cardiac and pulmonary rehabilitation

Question 1

Symptoms of the COPD

Answer 1

symptoms of COPD- SOB, SOBOE, cough- productive and non- productive, depression and fatigue

Question 2

negative cycle of inactivity

Answer 2

increased breathlessness and fatigue= reduced activity= reconditioning= anxiety/fear= avoidance of activity

Question 3

what is pulmonary rehabilitation

Answer 3

is an evidence based, multidisciplinary and comprehensive intervention for patients with chronic respiratory disease who are symptomatic and often have decreased daily function.

Question 4

what is pulmonary rehabilitation designed to do

Answer 4

reduce symptoms, optimise functional status, increased participation and reduce health care cost. advice for any COPD patient who has some form of functional disability, evidence based treatment for patients with COPD, combines exercise and education

Question 5

stages and content of pulmonary rehabilitation

Answer 5

selection, assessment, rehabilitation, re-assessment, maintenance
content- exercise education, disease education, psychological and social support

Question 6

evidence for pulmonary rehabilitation

Answer 6

improves dyspnoea/ fatigue/ depression/ self management, reduced hospital admissions, reduce mortality, highly cost effective, reduce number of home visits, cost saving, reduce readmissions, functional and maximal exercise capacity

Question 7

why do you exercise

Answer 7

increase exercise tolerance, improve muscle strength, reduces breathlessness and fatigue, benefits on QOL, other general benefits- cardiovascular, cholesterol and diabetes

Question 8

positive cycle of activity

Answer 8

mobility and strength, reconditioning, reduced breathlessness and fatigue, increased confidence and motivation, increased activity

Question 9

patient selection for pulmonary rehab

Answer 9

majority of COPD but will be extended to all patients with dyspnoea from respiratory disease in some areas, disabled by COPD no selection based on age, impairment, disability or smoking status, consider significant co-morbilities

Question 10

things to consider with patient selection

Answer 10

poor motivation, and logistical factors such as geography, transport, equipment usage and the group composition

Question 11

medical research council dyspnoea scale (MRC)

Answer 11

1- only get short of breath with strenuous exercise
2- get SOB when hurting on the level or walking up slight hill
3- I walk slower than people of the same age because of breathlessness or I have to stop when walking at my own pace on the level
4- have to stop for break after 100m walk
5- I am to breathless to leave house, or I am breathless when dressing or undressing

Question 12

exercise criteria

Answer 12

unstable angina/ diabetes, acute LVF, uncontrolled BP, uncontrolled arrhythmias, history of MI in last 6 weeks, mobility limited by MSK or neurological condition, cognitive problems, compliance issues, aortic aneurysm

Question 13

structure of programme

Answer 13

minimum of twice a week supervised, 6-12 weeks in length depending on where you live, rolling or cohort programme, include progressive muscle resistance training and aerobic training, should be offered within a month post discharge from hospital if relevant

Question 14

exercise in pulmonary rehab- main points

Answer 14

individualised, optimise medical management, doesn’t influence lung function- doesn’t reverse disease or improve function- feel less breathless, reconditions, psychosocial impact

Question 15

exercise in pulmonary rehabilitation

Answer 15

warm up, waking programme, aerobic programme, strength training programme, cool down

Question 16

exercise prescription

Answer 16

intensity borg scale (working in 4-5 reigion), RPE (13-16)

duration, frequency, specify, type interval or continuous, mode (walking cycling), progression- home programme

Question 17

measurement and prescription

Answer 17

measure saturations and HR as needed- tends to be for patients who may be desaturated on exercise

Question 18

assessment in pulmonary rehabilitation

Answer 18

generic measures- SF-36, hospital anxiety and depression scale, Nottingham extended activities of daily living, disease specific/ hearth status, 6 min walk test, incremental shuttle walk test, endurance shuttle walk test

Question 19

disease specific/ health status

Answer 19

CRQ-SR, SGRQ- 50 questions to measure health status and WOL, BPQ- breathing problem, GAD- anxiety, LINQ- lung inflammation

Question 20

incremental shuttle walk test

Answer 20

10M course marked by cones, audio signal sets the pace, pace increases each minute, end test when fails to make the cones, result expressed in meters, measure of HR, symptoms, Saturation

Question 21

topics covered In education

Answer 21

what’s happening inside my lungs? my lung condition, chest clearance, coping with breathlessness, medication in COPD- nurse specialists, diet, anxiety management and relaxation, energy conservation

Question 22

what is cardiac rehabilitation

Answer 22

the sum activities required to indolence favourably the underling cause of heart disease, as well as physical, mental and social conditions. maximise function and QOL. difference is patients often use reporting systems whilst exercising- pulse oximeters, ECGs

Question 23

aims of cardiac rehabilitation

Answer 23

reduce individuals risk of subsequent cardiac problems- relieve symptoms and reduce risk factors
promote the individuals return to a full and normal life- increase knowledge and understanding and enhance QOL

Question 24

concerns raised by patients

Answer 24

lifestyle changes, fear of dying, stress and anxiety, fear of over exertion, fears of intimacy, depression, anger

Question 25

exercises in CR- main points

Answer 25

a phased process, varies according to phase, still individualised but less than PR, reconditioning, cardiovascular disease, decrease risk factor

Question 26

measurements cardiac rehab

Answer 26

pulse rate, exercise tolerance- treatment test- picks up angina, increased BP problems, bruce protocool- exercise test looks at maximum exercise test