CLINICAL TEACHING ON

CARDIAC REHABILITATION

SUBMITTED TO; SUBMITTED BY;

PROF. RAJI RAJU RIYA PHILIPOSE

HOD, MED-SURG NURSING II YEAR M.Sc NURSING

VIJAYA COLLEGE OF NURSING VIJAYA COLLEGE OF NURSING

KOTTARAKARA KOTTARAKARA

SUBMITTED ON, 2-1-2020

Name of the student teacher : Ms. Riya Philipose

Subject : Medical - Surgical Nursing

Unit :

Topic : Cardiac rehabilitation

Group : II year M.Sc (N) students

Place : Vijaya hospital, Kottarakara

Duration : 30 mt

Date and time :

Previous knowledge of the class : From previous theory class

Method of teaching : Lecture cum discussion

A.V AIDS : Charts, PPT, leaflet, pamphlet

GENERAL OBJECTIVE

On completion of the class, the students acquire knowledge regarding cardiac rehabilitation, appreciate its clinical importance and
apply this knowledge in various health care settings.

SPECIFIC OBJECTIVE

At the end of the class the students will be able to,

- define cardiac rehabilitation

- enlist the indications of cardiac rehabilitation
- enumerate the phases of cardiac rehabilitation
- describe the procedure in cardiac rehabilitation
- identify the benefits of cardiac rehabilitation
TIME SPECIFIC CONTENT METHOD OF AV AIDS EVALUATIO
OBJECTIVE TEACHING

INTRODUCTION
Cardiac rehabilitation involves adopting heart-healthy
2mt Introduce the topic lifestyle changes to address risk factors for cardiovascular Lecture cum
disease. To help in adopting lifestyle changes, this program discussion
includes exercise training, education on heart-healthy living,
and counseling to reduce stress and help in return to an
active life. Cardiac rehab can improve our health and quality
of life, reduce the need for medicines to treat heart or chest
pain, decrease the chance of hospitalization or emergency
room for a heart problem, prevent future heart problems, and
even help to live longer. Cardiac rehab is provided in an
outpatient clinic or in a hospital rehab center. The cardiac
rehab team includes doctors, nurses, exercise specialists,
physical and occupational therapists, dietitians or
nutritionists, and mental health specialists.

DEFINITION OF CARDIAC REHABILITATION

Define cardiac 1. Cardiac rehabilitation (CR) is a branch of rehabilitation Lecture cum Chart What is cardi
2mt rehabilitation medicine or physical therapy dealing with optimizing discussion rehabilitation
physical function in patients with cardiac disease or
recent cardiac surgeries.
2. Cardiac rehabilitation is defined by the World Health
Organization (WHO) as "The sum of activity and
 interventions required to ensure the best possible physical,
mental, and social conditions so that patients with chronic or
post-acute cardiovascular disease may, by their own efforts,
preserve or resume their proper place in society and lead an
active life".
INDICATIONS FOR CARDIAC REHABILITATION
Enlist the i. Myocardial Infarction Lecture cum Leaflet What are t
5mt indications of Myocardial infarction (MI), also known as a heart attack, discussion indications
cardiac occurs when blood flow decreases or stops to a part of cardiac
rehabilitation the heart, causing damage to the heart muscle. The most rehabilitation
common symptom is chest pain or discomfort which may
travel into the shoulder, arm, back, neck or jaw.  Often it
occurs in the center or left side of the chest and lasts for
more than a few minutes.
ii. Angina ( stable)
Angina is a type of chest pain that results from reduced
blood flow to the heart. A lack of blood flow means our
heart muscle is not getting enough oxygen. The pain is often
triggered by physical activity or emotional stress. Stable
angina, also called angina pectoris, is the most common type
of angina.
iii. Coronary artery bypass surgery
CABG is a open-heart surgery in which the rib cage is
opened and a section of a blood vessel is grafted from the
aorta to the coronary artery to bypass the blocked section of
the coronary artery and improve the blood supply to the
heart.
iv. Compensated heart failure
The inability of the heart to pump blood adequately to fulfil
the metabolic demands of peripheral tissues is known as the
heart failure. When there is a reduction in the cardiac output
in the initial stage of heart failure, it triggers several
structural and functional changes in the cardiac tissues as a
measure of restoring the cardiac output. This is known as the
compensated heart failure.
v. Cardiac surgery
Any heart surgery.
Eg. CABG
vi. High risk for CAD
Coronary artery disease, also called coronary or
atherosclerotic heart disease, is a serious condition caused by a
build up of plaque in our coronary arteries, the blood vessels
that bring oxygen-rich blood to your heart.
vii. High risk for high blood pressure
In patients with a history of high blood pressure.
viii. End stage renal failure
It occurs in advance stage of chronic kidney disease. The
kidney loses its function completely.
ix. Status post pacemaker insertion
After pacemaker insertion, cardiac rehab is recommended.
x. Cardiomyopathy
Cardiomyopathy is a group of diseases that affect the heart
 muscle. Early on there may be few or no symptoms. As the
disease worsens, shortness of breath, feeling tired, and
swelling of the legs may occur, due to the onset of heart
failure. An irregular heart beat and fainting may occur.
Those affected are at an increased risk of sudden cardiac
death.
xi. PVD
It is a blood circulation disorder that causes the blood
vessels outside of our heart and brain to narrow, block or
spasm.
xii. Heart transplant
In patients after a heart transplantation, cardiac rehab is
needed.
xiii. High risk for diabetes
Those who are at a high risk for diabetes mellitus, cardiac
rehab may be helpful.
PHASES OF CARDIAC REHABILITATION
Enumerate the Phase 1 Lecture cum Pamphlet What are t
5mt phases of cardiac Objectives of Phase I Cardiac Rahabilation discussion phases
rehabilitation  Conditioning from acute event / post- CABG cardiac
 To make patient functionally independent. rehabilitation
 To adjust with discharge from the hospital.
 Psychological counselling
 Nutritional counselling
 Secondary prevention targeting
Phase 1
Phase 1 relates to the period of hospitalization following an
acute cardiac event. The duration of this phase may vary
depending on the initial diagnosis, the severity of the event
and individual institutions, usually one week acute event/
post-operative.
During this phase,
 Early mobilization and adequate discharge planning
 Individuals typically undergo a risk factor
assessment and risk stratification.
 Receiving information regarding their diagnosis, risk
factors, medications and work/social issues.
 Involvement and support of the partner and family is
facilitated and encouraged.
Phase 2
Objectives
i. Functional goals
Exercise training under supervision/ at home
ii. Psychosocial goals
Anxiety/depression management
iii. Secondary preventive targets
Phase 2
This phase encompasses the immediate post discharge
period, which is typically a period of 4-6 wks. It focuses on
health education and resumption of physical activity,
however the structure of this phase may vary dramatically
from centre to centre. It may take the format of telephone
follow up, home visits or individual or group education
sessions.
Phase 3
Objectives
i. Functional goals
Exercise training under supervision
ii. Psychosocial goals
- Return to work
- Return to hobbies and lifestyle
- Anxiety/depression management
iii. Secondary preventive targets
Phase 3
This phase is sometimes referred to as the ‘ Exercise’ phase.
It incorporates exercise training in combination with
ongoing education and psychosocial and vocational
interventions. The duration of phase 3 may vary from six to
12 weeks, with patients required to attend a CR unit two to
three times weekly for structured exercise and other lifestyle
interventions.
Phase 4
Objectives
i. Maintenance of achieved functional status
ii. Return to work – return to hobbies and lifestyle
modifications
iii. Secondary preventive targets
 Phase 4
This phase constitutes the components of long term
maintenance of lifestyle changes and professional
monitoring of clinical status.
PROCEDURE
Describe the Patients typically enter cardiac rehabilitation in the weeks Lecture cum PPT What is t
5mt procedure in following an acute coronary event such as a myocardial discussion procedure
cardiac infarction (heart attack), coronary artery bypass surgery, cardiac
rehabilitation with a diagnosis of heart failure,  replacement of a heart rehabilitation
valve, percutaneous coronary intervention (such as coronary
stent placement), placement of a pacemaker, or placement of
an implantable cardioverter defibrillator.
Inpatient programme
Patients receiving Cardiac Rehabilitation in the hospital after
surgery are usually able to begin within a day or two.
Simple motion exercises that can be done sitting down, such
as lifting the arms and legs. Heart rate is monitored and
continues being monitored as the patient begins to walk.
Outpatient program

 Most patients wishing to participate in outpatient CR

are able to begin within 4–6 weeks after surgery. In
order to participate in an outpatient program, the
patient must first obtain a physician's referral.
 Participation typically begins with an intake
evaluation that includes measurement of cardiac risk
 factors such as lipid measures, blood pressure, body
weight, and smoking status. An exercise stress test is
usually performed both to determine if exercise is
safe and to allow for the development of a custom
exercise program. During exercise, the patient's heart
rate and blood pressure are monitored to check the
intensity of activity.
 Short and long-term risk factors and goals are
established, and patients are closely monitored by a
"case-manager" who may be a cardiac-
trained Registered Nurse, Physiotherapist, respiratory
therapist, or an exercise physiologist.
 A dietitian helps create a healthy eating plan, and a
counselor may help to alleviate stress or, for smokers,
may give counseling on how to quit.
The duration of the program varies from patient to patient
and can range from six months to several years.  Even after
CR is finished, there are long-term maintenance programs
that should not be minimized, as benefits are maintained
only with long-term adherence.
Obesity
Weight loss is a tool used to aid in cardiac rehabilitation.
There is a strong correlation
between obesity and cardiovascular disease. Obesity is
 associated with excessive fat accumulation in the body,
which can inhibit bodily functions, such as blood flow
through veins and arteries. When adipose tissue expands, the
number of pro-inflammatory cytokines also increases. As the
name suggests, cytokines have an inflammatory reaction to
this, in which they induce the build-up of plaques in veins
and arteries.
Obesity stems from a diet high in saturated fats,
processed food and excess alcohol. These have all been
shown to increase the inflammatory response to produce the
plaque-building cytokines in the blood. In a randomized
meta-analysis, scientists found a 47% reduction in mortality,
following a change in lifestyle, regarding diet.
Another factor in obesity is sedentary lifestyle. Physical
activity is associated with a plethora of benefits, especially
blood flow and inhibition of plaque build-up.
BENEFITS OF CARDIAC REHABILITATION
 Offset deleterious psychologic and physiologic
effects of bed rest during hospitalization.
Identify the Lecture cum Chart What are t
 Provide additional medical surveillance of patients
2mt benefits of cardiac discussion benefits
 Enable patients to return to activities of daily living
rehabilitation cardiac
within the limits imposed by their disease.
rehabilitation
 Prepare the patient and the support system at home to
optimize recovery followed by hospital discharge.
  No consistent effects on cardiac arrhythmias
 Improves exercise tolerance without significant CV
complications.
 Improves skeletal muscle strength and endurance in
clinically stable patients
 Promotes favourable exercise habits
 Decreases angina and CHF symptoms

CONCLUSION

Cardiac rehab involves adopting heart-healthy lifestyle

changes to address risk factors for cardiovascular disease.
To help in adopting lifestyle changes, this program includes
exercise training, education on heart-healthy living, and
counseling to reduce stress and help in return to an active
life. Cardiac rehab can improve our health and quality of
life, reduce the need for medicines to treat heart or chest
pain, decrease the chance to go back to a hospital or
emergency room for a heart problem, prevent future heart
problems, and even help to live longer. Cardiac rehab is
provided in an outpatient clinic or in a hospital rehab center.
The cardiac rehab team includes doctors, nurses, exercise
specialists, physical and occupational therapists, dietitians or
nutritionists, and mental health specialists. Medicare and
most insurance plans cover a standard cardiac rehab program
that includes 36 supervised sessions over 12 weeks.
BIBLIOGRAPHY

1. Sharon L Lewis. (2014). Textbook of medical-surgical

nursing; Elsevier publishers.
2. Brunner and Suddharth.(2012). Medical-Surgical
Textbook, Wolters Kluwer publishers.
3. https://en.wikipedia.org/wiki/Cardiac_rehabilitation
4.https://www.nhlbi.nih.gov/health-topics/cardiac-
rehabilitation.