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What to Expect from your Student Practicum Experience

Cardiac Rehabilitation Deborah Sullivan MS, ANP-BC Cardiovascular Prevention and Rehabilitation Department Lahey Clinic Medical Center 41 Mall Road Burlington, MA 01805 Deborah.sullivan@lahey .org 781 744-2460. What to Expect from your Student Practicum Experience. Cardiac Rehabilitation.

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What to Expect from your Student Practicum Experience

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  1. Cardiac Rehabilitation Deborah Sullivan MS, ANP-BC Cardiovascular Prevention and Rehabilitation Department Lahey Clinic Medical Center 41 Mall Road Burlington, MA 01805 Deborah.sullivan@lahey .org 781 744-2460 What to Expect from your Student Practicum Experience

  2. Cardiac Rehabilitation What is Cardiac Rehabilitation • Medically supervised program • Optimize a cardiac patient’s • physical • psychological • social functioning • stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes • reducing death and disability AACVPR.org

  3. Patient Population • Myocardial infarction (heart attack) • Coronary artery bypass graft surgery (CABG) • Current stable angina pectoris • Heart valve repair or replacement • Percutaneoustransluminal coronary angioplasty (PTCA)/ or coronary stenting • Heart or heart-lung transplant ___________________________________________________ • Heart Failure and those with ventricular assist devices • Coronary artery disease equivalents such as diabetes or peripheral artery disease • Patients with diabetes • Peripheral arterial disease

  4. Components of Cardiac Rehabilitation • Cardiac rehabilitation is tailored to meet the patient’s individual needs and goals.  • Utilizes a multidisciplinary team • The Centers for Medicare and Medicaid Services (CMS) defines core components : • Prescribed exercise • Cardiac risk factor modification • Psychosocial Assessment • Medical Nutrition Therapy • Outcomes Assessment • ITP (Individual Treatment Plan)

  5. Cardiac Rehabilitation Three phases • Phase I: during hospitalization, • Phase II: a supervised ambulatory outpatient program lasting 3-6 months, • 2-4 weeks post event • Adjustment period • Telemetry monitored • Phase III: lifetime maintenance stage

  6. Typical day at the facility • No such thing as a typical day!! • Treat your practicum like a job • Choose the cardiac rehab setting because you want to be there!! • Dress appropriately, be on time, be prepared, be well rested, stay home if your sick • You will need your own stethoscope on your first day of your clinical experience (Littmann stethoscope is about $70.00) • Hospital orientation, confidentiality statement, orientation check list

  7. Typical day at the facility • Fast paced environment, multi-tasking • Monday, Wednesday, Friday • Early start at 7AM • Exercise classes run until about 6-7PM • Formal Education –monthly symposium • Team meeting • Tuesday, Thursday • Phase II or III programs

  8. Shadow a patient • Entrance evaluation • Review the patients information/discharge summary (medical jargon) • History • Physical assessment • Lab results • Procedures • Diagnostic Tests (i.e. echo, cardiac cath, x-ray, PFTs) • Musculoskeletal assessment

  9. Shadow a patient • Entrance Evaluation (at Lahey) • Pharmacist • Nurse • Social Worker • Dietician • Exercise Tolerance Test

  10. Principals of Exercise Physiology • METs • Calculation of max (ETT) and sub max METs • Patient education • Design the patients exercise prescription • Karvonen reserve formula based on the results of the ETT and MET level achieved (establish a THR) • ACSM guidelines • Borg Scale • Patient considerations

  11. Borg Scale of Rate of Perceived Exertion • 6 • 7 very, very light • 8 • 9 very light • 10 • 11 fairly light • 12 • 13 somewhat hard • 14 • 15 hard • 16 • 17 very hard • 18 • 19 very, very hard • 20

  12. Additional Tasks • Data entry to evaluate outcomes • Assist with establishing plans of care • Interactions with patients • Education (shoes, hydration, environmental factors, etc.) • Exercise leadership (free weights/resistance training) • Stretching and relaxation

  13. Your responsibility during the rehab session • Be familiar with emergency equipment and plan • Prescreening prior to beginning exercise; Assess for pain or discomfort (0-10 scale) • Check resting blood pressure, heart rate and rhythm • Guidance on warm-up exercises, proper body mechanics, safety precautions • Assist patients on exercise equipment, obtain exercise BP, HR, RPE, watts, METs, time, symptoms • Document information, communicate with team

  14. Review rhythm stripKnow how to diagnose normal sinus rhythm

  15. Pharmacology • Commonly used medications in cardiac rehab patients • Beta Blockers • Calcium Channel blockers • Statins • Nitrates • Diuretics • ACE Inhibitors/ARBS • Anti-platelets

  16. Bring your area of interest to your practicum and expand on it • Fish Oil Supplements & Benefits of Omega-3 Fatty Acids • By Timothy Duffy, UMass Lowell Exercise Physiology Student • The Importance of Resistance Training in Cardiac and Pulmonary Rehabilitation Settings • By Erin Foley, Student , UMass Lowell Exercise Physiology • Published in the MACVPR Newsletter (macvpr.org)

  17. Resources • Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs, 4th Edition • Cardiac Resource Manual • Guidelines for Pulmonary Rehabilitation Programs, 4th Edition • ACSM's Guidelines for Exercise Testing and Prescription, Eighth Edition macvpr.org aacvpr.org pcna.net Thank you!!

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