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HPW > Ch 18 F&D - Primary Prevention, Risk Reduction, Deconditioning > Flashcards

Ch 18 F&D - Primary Prevention, Risk Reduction, Deconditioning Flashcards

1
Q

prehabilitation

A

exercise dose that will maintain the patient’s conditioning level and prevent deterioration

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2
Q

prehabilitation parameters

A
  • intensity more important than frequency (better to complete high intensity exercise less frequently than low intensity exercise more often/frequently)
  • quality over quantity
  • more research for exercise prescription to prevent negative side effects of recumbency/bed rest
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3
Q

appropriate dosing needed to prevent “life-style related conditions” has not been determined with exception of:

A

ischemic heart disease can be prevented & “optimal” cardiovascular health can be achieved through moderate volume of regular physical activity at an intensity of 6 METs

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4
Q

what best represents the human condition

A

upright and mobile

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5
Q

what is the difference btw bed rest and deconditioning

A

deconditioning = cumulative affect; result of a person being sedentary and having restricted mobility (can be secondary to bedrest)

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6
Q

bedrest definition

A

physician written order that says they cannot get out of bed

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7
Q

physiological effects of bed rest

A
  • CV and pulmonary deterioration occurs more quickly than MS deterioration
  • Takes longer to recover from effects of bedrest than for the impairments of bedrest originally occur
  • worse in older adults than younger adults
  • active older adult has better physiological reserve to accommodate for illness/bedrest
  • Restricted mobility is associated with clinical depression
  • Additional considerations in Table 18-2 (p. 252)
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8
Q

mobilization and exercise ENHANCE mucociliary transport and airway clearance resulting in:

A

improved pulmonary function (top of hierarchy)

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9
Q

changes in body position assist in airway clearance to minimize pooling and stagnation of bronchial secretions resulting in:

A

decreased risk of atelectasis

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10
Q

effects of bedrest on the CV system

A
  • Loss of fluid-volume and pressure regulating mechanism
  • Decrease in plasma volume
  • Diuresis
  • Increased hematocrit
  • Increased risk for deep vein thrombosis (DVT) – this is PREVENTABLE!
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11
Q

effects of bedrest on the pulmonary system

A
  • *Increased work of breathing; secondary effect of decrease lung volumes:
  • dec. Functional Residual Capacity (worse in supine; improved in sitting)
  • dec. Residual Volume
  • dec. Forced Expiratory Volume
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12
Q

effects of bedrest on the MS system

A
  • Muscle Atrophy leading to weakness, dec coordination, impaired balance
  • Excessive strain on ligaments and joints (when they start to move again) leading to joint contracture
  • Disuse osteoporosis (once bone loss occurs it is irreversible, so inc fx risk)
  • Limited alternatives to lying in bed result in poor postural alignment, stiffness, soreness
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13
Q

effects of bed rest of other systems

A
  • Orthostatic hypotension
  • Inc risk for skin lesions and decubitus ulcers
  • Inc renal load leading to dysrhythmia, muscle wasting, weakness, neuropathy, glucose intolerance, and reduced bone density
  • dec activity of the sympathetic nervous system
  • dec electrical activity in brain
  • Emotional/behavioral changes
  • dec reaction times
  • sleep disturbance
  • impaired psychomotor performance
  • dec insulin sensitivity
  • dec lymphatic flow and impaired immune system response
  • depression
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14
Q

alternatives to bedrest

A
  • creatively-designed furniture that supports normal physiological functioning. (i.e. stretcher chair, kinetic bed)
  • Avoid passive positioning whenever possible!
  • Active standing > passive standing
  • Upright sitting > passive standing
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15
Q

indications for bedrest

A
  • Minimize effects of gravity to promote healing following trauma or orthopedic surgery
  • Minimize the effects of edema; can be achieved more specifically though
  • *Mobilizing patients and permitting bathroom privileges has been reported to be less stressful than having to use a bedpan
  • *disadvantages are better documented than benefits
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16
Q

acute effects of mobilization and exercise on cardiopulmonary system

A
  • *increased airway diameter in addition to the following increases:
  • Minute alveolar ventilation
  • Alveolar ventilation
  • Tidal Volume
  • Respiratory Rate
  • Air flow rates
  • Cardiac Output
  • Stroke volume
  • Heart rate
  • Blood pressure
  • Rate pressure product (HR + Systolic BP)
    • hemodynamic benefits are greater in an upright position
17
Q

For those with impaired venous return and myocardial contractility begin with…

A

moderate-intensity recumbent cycling

18
Q

In those with stroke and other clotting disorders ______ levels of activity are associated with _______ in platelet activity.

A

moderate; minimal increases

**No evidence to support this as a risk factor in this population

19
Q

role of resistance training

A
  • prevent mechanical ventilation or aid in weaning from it (respiratory m.)
  • Prevents m. atrophy
  • improved aerobic exercise responses in healthy older adults
  • *Should be included in cardiac and pulmonary rehabilitation programs
20
Q

before beginning resistance training use caution and screen for…

A
  • *caution in those with ischemic heart disease due to increased arterial wall stiffness
  • *Screen for risk factors before prescription of abdominal exercises due to intrathoracic pressure increases and SV decreases
21
Q

acute effects of mobilization and exercise on endocrine system

A
  • stimulation
  • Increased sympathetic nerve stimulation; improves processing of sympathetic neurotransmitters
  • increase catecholamines, including anti-inflammatory effects
22
Q

acute effects of mobilization and exercise on CNS

A
  • Arousal due to activation of the reticular activating system
  • Parasympathetic inhibition coupled with sympathetic activation to assist with systemic responses to exercise
23
Q

acute effects of mobilization and exercise on metabolic system

A
  • Improved sensitivity to insulin

- Increased growth hormone synthesis

24
Q

acute effects of mobilization and exercise on immune system

A
  • Improves WBC production
  • Dose-dependence unknown; know aerobic ex = better, but don’t know what threshold marks what amount will shift to worse than better for the immune system (what is the magic duration #/time?)
  • Prolonged exhaustive exercise is associated with compromised immunity
25
Q

acute effects of mobilization and exercise on psychological system

A
  • Improved well-being and mood

- Not well utilized amongst those with mental illness

26
Q
  • Identify factors contributing to deficits in oxygen transport.
  • Identify which parameters to monitor
  • Is mobilization/exercise indicated?
  • Select an appropriate mobilization to match the patients oxygen transport capacity.
  • Combine body positions (especially upright).
  • Set the duration according to patient response (not time).
  • Repeat mobilization as often as possible according to their beneficial effects and being safely tolerated by the patient.
  • Increase intensity and and/or duration to maintain optimal oxygen transport.
  • Continue progression until patient is able to resume activities and full participation or when the threat to oxygen transport is minimized.
A

Table 18-4

27
Q

preparing for mobilization

A
  1. The patient should be physically prepared. – untangle wires, tie gown, slipper socks on, etc.
  2. The patient’s medication schedule should be reviewed. – when did they receive their pain meds?
  3. Equipment should be noted and positioned appropriately.
  4. Move procedures and techniques should be discussed with the team before implementation.
28
Q

“Show me how you get out of bed. I’ll jump in and help you when you look like you need it.”

A

– teaching a new way when they are already sick and immobilized is not very effective.

29
Q

monitoring mobilization session

A
  • Adapt communication needs to the learner (Cognitive, language impairment, etc.)
  • Assess baseline; Laying in bed, sitting, Orthostatic hypotension
  • Metabolic response to mobilization and exercise should be monitored (Beginning, during, etc.)
30
Q

what to measure during mobilization session

A
  • Heart rate
  • Electrocardiogram
  • Blood Pressure
  • Rate Pressure Product
  • Respiratory Rate
  • Perceived exertion (RPE b/c HR blunted with beta-blocker)
  • Breathlessness
  • Pain/discomfort
  • Fatigue
31
Q

Long-Term Physiological Effects of Mobilization & Exercise - pulmonary system

A

Increased respiratory muscle strength and endurance

32
Q

Long-Term Physiological Effects of Mobilization & Exercise - CV system

A
  • Increased myocardial efficiency
  • Exercise-induced bradycardia
  • Decreased HR & BP
  • Improved orthostatic tolerance
33
Q

Long-Term Physiological Effects of Mobilization & Exercise - hematological system

A
  • Increased number of RBC

- Optimize hematocrit and cholesterol

34
Q

Long-Term Physiological Effects of Mobilization & Exercise - NM system

A
  • Improved neuromotor control
  • Improved postural control
  • Improved efficiency of movement
35
Q

Long-Term Physiological Effects of Mobilization & Exercise - MS system

A
  • Improved muscle vascularization
  • Increased glycogen storage capacity
  • Increased biomechanical efficiency
  • muscle hypertrophy
  • increased strength
  • endurance
  • ligament tensile strength
  • Maintain bone density
36
Q

Long-Term Physiological Effects of Mobilization & Exercise - immunological system

A

increased resistance to infection

37
Q

Long-Term Physiological Effects of Mobilization & Exercise - endocrine system

A

Increased efficiency of hormone production and degradation to support exercise

38
Q

Long-Term Physiological Effects of Mobilization & Exercise - CNS

A

Increased sense of well-being and concentration

39
Q

Long-Term Physiological Effects of Mobilization & Exercise - integumentary system

A
  • Increased efficiency of skin as heat exchanger and sweating efficiency
  • decreased skin breakdown
  • improved healing

HPW (2 decks)

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