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BR 3rd Ed > Ch 9 - Pulmonary Rehabilitation > Flashcards

Ch 9 - Pulmonary Rehabilitation Flashcards

1
Q

What does exercise cause regarding oxygenation?

A

Inc arterial venous oxygen (AVO2) difference by increasing oxygen extraction from arterial circulation

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2
Q

What are benefits of pulmonary rehab?

A

Inc exercise tolerance, work output, mech efficiency
Red dyspnea and RR
Inc ambulation capacity
Dec hosp rates

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3
Q

Which patients benefit the most from pulmonary rehab regarding exercise limitation?

A

Respiratory limitation of exercise at 75% of predicted maximum O2 consumption

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4
Q

Which patients benefit the most from pulmonary rehab regarding obstructive airway disease?

A

Forced Expiratory Volume in 1 second (FEV1) <2,000 mL or an FEV1/FVC (Forced Vital Capacity) ratio <60%

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5
Q

Which patients benefit the most from pulmonary rehab regarding restrictive airway disease?

A

Restrictive lung disease or pulmonary vascular disease with carbon monoxide diffusion capacity <80% of predicted value

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6
Q

What is Moser Classification 1?

A

Normal at rest

Dyspnea on strenuous exertion

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7
Q

What is Moser Classification 2?

A

Normal ADL performance

Dyspnea on stairs/inclines

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8
Q

What is Moser Classification 3?

A

Dyspnea with certain ADLs

Able to walk 1 block at slow pace

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9
Q

What is Moser Classification 4?

A

Dependent with some ADLs

Dyspnea with minimal exertion

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10
Q

What is Moser Classification 5?

A

Housebound
Dyspnea at rest
Assistance with most ADLs

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11
Q

What do central chemoreceptors monitor?

A

Hypercarbia in CSF

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12
Q

What do peripheral chemoreceptors monitor?

A

Carbon dioxide, oxygen, and pH levels in the blood

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13
Q

What is the primary muscle of inspiration and its innervation?

A

Diaphragm

Phrenic nerve

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14
Q

What are accessory muscles of inspiration?

A 
SCM
Trapezius
Pectoralis major
External intercostals
Scalene muscles
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15
Q

What are active muscles of expiration?

A

Typically passive
Abdominal
Internal intercostals

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16
Q

What is VO2 max?

A

Max volume of O2 that can be utilized in 1 minute during maximal or exhaustive exercise

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17
Q

How is VO2 max measured?

A

Milliliters of oxygen used in 1 min/kg of body weight

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18
Q

How is VO2 max calculated?

A

VO2 max = (HR × SV) × AVO2 difference

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19
Q

What is COPD characterized by?

A

Inc airway resistance due to bronchospasm, which may result in air trapping, low maximum mid-expiratory flow rate, and normal to increased compliance

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20
Q

How can hypoxemia result from COPD?

A

Possible perfusion-ventilation mismatching

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21
Q

How can COPD present clinically?

A

Inc airway resistance
Impaired expiratory airflow
Respiratory muscle fatigue
Flattening of the diaphragm seen on chest x-ray due to increased total and residual lung volumes

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22
Q

What is the MCC of COPD?

A

Cigarette smoking

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23
Q

What is chronic bronchitis?

A

Chronic mucus hypersecretion and respiratory infections as a result of tracheobronchial mucous gland enlargement

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24
Q

Describe mucus production in chronic bronchitis.

A

> 100 mL of sputum/day for >3 months, for at least 2 consecutive years

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25
Q

What is emphysema?

A

Distention of air spaces distal to the terminal nonrespiratory bronchioles with destruction of alveolar walls

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26
Q

What therapy improves mortality in hypoxic patients?

A

Oxygen

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27
Q

What is Cystic Fibrosis?

A

AR dz involving the chloride ion channels found in exocrine glands

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28
Q

What causes respiratory failure in Cystic Fibrosis?

A

Failure to adequately remove secretions from the bronchioles, resulting in widespread bronchiolar obstruction and subsequent bronchiectasis, overinflation, and infection

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29
Q

What does exercise cause in Cystic Fibrosis?

A

Inc sputum expectoration

Inc ciliary beat with improved mucous transport

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30
Q

Describe exercise limitation with FEV1 between 2-3L.

A

Mild exercise limitation (able to walk significant distances, but not at high speed)

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31
Q

Describe exercise limitation with FEV1 between 1-2L.

A

Mod degree of exercise impairment (intermittent rest periods are required to walk significant distances or to climb stairs)

32
Q

Describe exercise limitation with FEV1 <1L.

A

Severe exercise impairment (very short distance ambulation)

33
Q

What is Restrictive lung disease?

A

Impaired lung ventilation due to loss of normal elastic recoil of the lungs or chest wall

34
Q

What are causes of Restrictive lung disease?

A
  • Intrinsic lung diseases (inc stiffness of lung tissue)
  • Extrinsic lung diseases (inc stiffness of chest wall)
  • Neuromuscular diseases
  • Thoracic deformities
  • Pleural disease
  • AS
  • Cervical SCI
  • Obesity
  • Surgical removal of lung tissue
35
Q

What are pulmonary complications of Duchenne muscular dystrophy?

A

■ Atelectasis secondary to hypoventilation

■ Pneumonia

36
Q

What is the MC motor neuron disease to cause pulmonary complications?

A

ALS

37
Q

What scoliotic angle do patients complain of dyspnea?

A

> 90 degreees

38
Q

What scoliotic angle do patients develop overt hypoventilation and cor pulmonale?

A

> 120 degrees

39
Q

What is the rate of decrease of FEV1 due to normal aging?

A

FEV1 decreased at a rate of 30cc /year

40
Q

What is the rate of decrease of FEV1 in smokers?

A

FEV1 decreased at a rate of 60-90cc /year

41
Q

Quitting smoking at what age can increase lung function?

A

<35 yo

42
Q

When can pulmonary changes be seen in SCI?

A

C5 or high quadraplegia

43
Q

What causes decreases diaphragmatic excursion and the vital capacity (VC) in the sitting position in SCI?

A

ABD contents sag due to the greater strength of the diaphragm relative to the weakness of the abdominal wall muscles

44
Q

What are potential guidelines to adding ventilator support in DMD patients?

A

– Dyspnea at rest
– 45% predicted VC
– Maximal inspiratory pressure <30% predicted
– Hypercapnia

45
Q

When is aspiration risk increased in ALS?

A

VC falls to 25 mL/kg, the ability to cough is impaired

46
Q

What is the best indicator for noninvasive ventilation in ALS?

A

Forced vital capacity

47
Q

What are medications for dyspnea and to decrease exacerbations of COPD?

A

– Inhaled anticholinergics: ipratropium (Atrovent®), tiotropium (Spiriva),
– Short-acting inhaled b-2 agonists

48
Q

Which asthma patients may benefit from theophylline use for exercise induced asthma/bronchospasm?

A

Young patients w/ moderate asthma, who have tried b-2 agonists during exercise as well as mast cell stabilizers or leukotriene inhibitors

49
Q

When is supplemental oxygen recommended with exercise?

A

Patient exhibits an exercise-induced SaO2 below 90%

50
Q

What are benefits of home oxygen?

A 
– Red polycythemia 
– Improvement in pulmonary HTN 
– Red of the perceived effort during exercise
– Prolongation of life expectancy 
– Improvement in cognitive function 
– Red in hospital needs
51
Q

What are outcomes of controlled breathing techniques?

A

Red dyspnea
Red the work of breathing
Improve resp muscle function and pulmonary function parameters

52
Q

What are the benefits of diaphragmatic breathing?

A

Increased TV, decreased FRC, and increase in maximum oxygen uptake

53
Q

What is pursed-lip breathing?

A

Patient inhales through the nose for a few seconds with the mouth closed, then exhales slowly for 4 to 6 seconds through pursed lips. Expiration lasts 2-3x as long as inspiration.

54
Q

What are the benefits of pursed-lip breathing?

A

Prevents air trapping due to small airway collapse during exhalation and promotes greater gas exchange in the alveoli. Increases TV, reduces dyspnea and work of breathing

55
Q

What is the postural position to drain the upper lobes of the lung?

A 
– Patient is positioned sitting up
– Exceptions: 
■ Right anterior segment: supine 
■ Lingular: lateral decubital Trendelenburg 
■ Both posterior segments: prone
56
Q

What is the postural position to drain the middle and lower lobes of the lung?

A

– Patient is positioned in the lateral decubital Trendelenburg
– Exceptions:
■ Superior segment of the lower lobe: prone with buttocks elevated
■ Posterior lower segment: prone Trendelenburg position with buttocks elevated
■ Anterior segment: supine Trendelenburg

57
Q

What degree of Trendelenburg can COPD patients tolerate?

A

Up to 25° tilt

58
Q

What should postural lung drainage be avoided in?

A 
– Pulmonary edema
– CHF
– HTN 
– Dyspnea 
– Abd: hiatal hernia, obesity, recent food ingestion, abdominal  distention
59
Q

How do alveoli change from sitting to supine position?

A

Expand in size, increasing ventilation at the base of the lung

60
Q

Where is the ventilation/perfusion (V/Q) mismatch most effective in upright sitting?

A

Middle lung lobes

61
Q

Which lobes are preferentially perfused in sitting?

A

Lower lung lobes

62
Q

Which lobes are preferentially ventilated in sitting?

A

Upper lung lobes

63
Q

When changing from a sitting to supine position, how does venous pressure change in relation to arterial pressure?

A

Venous pressure increases in relation to the arterial pressure in dependent areas of the lung

64
Q

What are advantages of pre and post op chest therapy program?

A

– Dec pneumonia risk

– Red postop atelectasis following thoracic and abdominal surgery

65
Q

What aerobic exercises can be done in CF patients?

A

– Exercises involving the trunk muscles, such as sit-ups
– Swimming
– Jogging/structured running

66
Q

What does Continuous positive airway pressure (CPAP) provide?

A

Splinting of the

pharyngeal airway with positive pressure delivered through a nose mask and prevents desaturation.

67
Q

What are uses of glossopharyngeal breathing?

A

– Breathe w/o mech vent (mins up to 4 hrs)
– Improves the volume of the voice and the rhythm of speech
– Prevent microatelectasis
– Deeper breaths for more effective cough
– Improves or maintains pulmonary compliance

68
Q

What are examples of Intermittent abdominal pressure ventilator (IAPV)?

A

Pneumobelt

Exsufflation belt

69
Q

What is a Rocking bed?

A

Rocks the patient along a vertical axis (15° to 30° from the horizontal) utilizing the force of gravity to assist ventilation

70
Q

What is the preferred method to treat obstructive sleep apnea?

A

Continuous positive airway pressure (CPAP)

71
Q

Which patients are candidates for Fenestrated tracheal tubes?

A

Able to speak and require only intermittent ventilatory assistance

72
Q

Which patients are candidates for Non-Fenestrated tracheal tubes?

A

Require continuous mechanical ventilation or are unable to protect the airway during swallowing

73
Q

How can patients talk with a Non-Fenestrated tracheal tubes?

A

One-way talking valve taht open on inhalation and close during exhalation to produce phonation

74
Q

Which patients are candidates for Speaking tracheal tubes?

A

Alert and motivated patients, who require an inflated cuff for ventilation and who have intact vocal cords and the ability to mouth words

75
Q

What are indications for one-way speaking valves?

A

■Alert, awake
■ Medically stable, able to exhale efficiently
■ Tolerate complete cuff deflation an speaking valve trial

76
Q

What are contraindications for one-way speaking valves?

A 
■Unconscious/coma
■ Vocal cord paralysis-adducted position
■ Inflated tracheostomy 
■ Foam-filled cuffed trach
■ Severe airway obstruction, laryngeal stenosis or tracheal stenosis
■ Thick secretions
■ Severe risk for aspiration
■ COPD
77
Q

What are complications of trach suctioning?

A

Bleeding, infection, atelectasis, hypoxemia, CV instability, elevated ICP, cause lesions to the tracheal mucosa

BR 3rd Ed (92 decks)

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