Rehabilitation and Health Promotion

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Introduction
This is a case study of Aneka Jacobsen, who seeks cardiac rehabilitation (CR) phase III, after a recent myocardial infarction (MI) which is commonly known as a heart attack. This is considered the intensive supervised phase, usually 4-6 weeks post event and discharge from hospital. It may be offered in supervised groups within the outpatient department of a hospital, in community setting or as part of a home-based package. The case study briefly examines her past and current history, including data given from an exercise tolerance test (ETT), performed by the patient prior to being discharged from the hospital. Evidences collected from various research studies and guidelines from a number of heart associations worldwide has been used to support and justify clinical reasoning why patients like Aneka would benefit from participating in this rehabilitation phase after her recent cardiac event. The risks factors for Aneka has been evaluated and following this, an appropriate CR phase III programme has been proposed for her from the role of a physiotherapist as part of the multidisciplinary team (MDT) approach in the management of this patient.

Cardiac Rehabilitation
Acevedo et al 2011, reported that coronary heart disease (CHD) is the leading cause of death worldwide and in recent years there has been success in treating modifiable risk factors of CHD, such as high blood pressure and dyslipidemia. However, it has not been as successful to treat other risk factors such as overweight, obesity and physical inactivity, since these required lifestyle changes. Thus, most patients with cardiac disease present as sedentary individuals who do not participate in any form of regular exercise or physical actively accumulating 30 mins. Hence, they are often deconditioned and overweight. Over the past few decades, CR programmes have been prescribed for patients following MI or coronary artery bypass graft (CABG) surgery but more recently, CR encompasses a wide range of cardiac problems (Taylor et al, 2008). The NICE guidelines 2003, Scottish Intercollegiate Guideline Network (SIGN) 2002, the American Heart Association (AHA), American College of Cardiology (ACC), the National Institute of Health, the American College of Sport Medicine (ACSM), the European Society of Cardiology (ESC) have all strongly advocated regular physical activity as a strategy to reduce risks of CHD in their guidelines (Acevedo et al, 2011). CR programs should not only include exercise components but also provide comprehensive care and education about cardiovascular risk factors such as smoking, behavioural intervention, weight management and vocational rehabilitation to assist patients returning to work or retirement (Taylor et al, 2008). Furthermore, they stated that CR programmes should pertain to the emotional, physical and educational requirements of the patient and their family. The integral part of their management should include goals to:

Decrease cardiac morbidity and relieve symptoms.
Encourage ability to resume normal activities by increasing fitness.
Reduce anxiety by understanding own disease and promote self-confidence. Common hallmark problems associated with CVD is a marked reduction in exercise capacity accompanying with symptoms of severe shortness of breath (SOB) and fatigue during exercise. Reduced exercise capacity, measured as peak oxygen consumption, (VO2max) is major contributor of poor quality of life since it has direct impact of ability to perform activities of daily living ( ADL) and is a predictor of rehospitalisation and mortality (Francis et al, 2000). However, it has been suggested that exercise intolerance is not exclusively dependent on poor cardiac pump function alone, but is also due to changes in the skeletal muscle in the periphery (Coats et al, 1994). These peripheral abnormalities include reduced capacity of exercising muscle to utilise oxygen, impaired blood flow to exercising muscles, increased...
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