CARDIAC REHABILITATION
By
Dr. Prashant P. Kashyap
Chief physiotherapist
Vikram hospital pvt. Ltd.
PROTOCOL FOR CARDIAC REHABILITATON
Patient assessment
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Evaluation
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Treatment plan
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Pre operative evaluation
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Post operative evaluation
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Home program
PATIENT ASSESSMENT
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History:- Present , Family, Social
Observation: - Chest deformities, Clubbing,
Cyanosis, Edema.
Auscultation:- Breath sounds, Added sounds
Reports: - ECG, PFT, X- RAY, TMT.
EVALUATION
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Breathing pattern, respiratory, heart rate
Effectiveness, productivity of cough
Accumulation of secretions and the possible
need for postural drainage
Range of motion particularly shoulder joint
Posture and an alignment of trunk
PRE OPERATIVE PHYSIOTHERAPY
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It is an ideal time to prepare the patient physically and
psychologically for the surgery and to teach the
patient activities that will be carried out in the early
post operative days.
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Instructions about the location of incision, incisional
pain, the placement and IV tubes, Foley’s catheter,
arterial line
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Breathing exercise instructions with emphasis on deep
inspiration, posterior basal breathing, intensive
spirometry or inspirometry
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Effective cough instruction and an explanation of
wound splinting techniques
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Removal of any accumulative secretions with or
modified postal drainage
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Lower extremity exercise to maintain circulation
and prevent deep vain thrombosis or pulmonary
embolism
POST OPERATIVE
PHYSIOTHERAPY:
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The program starts from the bed in CCU to
climbing to flights at the end of 7th day.
1st post operative day :
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monitoring the vitals
Position the patient
Modified postural drainage
Chest physio with postural drainage
Support to the incision
Wound assisted coughing and huffing
Deep Breathing exercises
Spirometry and ATM
Monitoring the amount and colour of drain
Milking
2nd post operative day:
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Repeat the same procedure as in the first POD
if the drains are not removed
Make the patient to sit on the bed in the
morning
Ambulate the patient in the ICU once the drains
and the femoral line are removed
3rd post operative day:
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Chest physiotherapy is given only when the
secretions are more.
Steam and nebulization is continued
Well ambulated in the ward.
Check the BP and HR each time.
4th post operative day:
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Same treatment in the 3rd POD is continued
Frequency of chest physio can be reduced
according to the air entry in the lung fields
Certain exercises are taught to the patient to
prevent the stiffness in the shoulder and neck.
Arm, shoulder, trunk and leg exercises to be
performed including abduction and adduction
Independent walking in the ward
5th post operative day:
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Continue the same management as earlier,
Check the X-ray, lab reports and ECG
Take the patient to the flights,( 10 steps up and
down )
Check the vitals & stabilize the patient.
6th post operative day:
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Discharge counselling to be done
Do’s and don’ts to be explained
Home programs to be taught
Patient is ready for discharge.
DISCUSSION
Thank you