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Special Considerations

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Chapter 9 Special Considerations Older Populations 65 Decreased Referrals Increased disease severity Decreased functional status Financial barriers Transportation ... – PowerPoint PPT presentation

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Title: Special Considerations


1
Chapter 9
  • Special Considerations

2
Older Populations gt 65
  • Decreased Referrals
  • Increased disease severity
  • Decreased functional status
  • Financial barriers
  • Transportation barriers
  • Increased Psychosocial concerns
  • Figure 9.1

3
Comorbidities
  • Diabetes Mellitus
  • PVD
  • COPD
  • Obesity
  • Arthritis
  • Congestive Heart Failure

4
Physiological Changes
  • Body Fat Increases
  • Decreased Fast Twitch
  • Muscle Mass Decreases
  • Diminished Glycogen Stores
  • Decreased of neurons
  • Loss of elasticity to connective tissue
  • Lungs less able to supply O2
  • Diminished stress adaptation

5
Special Considerations
  • Safety
  • Functional Independence
  • Modify Routines
  • Alternative Learning Approaches
  • Long-term exercise options

6
Risk Factors gt Older Adults
  • Smoking Cessation 20-70
  • Hypertension gt 65
  • Dyslipidemia Higher, difficult to manage
  • Obesity Clustering of RF increases rates
  • Diabetes Body mass relationships
  • Psychosocial support, depression, sensory
  • Physical Inactivity longer participation

7
Young Adults
  • Return to Work
  • Anxiety, Denial, Anger
  • Time Pressures
  • Promoting Self-Management
  • Compliance

8
Women
  • Atypical CP
  • CAD 1 Killer
  • Fewer women in CR
  • Menopausal Status
  • Increased Depression
  • Increased Body Fat
  • Functional Status
  • Fewer Social Support

9
Different Programming
  • Womens Support Group
  • Family Involvement
  • Mall Walking
  • Buddy System
  • Womens Hour of Exercise
  • One-on-one Orientation

10
Diversity
  • CAD Most common deaths among all races
  • Black Americans Hypertension
  • Native Americans Increased Smoking
  • Black American Women Increased Mod. Risk Factors
  • Asian/Pacific Islander Women Lowest Risk
  • Socioeconomic Status
  • Language Communications
  • Social Issues
  • Transportation

11
RevascularizationCABG Valve
  • Decreased risk of ischemia
  • Increased mental depression
  • Infection Rates
  • Physical Function
  • http//www.sts.org/doc/3705 - 4

12
Valve
  • Anticoagulant Medication
  • Low Resistance Training
  • Aortic Semilunar Valve, Bicuspid Valve
  • Mechanical Valves, Pig Valves, and Cow Valves
  • Coumadin Management
  • http//health.allrefer.com/health/heart-valve-surg
    ery-heart-valves-anterior-view.html

13
MIDCAB
  • Avoidance of Sternotomy
  • IMA Radial Artery
  • Quicker Recovery
  • http//www.heartsurgery-usa.com/What_s_New/MIDCAB/
    body_midcab.html

14
PTCA/Stent
  • Secondary Prevention
  • Revascularization
  • Plavix Blood Thinners
  • Perclose
  • Coated Stents
  • Brachytherapy
  • Re-Stenosis Rates
  • http//www.heartsite.com/html/ptca.html

15
Atrial/Ventricular Arrhythmias,Pacemakers,
AICDs
  • Safety
  • Symptoms
  • Exercise Tolerance
  • http//www.heartpoint.com/pacemakers.html

16
Atrial Fibrillation
  • Uncontrolled Contraindication
  • Coumadin Diet Bleeding
  • Digitalis Can cause ST depression
  • Use wider range for Target Heart Rate
  • Low Level Therapy Initially
  • Reduce Caffeine intake nicotine
  • http//www.aboutatrialfibrillation.com/

17
Pacemakers AICDs
  • No lifting over 10 lbs.
  • Avoid Contact Activity
  • Clean Incisions
  • Fever?
  • Drainage
  • ID Card
  • Maintain MD appointments
  • Avoid Strong Magnetic Fields (MRI devices,
    Welders, Airports)
  • Cough CPR
  • Inform Dentists
  • AICDs Shock can be felt
  • TTR 10-15 below Shock Rate

18
Congestive Heart Failure
  • Poor Exercise Tolerance
  • Volume Overload
  • 1 admission for pts over 65
  • Sodium Restriction
  • Daily Weighing
  • Medication Use
  • Exertional Hypotension
  • Increased LV Pressures

19
LVAD
  • End Stage CHF
  • Transplants
  • http//www.chfpatients.com/implants/lvads.htm

20
Transplant Patients
  • 3,000 per year
  • Immunosuppressants
  • RHR 95-115
  • EKG May have 2 distinct P Waves
  • RPB typically Higher
  • VO2 increase 25 - 2-6 months
  • Increased HR
  • Increased Exercise Endurance
  • Increased Symptoms
  • Increased peak BP

21
Diabetics
  • Type I Type II
  • Normalization of BS Levels
  • Minimize Diabetic Complications
  • Management of Weight

22
COPD
  • Smoking
  • Medication Use
  • O2
  • Rest Periods
  • Pursed Lip Breathing
  • Disease Management

23
Peripheral Arterial Disease - PVD
  • Intermittent Claudication
  • Rest Periods
  • Peripheral Pulses ( Doppler studies Peripheral
    Pulses )
  • Smoking Cessation
  • Skin Foot Assessment
  • Entry Level 50 Functional Capacity

24
Heart Anatomy
  • http//www.gwc.maricopa.edu/class/bio202/cyberhear
    t/hartint0.htm
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