Alison Lovkay

Background

I knew little about cardiac rehab until I took kinesiology 325 during my junior year at URI. I joined the kinesiology program in hope to become a Physical Therapist. I realized it wasn’t for me but soon after discovered that the Physician Assistant career was perfect. I have worked on an ambulance on campus for a year and found that the calls that intrigued and challenged me the most were the cardiac calls. In kinesiology 325 we learned about exercise prescription and the risk factors for patients who have cardiac disorders but need exercise to get better. I found this to be very interesting and wanted to learn more about it. When searching for a site for my internship, I knew I wanted to be a part of cardiac rehabilitation. When I went for an interview at The Center of Cardiac Fitness at Miriam Hospital, I knew that this facility would be a great fit for me. A big part of getting into PA school is getting direct patient care experience and I thought this would be a great way to work with patients in a different environment than what I am used to. From someone who has seen patients during their cardiac event, I was interested in seeing what happens after. I knew that this internship would give me the knowledge, experience and professionalism that I needed to gain before pursuing the rest of my healthcare career. 

Internship Details

• Internship Hours: 32 hours/week

  Internship Placement: Miriam Hospital Center for Cardiac Fitness

  Internship Supervisor: Adam Mancini

  Internship Job Title: Cardiac Rehab Intern 

   

• Duties:

• Take blood pressures, oxygen saturation, RPE and pulse rate before and during exercise.

• Learn how to set patients up on telemetry and to teach them how to prep the electrodes themselves

• Explain to patients how to safely set up and use each set of equipment. Explain to them how to change the speed, load, time, and seat.

• Guide the patients with relaxation/stretching exercise after their class.

• Understand risk factors for each individual patient and how these considerations determine the exercise prescription

• Understand how to progress a patient’s exercise based on THR, RPE and BP

• Understand a healthy diet and how to pass that onto the patients

• Observe intakes to eventually do them on my own. This includes completing the blank forms, taking blood pressures, pulse and weight, learning about past medical histories, determining goals for each patient and giving a tour of the facility.

• Observe and learn how to perform an entrance/exit stress test.

• Set up 12 lead EKG’s

• Learn the contraindications, endpoints, protocol and special considerations for each patient during their stress test

• Learn how to evaluate a 12 lead EKG  

 

Evaluation:

 

Every week, I will be having meetings with my internship supervisors. These are the topics we will be going over:

• Evaluating a Stress Test

• Establishing THR

• Risk Stratification

• Exercise Prescription: Initiating and Progressing

• Basic Telemetry

• Medications

• Questions to ask if abnormal BP or HR

• Questions to ask if symptoms

• Basic Blood Glucose

• Basic diet

 

 

Personal Objectives

1. Learn how to administer and evaluate a 12 lead EKG stress test; learn the contraindications, special considerations and what constitutes an endpoint.

Activities and Resources:

• Observe stress tests for entrance, exits and weight management.

• Learn the anatomical landmarks for each electrode with extremities and without extremities.

• Observe the different protocols that patient with special considerations need. Note different reasons why a stress test is terminated.

• Work with the nurse administering the test to better understand how to evaluate the EKG for any abnormalities.

Evidence:

• View my page on stress tests!

 

2. Understand how to set up and individualize each patient’s exercise program by using past medical history and risk stratification and eventually be able to progress a patient through their program.

• Work with the exercise physiologists to understand each patient’s past medical history.

• Observe patients and any challenges they have with different modes of exercise.

• Work with the patients to use their RPE to understand if they can progress to a greater challenge, while being in their THR.

• Use textbooks to better understand what constitutes an exercise prescription as well as the risk factors that these patients have.

Evidence:

• View my page on exercise prescription!

• View my page on Patient A

 

3. Be familiar with the different types of cardiopulmonary diseases, including the onset, diagnosis, symptoms, treatment and challenges of each as well as learn different types of cardiac medications. Understand how exercise is a beneficial part of the treatment plan.

Activities and Resources:

• Use textbooks, lectures and articles to learn the pathology of each disease.

• Observe a PA, open heart surgery and catheter lab

• Talk to patient’s about their stories and observe the specific challenges that they each face on a day to day basis

• Follow patients through their program and watch the transformation they have with their goals and expectations.

Evidence:

• View my page on cardiopulmonary diseases!

 

4. Understand the pathology, prevention, and management that goes along with diabetes as well as the effect it has on cardiopulmonary diseases.

Activities and Resources:

• Attend a 2 hour class every Thursday for 6 weeks, along with diabetes patients, to learn about the different aspects of the disease

• Work with the Dietician, Registered Nurse and Exercise Physiologist to learn about the prevention and management of diabetes

• Use textbooks to learn the pathology, anatomy and physiology.

• Communicate with patients to better recognize the challenges that they have with diabetes, emotionally and physically.

Evidence:

• View my page on Diabetes!

 

 

5. Be able to evaluate the different rhythms of a 3 lead and 12 lead EKG.

Activities and Resources:

• Practice looking at different monitors with the Nurses and Exercise Physiologists

• Use lectures and textbooks to understand the anatomy/physiology/function of the heart.

• Use textbooks to learn what a normal sinus rhythm looks like and go from their to be able to point out abnormalities.

Evidence:

• View my page on EKG's