Following a treadmill test and cardiac catheterization, the client is found to have coronary artery disease, which is inoperative. He is referred to the cardiac rehabilitation unit. During his first visit to the unit he says that he doesn’t understand why he needs to be there because there is nothing that can be done to make him better. The best nursing response is:
A. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
B. “Here we teach you to gradually change your lifestyle to accommodate your heart disease.”
C. “You are probably right but we can gradually increase your activities so that you can live a more active life.”
D. “Do you feel that you will have to make some changes in your life now?”
Correct Answer: A. “Cardiac rehabilitation is not a cure but can help restore you to many of your former activities.”
Such a response does not have false hope to the client but is positive and realistic. The answer tells the client what cardiac rehabilitation is and does not dwell on his negativity about it. Cardiac rehabilitation programs aim to limit the psychological and physiological stresses associated with cardiovascular disease, reduce the risk of associated mortality, and improve cardiovascular function to help patients optimize their quality of life.
Option B: Cardiovascular disease (CVD) is one of the leading causes of death worldwide and the leading cause of death in the United States. Cardiac rehabilitation is customized to individual patients. Candidates for cardiac rehabilitation include patients with cardiovascular diseases such as ischemic heart disease, heart failure, or myocardial infarctions, or patients who have undergone cardiovascular interventions such as coronary angioplasty or coronary artery bypass grafting.
Option C: Cardiac rehabilitation can reduce smoking, body weight, serum lipids, and blood pressure. Milani et al. found that cardiac rehabilitation decreased depression in heart disease patients who suffered a major coronary event. A Cochrane review noted that cardiac rehabilitation reduced hospital admissions and showed a long-term decrease in all-cause mortality in heart failure patients with preserved ejection fraction.
Option D: Accomplishing these goals is the result of improving overall cardiac function and capacity, halting or reversing the progression of atherosclerotic disease, and increasing the patient’s self-confidence through gradual conditioning. Overall cardiac rehabilitation increases the quality of life and decreases health care costs. Cardiac rehabilitation has many physiologic benefits due to its exercise component. Exercise training has been shown to increase maximal oxygen uptake (VO2max), improve endothelial function, and improve myocardial reserve flow.
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