Case 2 - Gordon - COPD

Question 1

What is emphysema?

Answer 1

Emphysema damages the walls of the air sacs, causing them to break and form larger air pockets. This traps stale air in the damaged tissue, making it harder for the body to get oxygen

Question 2

Types of COPD

Answer 2

Chronic bronchitis and emphysema, some people also class asthma.

Question 3

What might you hear on auscultation?

Answer 3

Course crackles (both phases respiration), reduced breath sounds, possible wheeze (both phases).

Question 4

Pulmonary rehab warm-up

Answer 4

Neck rotations, neck side flexion, shoulder rotations, Chest stretch, trunk rotations, trunk side bends, marching on spot, knee extensions, heel raises, walking.

Question 5

Pulmonary rehab conditioning

Answer 5

Half squat, standing press up, knee lifts, shoulder press, hip abduction, upright row, knee extension, bicep curls, step-ups

Question 6

Pulmonary rehab cool down

Answer 6

Thigh stretch, calf stretch, trunk tilts, hamstring stretch, chest stretch, triceps stretch, walking (slow)

Question 7

Pulmonary rehab resistance prescription

Answer 7

40-50% 1RM, 1-4 sets, 10-15 reps, 2-3 mins rest.

Question 8

Pulmonary rehab endurance prescription

Answer 8

30-40% peak work rate, 20-60 minutes.

Question 9

Pulmonary rehab precautions

Answer 9

Unstable cardiac disease, locomotor issues, difficulty following instructions/psychiatric difficulties.

Question 10

What does pulmonary rehab do?

Answer 10

Wasserman’s gears diagram: muscle work increases cardiac output, redistributes blood flow, and increases ventilation. The capacity to maintain muscle contraction is determined by the effectiveness of these mechanisms. Pulmonary rehab acts on muscle and circulation.

Question 11

What does ‘blow as you go’ techniques do?

Answer 11

Exhaling during exertion reduces intrathoracic pressure and allows the airways to stay open for longer, aiding gas exchange by increasing oxygenation and blowing off CO2 build up.

Question 12

What does pursed-lip breathing do?

Answer 12

Creates positive back pressure to open airway, allowing more air to enter/leave the lungs, more gas exchange to occur by keeping airways open longer, decreases breathing frequency, increases tidal volume and gives an improved sense of control for breathing and oxygenation.

Question 13

CXR step-by-step (A-I)

Answer 13

A = airways
B = bone
C = cardiac
D = diaphragm
E&F = fields and fissures
G = gastric bubble
H = hilum and mediastinum
I = Impression

Question 14

Too white on CXR?

Answer 14

Collapse, atelectasis, consolidations, pleural effusion, pulmonary oedema

Question 15

Too black on CXR?

Answer 15

Pneumothorax, COPD

Question 16

How do you check exposure on CXR?

Answer 16

Look through top part of the heart, can I see the vertebral bodies, if you can just about that is ok.

Question 17

How to check position of Pt on CXR?

Answer 17

Distance from clavicles to vertebral body + shoulder be equal

Question 18

What would emphysema look like on a CXR?

Answer 18

Hyperinflation, flattened diaphragm, bullae (pockets of air).

Question 19

Energy conservation, what does it do?

Answer 19

Education on energy conservation techniques can reduce O2 utilization when performing an activity to prevent SOB + minimize muscle fatigue.

Question 20

Physiology of Wasserman’s gears diagram

Answer 20

• Oxygen flow: oxygen flows from the atmosphere through the lungs, then to the muscles through the circulatory system.
• Carbon dioxide flow: carbon dioxide produced by the muscles flows in the opposite direction, along the same pathway as the oxygen.
• Increased cardiac output: muscle work increases cardiac output and redistributes blood flow.
• Increased ventilation: increased metabolism and the production of carbon dioxide in the blood lead to increased ventilation.