Phases of Heart Disease Rehabilitation
Tuesday, September 24, 2013
According to WHO (World Health Organization), heart disease is the leading cause of death in the UK, USA, Canada and Australia.
Phase I
Start immediately after the acute illness episode, usually when the patient is still in the cardiac care unit. After the acute episode, the patient will usually bed rest less than 24 hours if there are no complications such as heart failure or dysrhythmia development. Although the myocardium should be laid to rest, bed rest makes the patient has a risk of hypovolemia, hypoxemia, muscle atrophy, and pulmonary embolism. Therefore, it needs to be prevented. If the patient's nausea, given a liquid diet until nausea is reduced. Nurse or passive physiotherapy should start training. Along with the increased strength of the patient, allow the patient to sit on the side of the bed and swung her legs for a while. Ambulatory patient to the chair on the side of the bed for 15-20 minutes after the first day if the patient is able to swing the leg without any chest pain, dysrhythmias, or hypotension. When the patient was transferred to the cardiac care unit of a common unit or intermediates, freedom of use of the bathroom and self-care activities is needed. Wireless heart monitoring (telemetry) can be resumed. Allow the patient to walk around for a few moments with supervision in the corridor. Mileage and duration on the roads is increasing progressively.
Patients lose 10% to 15% of skeletal muscle contractility and strength during the first week of bed rest and 20% to 25% after a bed rest for 3 weeks. Patients should increase their activities to prevent excess current work of the heart to pump blood containing oxygen to the muscles. Metabolic Equivalent Test (MET) is a way to measure the amount of oxygen required to perform the activity: 1MET = 3.5 ml O2/kg/min. Early mobilization after MI should not be more than 1-2 MET such as shaving and eating. Assess pulse, blood pressure, fatigue levels due to increased levels of patient activity. Help the patient to prevent fatigue. During phase 1, health education should be provided include cardiac anatomy, physiology and management of risk factors of CHD, counseling habits, and activity in the home.
Phase 2
Occur before the patient's discharge, during the second phase of the nurse can help the patient towards the achievement of goals for independent living, although still under strict bed rest. This phase is achieved by directing the patient's mind to a time when it will be active again. The purpose here is not to change the lifestyle of patients in total, but encourage the necessary adjustments. But avoid attention to the things that can not be done the patient, but rather encourage achievement of short-term and long-term based on the needs of each individual. Course of the disease needs to be explained, answered all the questions honestly, and give confidence to the patient that most people are able to return to work after MI. This positive approach will help patients to not undergo cardiac defects. Resume sexual activity after MI is the most difficult thing. Such activities may be resumed usually 4-8 months after MI. Patients must be able to perform the activity up and down the stairs before resuming sexual activity. Patients also should not eat or drink that contains alcohol before sexual activity. Instruct patient to stop smoking, encourage the patient to take long walks. During the second phase, the patient performs exercises for 20-30 minutes for 3-4 times per week to be monitored by the cardiac rehabilitation staff. Some patients may return to work at week 8 or 9 if asymptomatic. Between weeks eight to ten e dank, patients are encouraged to complete a physical examination, including ECG, exercise stress tests, lipid analysis, x-ray examination of the chest. Health workers should ensure weather health problems that contribute to the development of CHD is not there (hypertension, anemia, hyperthyroidism).
Phase 3
Begins when the patient went home and took place during the recovery period, starting from month 4 to month 6. 3 phase goal is to restore the patient's activity at a level that allows it to work or return to regular activity before the illness. This phase is usually performed with the patient enrolled in a formal rehabilitation program suau who oversaw an increase in patient activity. Most programs like this schedule meetings in the morning, afternoon or evening so that patients who have been re-worked to arrange an appointment that fit their daily activities.
Phase 4
Focused on long-term adjustment is in the maintenance of cardiovascular stability. In this phase, the patient is usually able to organize themselves and do not require patient surveillance program. The purpose of each stage is determined and based on the achievement of the previous stage.
Throughout all stages of rehabilitation, activity goals and exercise tolerance is achieved through physical adjustment, which is done to improve the efficiency of the heart and lower blood pressure, thereby reducing oxygen demand and cardiac workload. Physical adjustments occur in Phase I begins with the arm range of motion exercises. Phase 2 includes sitting in a chair, walking, and climbing stairs. Phase 3 could include a faster way, finally phase 4 in the form of jogging. Physical adjustment should only be done under medical supervision. Patients were observed for activity against chest pain, dyspnoea, weakness, fatigue, and an increase in heart rate that exceeds the threshold frequency. When one of these symptoms appear, the patient should be warned to immediately stop the activity and contact your doctor.
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