Planned Interventions

Transcription

1 Risk Factors Exercise Diabetes Hypertension Tobacco Use Initial Status Patient is currently exercising: More than 150 minutes Less than 150 minutes Per Week Type 1 Type 2 Borderline Diabetic :HgA1c < 6.5%; FBG < 120 : HgA1c= %; FBG= : HgA1c > 8.0%; FBG > 180 : Systolic<120;Diastolic <80 : Systolic = Diastolic = : Systolic>140;Diastolic> 90 Never Used tobacco Former; Quit Recently Quit Currently using tobacco Patient Goals / Educational Needs Pt will: Develop tolerance of >150 min/week at RPE rating of in wks Self monitor independent exercise in wks Consistently monitor blood glucose levels and report abnormalities to doctor in weeks Maintain fasting blood sugar levels < 120 in 8-12 weeks Maintain resting BP < 120/80 in 8-12 weeks Understand low risk blood pressure goals in 4 wks Demonstrate / verbalize understanding of daily sodium intake of 2,000 3,000 mg in 8-12 weeks Maintain complete Adhere to prescribed pharmacotherapy Quit Planned Interventions Cardiac Rehab Staff will: Provide and instruct patient in home exercise program Educate patient, spouse or family friend or care giver on benefits of exercise in disease reduction Assist in home exercise plans Educate patient to recognize S/Sx s hypo / hyperglycemia Discuss importance of diabetic diet compliance Discuss importance of exercise to manage diabetes Initial referral to Diabetes Management program as staff / patient agree upon Educate patient and family on recommended sodium intake Educate patient and family on how stress affects BP Report consistently abnormal blood pressure reading to referring physician Refer to primary physician for pharmacotherapy prescription Refer patient to American Cancer Society counseling minutes/week METs Home Exercise: Patient is not diabetic FBG = mg/dl Does not monitor RHR = Maintained Considering tobacco Currently using tobacco minutes/week METs Home Exercise: Patient is not diabetic FBG = mg/dl Does not monitor RHR = Maintained Considering tobacco Currently using tobacco minutes/week METs Exercise Plan at DC: Patient is not diabetic FBG = mg/dl Does not monitor RHR = Maintained Considering tobacco Currently using tobacco Page 1 of 6

2 Risk Factors Dyslipidemia Weight Management Psychosocial Concerns Initial Status ne on file : LDL<100; TC/HDL Ratio<5.0; Trig<100 : LDL= ; TC/HDL Ratio= ; Trig= : LDL > 130; TC/HDL > 6.0; Trig >150 Underweight = BMI < 20 Healthy Weight = BMI Over weight (BMI = 25-30) Obese (BMI >30) Initial Weight = # Waist to Hip Ratio = Stress per patient report: Low Moderate High QOL Index Score: CES-D Score: Patient Goals / Educational Needs Pt will: Verbalize knowledge of blood lipid definition and knowledge of normal guidelines in 4-8 weeks Maintain blood lipids within normal limits in 12 weeks Reduce weight by pounds in weeks Maintain weight Reduce stress though coping skills Educate on S/Sx s of depression Comply with prescribed medication regimen to manage symptoms Planned Interventions Cardiac Rehab Staff will: Educate patient and family on reading food labels for fat and sodium Issue and review low fat diet material Recommend patient attend dietary class with dietician Advise patient on heart healthy recommendations based on results of nutrition assessment Review / Discuss findings from nutrition assessment and set specific weight loss goals Provide patient and/or family member with educational handouts Educate patient on coping skills and techniques Assist / Encourage action plan to minimize stressors effects Refer patient to primary physician for counseling referral new results on file Weight lbs Change Increased by # Decreased by # Stress: Low Mod High new results on file Weight lbs Change Increased by # Decreased by # Stress: Low Mod High new results on file Weight lbs Change Increased by # Decreased by # Waist = Hip = WH Ratio = Stress: Low Mod High Quality of Life Score: CES-Depression Score: Page 2 of 6

3 Initial Risk Stratification Fall Risk ne Fall Risk Assistive Device Used: ne Fall Risk Assistive Device ne Fall Risk Assistive Device ne Fall Risk Assistive Device Incisions Patient Centered Goals ne Approximating / Healing Early signs of infection Open/Draining Sites Examined: Sternum Left Leg Right Leg Left Arm Right Arm Drain Sites Comments _ ne Approximating / Healing Early signs of infection Open/Draining Comments ne Approximating / Healing Early signs of infection Open/Draining Comments ne Approximating / Healing Early signs of infection Open/Draining Comments Subjective Info from Patient Diagnosis: 2Assessment / Clinical Impression: Planning: Maintenance Program Fitness Program Home Program Other Rehabilitation potential to reach above goals is: Excellent Good Fair Poor Beneficial factors affecting rehabilitation potential Limiting factors affecting rehabilitation potential Page 3 of 6

4 Initial Exercise Prescription Modes: Treadmill (TM), Lap Walking (Laps), Stationary Bike (SB), Recumbent Bike (RB), Arm Ergometer (AE), NuStep (NS), Elliptical Trainer (ET), Stair Climber (SC), Other 2-3 days per week for weeks Duration: - minutes Intensity: Resting Heart Rate plus % - 70% Age Predicted Maximum HR RPE not to exceed 14 Progress duration to minutes cardiovascular exercise Progress intensity to maintain RPE Modify intensity to maintain Target Heart Rate as listed above Mode: TM Laps AE FW SB RB NS ET SC days / week Duration: min Intensity: HR = - RPE = Maintain RPE 1-3 sets; 8-15 reps Mode: TM Laps AE FW SB RB NS ET SC days / week Duration: min Intensity: HR = - RPE = Maintain RPE 1-3 sets; 8-15 reps Mode: TM Laps AE FW SB RB NS ET SC days / week Duration: min Intensity: HR = - RPE = Maintain RPE 1-3 sets; 8-15 reps 1-3 sets; 8-15 reps as tolerated restrictions to weight lifting; may begin anytime For PTCA: Begin 2 weeks post intervention Begin at 6 weeks post event / surgery Begin weight training after physician release on _ Angina w/ex: EKG: Resting HR Range: to bpm Angina w/ex: EKG: Resting HR Range: to bpm Angina w/ex: EKG: Resting HR Range: to bpm Compliance: Attended of visits Compliance: Attended of visits Compliance: Attended of visits Page 4 of 6

5 Initial Rehab Plans Participate in Cardiac Rehab program 2-3 times per week for weeks Patient/Family have been given the opportunity to participate in goal setting and agree with this Treatment Plan. Staff Comments: Continue for 4 weeks DC to home program Follow up with MD Comments: Continue for 4 weeks DC to home program Follow up with MD Comments: Continue for 4 weeks DC to home program Follow up with MD Comments: Cardiac Rehab Staff Signature ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Physician Comments: I certify the need for these services furnished under this plan of treatment and while under my care. Staff Signature Date ~~~~~~~~~~~~~~~~~~ I have met face to face with the patient to review progress I agree with above recommendations I advise Staff Signature Date ~~~~~~~~~~~~~~~~~~ I have met face to face with the patient to review progress I agree with above recommendations I advise Staff Signature Date ~~~~~~~~~~~~~~~~~~ I have met face to face with the patient to review progress I agree with above recommendations I advise PHYSICIAN SIGNATURE Date: CR Supervising Physician Signature Date CR Supervising Physician Signature Date CR Supervising Physician Signature Date Page 5 of 6

6 Learning Style: (circle those that apply) Listening Reading Pictures Demonstration Reading Lips Other Educational Level: Highest Grade Completed: Desire / Motivation to learn: (circle one) Good Fair Poor Unable to Determine Patient/Family barriers to learning: (circle those that apply) Accommodations to Barriers: reading language visual cultural religious hearing physical emotional financial cognitive Language Spoken (circle all that apply): English Spanish ne Other Other Language Read (circle all that apply): English Spanish ne Key: I=instructions given; H=handouts issued; F=family included; N=needs re-enforcement D= demonstrates understanding Illness anatomy Precautions / prevention Risk factor modification Low Cholesterol Diet Cholesterol Management Edema control Sodium Intake Blood Pressure Management Diabetes Management Weight Management Smoking Cessaion Posture/body mech Home Exercise Program Exercise Principles Weight Training Strategies Controlled Breathing Community resources Date: Education Plan Educator Initials: Educator Signature: Educator Signature: Educator Signature: Initials: Initials: Initials: Cardiac Rehab Patient Education Flow Sheet Page 1 of 1