Myocardial Infarction - Rehabilitation and Education.

Cardiac rehabilitation following AMI is an essential component of professional and personal management. The following are recommendations for managing rehabilitation of clients who have suffered an AMI:

• All clients with cardiovascular disease should adopt a cardio protective dietary pattern.

• Intensive dietary advice, compliance checks, and long-term follow-up should be given, preferable by a dietitian.

• There is insufficient evidence to recommend nutritional supplements of antioxidant vitamins, minerals, or trace elements for the prevention of cardiovascular disease.

• Fish and fish oil supplements may reduce the risk of sudden cardiac death.

• For overweight and obese clients with CHD, the combination of reduce –energy diet and increased physical activity is recommended.

• Initial goal of weight loss therapy should be to reduce the client’s weight by 10%.

• All clients with cardiovascular disease should be advised to quit smoking and should be supported to stop smoking as a priority measure.

• All clients with CHD should consider having standard pharmacotherapy with aspirin, beta- blocker, ACE inhibitor, and a statin unless contraindicated.

• Comprehensive cardiac rehabilitation should embrace a case management approach.

Six important sub goals of the rehabilitation process are as follows:

1. Developing a program of progressive physical activity.

2. Educating the client and significant others about the cause, prevention, and treatment of CHD

3. Helping the client accept the limitations imposed by illness.

4. Aiding the client in adjusting to changes in occupational goal

5. Lessening the exposure to risk factors.

6. Changing the psychosocial factors adversely affecting recovery from CHD.

Cardiac rehabilitation consists of four phases:

Phase 1. (Inpatient). Phase 1 begins with admission to the coronary care unit. After AMI, clients usually remain on bed rest for less than 24 hours unless complications such as heart failure or dysrhythmias develop. Provide complete bed rest for the first day or so with use of a bedside commode for bowel movements. Most clients receive a 2-g sodium diet. If the client is nauseated, provide a clear liquid diet until nausea subsides. A coronary care nurse or physiotherapist should start passive exercises.

During phase 1, client education should include cardiac anatomy and physiology risk factors and management of CHD, behavioral counseling, and home activities.

Phase 2 (immediate outpatient)

If no complications arise, the physician discharges the client to the home by the end of the second week. Advice the client to stop smoking. Encourage frequent walk, but warn against strenuous activities, such as shoveling snow. The walking program aims for a goal of

2 miles in less than 60 minutes.

Phase 3 (intermediate outpatient). The extended outpatient phase of cardiac rehabilitation lasts from 4 to 6 months. Exercise sessions continue to be supervised, and clients are taught how to monitor their exercise intensity by taking their pulse or, if in a walking program, by counting the number of steps they take in a 15 second interval.

Phase 4 (maintenance outpatient). Phase 4, the final phase of cardiac rehabilitation, usually takes place in the home or community and is unsupervised. The client maintains a program of regular exercise and other lifestyle modifications to modify cardiac risk.. Clients should undergo an exercise testing and risk factor assessment annually.

REFERENCES

1. Black JM, Hawks JH. Medical – Surgical Nursing: clinical management for positive outcomes. 7^th ed. Saunders: Elservier 2004.

2. Lewis SM, Heitkempter MM, and Dirksen SR.Medical-Surgical Nursing: Assessment and management of clinical problems.6^th ed.Mosby: Philadelphia.

3. Luckmann, Sorensen’s . Medical – Surgical nursing : A psychophysiologic approach . 4^th ed. WB Saunders company : Philadelphia.

4. http://www.emedicine.com/emerg/topic412.htm

5. http://en.wikipedia.org/wiki/Myocardiac_infarction

Category: Medicine Notes