Exercise Prescription and Rehabilitation Considerations for Older Adults: Summary 82
AEROBIC CAPACITY CASE STUDY NOTE: please refer to video presentation for additional discussion and insight to case study
Patient is a 76-year-old male who developed chest pain when performing lifting activities while doing yard work. Went to the nearest hospital and was given nitroglycerin for the chest pain. Diagnosed with acute myocardial infarction and transferred to the nearest cardiac surgical center. Cardiac catheterization revealed 80% stenosis in the midportion of the L anterior descending artery, 90% stenosis in the circumflex artery and 100% occlusion in the 2nd diagonal and R coronary artery. • Patient had CABG x 4 emergently using the L mammary artery and L saphenous vein as conduit vessels. Surgical approach was a median sternotomy. Hospital discharge occurred 6 days post surgery. • The patient was referred to outpatient rehabilitation.
• Physical therapy evaluation was 2 days post hospital discharge. • PMH: R shoulder fracture, HTN, and type 2 DM (no major surgeries).
Medications: • Aspirin • Atorvastatin (Lipitor) • Lansoprazole (Prevacid) • Ferrous sulfate • Amlodipine besylate (Norvasc) • Insulin • Albuterol inhaler • Hydrocodone/acetaminophen (Lortab) • Furosemide (Lasix) Subjective: • The patient lives in a rural area with his wife in a 2-story house. • He quit smoking 10 years ago, did not have a lot of exercise in his lifestyle, and enjoyed a lot of red meat. • Family history is unremarkable for cardiovascular or other chronic diseases. • He works on a cattle farm where he lifts bales of hay up to 70 pounds. • His goal is to return to his previous lifestyle including working on the farm. • At his physical therapy evaluation (2 days after hospital discharge) he needed assistance with getting out of the chair, walking, and reported he could not complete any work activities. • His symptoms at that time were: chest pain, dyspnea, severe fatigue and swelling in his hand and feet. Discussion:
1. What would you include in a systems review? 2. What is your interpretation of the vital signs? Vital Signs
Heart Rate Blood Pressure O2 Stats
Resting in chair
70 93 92 74
138/76
97% 94% 90% 97%
Walking after 3 minutes Walking after 6 minutes Recovery after 5 minutes
Not taken
147/54 136/56
○ What is your assessment of this patient? ■ Edema? ■ Risk factors? ■ Current knowledge of exercise importance? ■ Aerobic capacity? ○ Why does this patient have aerobic impairment?
○ What is the patient’s prognosis? ○ What should plan of care include?
Powered by FlippingBook