1、.1.2.3.4.5.6.7.8.9.10.11PharmacistNurseConsultantGPDieticianExercise instructorSmoking cessation advisorPsychologistDistrict NursesPractice nursesHealth VisitorSecondary care.12.13.14.15.16.17.18DiagnosisFunctional CapacityQOLMorbidityMortalityAMI+CABG+Stable angina+PCI+?CHF+Cardiac Transplant+?Valv
2、e replacement+?.19FunctionTimeNo rehabilitationHospital admissionPost RecoveryABRehabilitationThreshold of Independence.20.21.22“Function”“Strength”PoorNormalLowHighHealthyAdultsFrailAdultsNearFrailTHRESHOLDEstablished Populations for Epidemiologic Studies of the Elderly(EPESE).J Gerontology,1994;49
3、(3):M109-15y,1994;49(3):M109-15.23.24.25.26Challenges for the Pt and FamilyFrightening,life threatening event(MI,major surgery)A chronic illness,reduced life expectancy,symptomsAltered identity-an invalid,walking time bombFears for family and partner being left aloneThreat to employment and financia
4、l statusMedication side effects(lethargy,impotence)Being treated differently by other peopleNeurological impairement(esp.cardiac arrest pats.)Making lifestyle changes,smoking,diet,activity.27.28.29.30.31.32.33.34.35.36.37.38.39.40Evaluation.41.42.43.44.45.46.47.48.49.50.51.52.53.54.55.56.57.58.59.60.61.62.63.64.65.66.67.68.69.70.71.72.73Stage Speed GradeTimeMETsOne1.7mph0%3 min2.3Two1.7mph5%3 min3.5Three1.7mph10%3 min4.6Four2.5mph12%3 min6.8.74.75.76.77.78.79.80.81.82.83.84.85Nutritional Counseling.86.87.88.89.90.91.92.93.94.95Weight Management.96.97.98.99.100.101.102