Page 874 - Cardiac Nursing

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850 PA R T V / Health Promotion and Disease Prevention

DISPLAY 37-7 Energy Cost in Mets (Metabolic Equivalents) of Activities

Very Light Activity Moderate to Heavy Activity
1 MET 6 METs
Resting Shoveling snow
Eating Digging
Writing Sawing wood
Hand sewing or knitting Tennis
Skiing
2 METs Walking briskly on level, 5 mph
Light calisthenics (e.g., stretching)
Driving (can be higher under stressful conditions) 7 METs
Light household activities (cooking, ironing) Jogging, moderate pace
Walking, 2.2 mph Carrying boxes
Skiing, general
3 METs Ice skating
Self-care (washing, dressing)
Walking, 3.0 mph 8 METs
Moderate household activities (e.g., sweeping, mopping, Cycling, 13 mph
cleaning) Swimming, 40 yd/min
Level ski touring, 4 mph
Light Activity Walking upstairs, briskly
4 METs Very Heavy Activity
Gardening (seeding)
Ballroom dancing 10 METs
Canoeing, golf (without cart) Swimming (crawl, 55 yd/min)
Cycle uphill
5 METs
Mowing lawn, power mower
Washing car
Heavy carpentry (scraping, painting—outdoors)

activities in METs should be explained to the patient (Display Medications that may have an effect on HR or blood pressure
37-7) and appropriate household or recreational activities should should be discussed with the patient (i.e., -blockers, calcium
be recommended accordingly. Patients should also be taught how channel blockers). Patients also should be reminded when and how
to take their HR and how to use the rating of perceived exertion to take nitroglycerin and when to call for medical assistance. Inpa-
(RPE) scale. This scale is useful because it is highly correlated with tients’ retention of information is low; therefore, it is important to
HR and, when given a range of RPE, the patient can then objec- repeat certain guidelines several times and also to provide written
tively judge his or her level of exercise exertion (Table 37-4). information. Patients should have a written walking or cycling pro-
gram that includes mode, frequency, and duration of exercise. A
copy of warm-up and cool-down exercises, preferably the same ones
they were taught as an inpatient, can be helpful. A target HR should
Table 37-4 ■ 6 TO 20 AND 0 TO 10 BORG’S PERCEIVED be provided (usually 20 beats/min above the standing resting HR
EXERTION SCALES for the initial phase after discharge); and an RPE scale should be
provided, noting the appropriate intensity when exercising (10 to
Original Scale Revised Scale
12 is appropriate at the beginning). A chart to record HR, RPE, and
6 0 Nothing symptoms can also be useful to track patients’ adherence to the ex-
7 Very, very light 0.5 Very, very weak ercise prescription and to help determine appropriate progression.
8 1 Very weak It is important that patients are familiar with precautions about ex-
9 Very light 2 Weak
10 3 Moderate ercise (Display 37-8). At the time of discharge, some method of
11 Fairly light 4 Somewhat strong contacting the patient for outpatient cardiac rehabilitation follow-
12 5 Strong up should be established, and appointments should be made for
13 Somewhat hard 6 outpatient cardiac rehabilitation within 1 to 3 weeks after discharge.
14 7 Very Strong
15 Hard 8 Initiation of Inpatient Activity
16 9
17 Very Hard 10 Very, very strong Once the medical evaluation has been performed and the patient’s
18 Maximal clinical condition has been stabilized, inpatient activity can be ini-
19 Very, very hard tiated. The objectives for inpatient activity include the following:
20
■ To educate the patient and family about the particular cardiac
event and diagnostic tests and to prepare them for the stages of
From Borg, G. A. V. (1999). Borg’s perceived exertion and pain scales. Champaign, IL:
Human Kinetics. cardiac rehabilitation and returning to life at home