1. Rehabilitation Nursing
Lesson #3
Cardiopulmonary Rehab Nursing

2. Objectives
Identify energy utilization and energy conservation techniques.
Describe factors that influence endurance and fatigue.
Define fatigue and list the nursing interventions for prevention of fatigue.
Identify outcomes of care for clients involved in cardiac and pulmonary rehabilitation.

3. Cardiopulmonary Rehab Purpose
Decrease the risk of another event
Next time may not survive it
Focus on Prevention

4. Cardiopulmonary Rehab Goal
To help our clients to get to the highest level of:
Wellness
Ability to work

5. Energy Utilization Energy Conservation

6. Energy Utilization
Defined
Use FIM scores of ADLs

7. Energy Utilization Endurance
#1 Ability to continue an activity as stress increases:
Physically
Psychologically
#2 Endurance is seen before fatigue
#3 Cardiac Stress Test
requires Measurements:
Apical/radial pulse rate
Observe Cardiac rhythm changes
Respiratory rate/effort/lung sounds/sputum
BP at specific times

8. Cardiopulmonary Rehab Client and Energy Utilization
Look at what they have to offer:
CV system
Need adequate pump/intact system
Respiratory system
Adequate intake/outtake of air
Metabolic system
Adequate hormones

9. Cardiopulmonary Rehab Client and Energy utilization
All energy is used at the cellular level
Two Types of Results:
#1 Anaerobic
Lactic Acid
#2 Aerobic
Pyruvic Acid

10. Cardiopulmonary Rehab Client and Energy Utilization
What Influences energy requirements:
Body size
Age
Activity Level
Environment
Presence of illness or injury
Medication use
Body temperature

11. Cardiopulmonary Rehab Levels of Patient Activity
Basal energy level
Add activity increasing calories:
Sedentary
Moderate
Vigorous to strenuous

12. Cardiopulmonary Rehab Change in activity
Sudden reduction changes kilocalorie need. In some cases increases need for calories:
CVA
TBI
Coma
Severe illness or disease
A slow reduction of activity causes a decreased kilocalorie need over time:
COPD

13. Cardiopulmonary Rehab Energy Conservation
Monitor for wasted energy
Desire client to rest in two ways:
Efficient rest
Appropriate rest
Rehab interventions used:
Save energy
Spread energy out overtime period for when really need it

14. Energy Conservation Nursing Interventions
#1 Maintain a correct body position
#2 Rest Prescriptions
Helps give time to repair
Increases endurance for next activity
Increases muscle strength
Daily rest periods
Creating rest periods
All about balance!

15. Energy Conservation What influences Endurance
#1 Personal factors
Obese
Frail
Fragile
#2 Environmental factors
Too hot
Too cold
#3 Diseases or disorders present
Chronic pain
#4 Ordered medical treatments
Chemo or radiation

16. Rehab Assessments Patient’s subjective complaints Activity Analysis
FIM performance of ADLs
Fatigue of used muscle groups
Sleep patterns

17. Positive Effects of daily Exercise
Body overall functions better
Increase in strength and endurance
Many mental health/body benefits observed within one week

18. Negative Effects of exercise
Muscle soreness
Muscle imbalance
Warning
Nursing interventions

19. Fatigue and Prevention

20. Fatigue Defined Observed Three Causes: CNS fatigue
Neurological Junction fatigue
Lactic acid or lactate fatigue

21. Assess Patterns of fatigue
Frequency of occurrence
Duration
Intensity
Aggravating factors?
Alleviating factors?
Interference with Lifestyle
Labwork off?
V/S changed?
Sleep OK?
Sensory or environment problems?

22. Nursing Interventions
Prevention
Appropriate planning
Stick to the routine
Encourage activity at patient’s most energetic times
Adjust therapy sessions as needed
Avoid excessive activity for patient
Assist as required
Help patient prioritize
Plan rest periods
Encourage good nutrition
Perform pain management

23. Cardiac Rehabilitation

24. Cardiac Rehab Principles
Used for clients with cardiac history
#1 Client to see care is for long term
#2 Client must participate in planned activities
#3 Client must assist with prevention of complications
#4 Client is treated in three areas:
Socially
Emotionally
Vocational

25. Three Components Cardiac Rehab
#1 Physiologic
Med/surgical management
Counseled on activity/diet
#2 Vocational
Assesses ability to return to work and perform adequately under the stress
#3 Educational
To decrease risks of second event
Lifestyle modifications
Mandatory to follow medication and exercise regime

26. Goals of Cardiac Rehab Increase function
Decrease activity related symptoms
Decrease disability
Decrease coronary risk facors

27. Basic Schedule for Cardiac Rehab
PT begins exercises in ICU or CCU
All exercises are performed to increase:
Stability
Endurance
Confidence
Coping with stress

28. Four Phases of Cardiac Rehab
#1 Inpatient-Acute care
#2 Inpatient-Subacute care
#3 Full outpatient maintenance
Biggest Challenge: Compliance
If compliant:
Decreases risk of heart arrhythmias
Decreases other risk factors
Decreases stress, fear and anxiety of second event

29. Pulmonary Rehabilitation

30. Pulmonary Rehab Goals Used for COPD patients
#1 Decrease dyspnea episodes
#2 Increase function and mobility
#3 Decrease number of acute care per year
#4 Increase ability to perform ADLs/activities
#5 Increase management of client/family coping with COPD
#6 Promote education

31. Program Benefits Retrains breathing muscles
Educates patients on prevention to decrease O2 use RT stress
Decreases complications
Stabilizes COPD progression
Supports decrease of smoking

32. Pulmonary Rehab Benefits
Offers appropriate therapies to help mobilize secretions
Tailored therapeutic exercise
Goal
Work simplification
Diet modification
Medical regimen
Safety practices of O2 use

33. Pulmonary Rehab Outcomes
Increased tissue perfusion
Increased ability to breathe
Decreased risk factors
Increased activity
Decreased anxiety level
Big Goal!!!!

34. Summary Name one thing you learned in this lesson
How will you use this in your clinical practice?

35. References