disorientation Confusion Decreased urine output Anxiety Anuria (dialysis is required) Agitation Increased creatinine levels 42 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  MODS: TREATMENTS AND THERAPIES Antibiotics Sedation Mechanical Ventilation IV Fluids Medications Nutrition Hemodynamic Monitoring 43 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  MODS: DISCUSSION QUESTION You are the ICU nurse caring for an 88-year-old client who was initially admitted to a medical-surgical unit for treatment of urinary tract infection with IV antibiotics. The client developed sepsis and was transferred to the ICU yesterday and is requiring mechanical ventilation for respiratory support. You are continuously monitoring the client’s hemodynamic status and have noted that the client has a decreased cardiac output. In addition, the client has a rising creatinine level and is anuric. The client is receiving a continuous drip of dopamine 10 mcg/kg/min IV. What is the rationale for administering dopamine? What precautions should you take when administering IV dopamine? What is the optimal outcome for this client? What is the most likely outcome for this client? 44 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  HEMODYNAMIC MONITORING Pulmonary artery Central venous catheter-Gives catheter- Arterial line- easy details on CO Measures right access to blood. measurements. heart preload Continuous BP (blood returning monitoring. Has port for IV to right side of meds. heart) PULMONARY ARTERY CATHETER  HEMODYNAMIC MONITORING Arterial Pressure Monitoring Radial artery Displays waveform and constant blood pressure reading Especially helpful if BP is labile and on vasoactive meds Allows health care team to see trends or abrupt changes in blood pressure. Can be used for frequent lab draws. **NOT placed by RN. **Clearly label so nobody puts IV meds in it! This is when we do the Allen Test first to ensure adequate blood flow 47 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  THE PHLEBOSTATIC AXIS- MIDPOINT OF L ATRIUM, 4 TH INTERCOSTAL SPACE, MIDAXILLARY LINE This axis is the location of the right atrium and most accurately reflects a patients hemodynamic status. The transducer should be at THIS level and NOT the level of the arterial line in order to be “zero’d out” and be accurate. CENTRAL VENOUS MONITORING Central venous pressure Catheter- Long catheter threaded through the jugular, subclavian, or femoral vein to the vena cava and into the atrium.  Right atrial pressure  CVP monitoring can be done with this line  Estimates right ventricular filling pressures or volume returning from systemic circulation (preload)  Normal CVP is 2-6mm Hg CENTRAL VENOUS PRESSURE CATHETER  Measures Pulmonary artery pressures PULMON ARY Can alert for Pulmonary hypertension ARTERY CATHETE Assesses Right heart function R **Place in Trendelenburg before placement and during removal to prevent air embolism  Myocardial Infarction (MI) Acute Coronary Syndrome STEMI Stable Angina Due to an abrupt disruption of blood flow to an area of the heart. This is bad. Chest pain that occurs To the cath lab ASAP! (within 90 mins) when the heart requires If that doesn’t work, may need CABG sx more oxygen than it NSTEMI usually does (such as Similar characteristics of unstable angina except cardiac markers are elevated with during exercise). NSTEMI Ischemia, not necrosis! Also not great, but not as bad as STEMI. Unstable Angina Treatment Angina at rest Typically more pain=more necrosis Rest Vomiting is not a good sign Often a precursor to a heart attack in the future Nitroglycerin 52 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  MI Diagnostic Studies Electrocardiogram Done for any c/o of chest pain. Even if you think it’s anxiety or GERD. If in ER, ideally done within 10 minutes of patient arrival “Time is muscle” ST segment elevation in 2 adjoining leads ST depression or T wave inversion in 2 adjoining leads 53 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  MI Diagnostic Studies (2 of 2) Cardiac Catheterization (angiography) – Gold standard for CAD evaluation and tx blockages Ask first if allergic to iodine or shellfish, explain the “hot shot” and that palpitations are normal. Watch after for bleeding at site, infection, s/s of another blockage, kidney issues d/t contrast Assess extremities distal to puncture site for 5 P’s Hold metformin for 48 hours after (kidneys!) Stress Tests Exercise Stress Test Stress Echocardiogram Nuclear Stress Test X-Ray Looking for heart enlargement, fluid in lungs, or structural abnormalities 54 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  MI: Lab Studies Cholesterol Total Cholesterol Low-density lipoprotein (LDL)- “bad”. Main source of buildup. High-density lipoprotein (HDL)- “good”. Carries cholesterol away from arteries. Homocysteine- Can lead to blood clots or blockages. Is a risk factor, is not used to dx. C-reactive protein- Detects inflammation Cardiac Enzymes Troponin 1- Troponins are highly sensitive and present 4 hrs- up to 3 weeks after injury. They peak in 24-48 hrs. Troponins are most specific Troponin T Creatine kinase-MB (CK-MB)- Cardiac specific. Detected within 4 hrs and peaks by 24hrs. Returns to normal by 48-72 hrs. Used to help with reinfarct dx 55 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  Nitroglycerin (Nitrostat): Sublingual Causes venous and arterial DILATION Decreases preload and afterload Since dilates coronary artery, increases blood flow to myocardium Take 1 tablet every 5 minutes X 3 doses Do not swallow Keep in dark , glass bottle in dry, cool place Isn’t working after 3 doses? Call 9-1-1 OR if hospital, try IV nitro May or may not burn or fizz Can cause a headache **Research shows higher mortality with morphine, so nitro is preferred! Safety Alert! *Will cause sudden drop in BP- Make sure pt is SITTING down and warn them * NEVER leave an unstable patient (I.e. one that is having a possible heart attack and just received a medication that will affect their CO). 56 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  CORONARY ARTERY BYPASS GRAFT (CABG) Restores blood flow to the heart muscle caused by narrowing of the coronary arteries. Blood vessels are taken from a vein in the leg, chest, or arm and grafted onto a section of the aorta and an area distal to the coronary artery blockage. The graft opens the artery to allow a clear blood flow to the heart muscle. Multiple graphs are used if there are multiple blockages. 57 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved. Coronary Artery Bypass Grafting: Post Op Post-CABG Care BP- maintain TIGHT BP control to prevent graft collapse from hypotension OR bleeding from hypertension Administer fluids and medications as ordered- Vasodilators, vasoconstrictors, inotropes, diuretics Rewarm patient slowly- blankets, fluids, air flow devices. PREVENT SHIVERING. Monitor body temps hourly Administer pain medication and continuous sedation medications Pulmonary hygiene- reposition frequently, suction PRN, oral care q4hrs. Early mobility or ambulation Wound care 58 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  CABG Post-Op Continued Teaching Post-CABG Signs of infection Sternal precautions Do not lift weight over 10 lbs, raise arms overhead, bend at the waist, participate in vigorous activity until cleared by physician — These activities may interfere with sternal wound healing Cardiac rehabilitation Helps to change modifiable risk factors and decrease repeated MIs Smoking cessation Diet changes-low Na, low fat, low cholesterol No isometric exercises (No weight lifting) No Valsalva When you can walk a block or up stairs with no discomfort you can have sex Morning is the safest time for sex Walking is the best exercise S/S of heart failure 59 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  DISCHARGE: DISCUSSION QUESTION Your client is being discharged to home after undergoing CABG surgery. What information will you include in your discharge teaching plan? 60 Copyright 2023 Assessment Technologies Institute, L.L.C. All rights reserved.  Myocardial Infarction Nursing Interventions – Teaching Report s/s of M I Medication education Cardiac rehab 1.No smoking of cigarettes or other tobacco products 2.Maintain a normal body weight 3.Exercise for at least 150 minutes with moderate-intensity activity, or 75 minutes of vigorous-intensity activity, or a combination of each per week 4.Eat a healthy diet that follows the current American Heart Association recommendations 5.Maintain total cholesterol level less than 200 mg/dL 6.Keep BP less than 120/79 mm Hg 7.Keep fasting blood glucose less than 100 mg/dL 61 Copyright 2022 Assessment Technologies Institute, L.L.C. All rights reserved.  Cardiomyopathy Patho Structural changes to heart that make it Weak Enlarged Thick or rigid Decreased function in heart muscle….because it is WEAK= Decreased CO 3 types: 1. Dilated- Most common. Often causes