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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
What is emphysema?
Distention of air spaces distal to the terminal nonrespiratory bronchioles with destruction of alveolar walls
26
What therapy improves mortality in hypoxic patients?
Oxygen
27
What is Cystic Fibrosis?
AR dz involving the chloride ion channels found in exocrine glands
28
What causes respiratory failure in Cystic Fibrosis?
Failure to adequately remove secretions from the bronchioles, resulting in widespread bronchiolar obstruction and subsequent bronchiectasis, overinflation, and infection
29
What does exercise cause in Cystic Fibrosis?
Inc sputum expectoration | Inc ciliary beat with improved mucous transport
30
Describe exercise limitation with FEV1 between 2-3L.
Mild exercise limitation (able to walk significant distances, but not at high speed)
31
Describe exercise limitation with FEV1 between 1-2L.
Mod degree of exercise impairment (intermittent rest periods are required to walk significant distances or to climb stairs)
32
Describe exercise limitation with FEV1 <1L.
Severe exercise impairment (very short distance ambulation)
33
What is Restrictive lung disease?
Impaired lung ventilation due to loss of normal elastic recoil of the lungs or chest wall
34
What are causes of Restrictive lung disease?
* 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
What are pulmonary complications of Duchenne muscular dystrophy?
■ Atelectasis secondary to hypoventilation | ■ Pneumonia
36
What is the MC motor neuron disease to cause pulmonary complications?
ALS
37
What scoliotic angle do patients complain of dyspnea?
>90 degreees
38
What scoliotic angle do patients develop overt hypoventilation and cor pulmonale?
>120 degrees
39
What is the rate of decrease of FEV1 due to normal aging?
FEV1 decreased at a rate of 30 cc /year
40
What is the rate of decrease of FEV1 in smokers?
FEV1 decreased at a rate of 60-90 cc /year
41
Quitting smoking at what age can increase lung function?
<35 yo
42
When can pulmonary changes be seen in SCI?
C5 or high quadraplegia
43
What causes decreases diaphragmatic excursion and the vital capacity (VC) in the sitting position in SCI?
ABD contents sag due to the greater strength of the diaphragm relative to the weakness of the abdominal wall muscles
44
What are potential guidelines to adding ventilator support in DMD patients?
– Dyspnea at rest – 45% predicted VC – Maximal inspiratory pressure <30% predicted – Hypercapnia
45
When is aspiration risk increased in ALS?
VC falls to 25 mL/kg, the ability to cough is impaired
46
What is the best indicator for noninvasive ventilation in ALS?
Forced vital capacity
47
What are medications for dyspnea and to decrease exacerbations of COPD?
– Inhaled anticholinergics: ipratropium (Atrovent®), tiotropium (Spiriva), – Short-acting inhaled b-2 agonists
48
Which asthma patients may benefit from theophylline use for exercise induced asthma/bronchospasm?
Young patients w/ moderate asthma, who have tried b-2 agonists during exercise as well as mast cell stabilizers or leukotriene inhibitors
49
When is supplemental oxygen recommended with exercise?
Patient exhibits an exercise-induced SaO2 below 90%
50
What are benefits of home oxygen?
``` – 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
What are outcomes of controlled breathing techniques?
Red dyspnea Red the work of breathing Improve resp muscle function and pulmonary function parameters
52
What are the benefits of diaphragmatic breathing?
Increased TV, decreased FRC, and increase in maximum oxygen uptake
53
What is pursed-lip breathing?
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
What are the benefits of pursed-lip breathing?
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
What is the postural position to drain the upper lobes of the lung?
``` – Patient is positioned sitting up – Exceptions: ■ Right anterior segment: supine ■ Lingular: lateral decubital Trendelenburg ■ Both posterior segments: prone ```
56
What is the postural position to drain the middle and lower lobes of the lung?
– 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
What degree of Trendelenburg can COPD patients tolerate?
Up to 25° tilt
58
What should postural lung drainage be avoided in?
``` – Pulmonary edema – CHF – HTN – Dyspnea – Abd: hiatal hernia, obesity, recent food ingestion, abdominal distention ```
59
How do alveoli change from sitting to supine position?
Expand in size, increasing ventilation at the base of the lung
60
Where is the ventilation/perfusion (V/Q) mismatch most effective in upright sitting?
Middle lung lobes
61
Which lobes are preferentially perfused in sitting?
Lower lung lobes
62
Which lobes are preferentially ventilated in sitting?
Upper lung lobes
63
When changing from a sitting to supine position, how does venous pressure change in relation to arterial pressure?
Venous pressure increases in relation to the arterial pressure in dependent areas of the lung
64
What are advantages of pre and post op chest therapy program?
– Dec pneumonia risk | – Red postop atelectasis following thoracic and abdominal surgery
65
What aerobic exercises can be done in CF patients?
– Exercises involving the trunk muscles, such as sit-ups – Swimming – Jogging/structured running
66
What does Continuous positive airway pressure (CPAP) provide?
Splinting of the | pharyngeal airway with positive pressure delivered through a nose mask and prevents desaturation.
67
What are uses of glossopharyngeal breathing?
– 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
What are examples of Intermittent abdominal pressure ventilator (IAPV)?
Pneumobelt | Exsufflation belt
69
What is a Rocking bed?
Rocks the patient along a vertical axis (15° to 30° from the horizontal) utilizing the force of gravity to assist ventilation
70
What is the preferred method to treat obstructive sleep apnea?
Continuous positive airway pressure (CPAP)
71
Which patients are candidates for Fenestrated tracheal tubes?
Able to speak and require only intermittent ventilatory assistance
72
Which patients are candidates for Non-Fenestrated tracheal tubes?
Require continuous mechanical ventilation or are unable to protect the airway during swallowing
73
How can patients talk with a Non-Fenestrated tracheal tubes?
One-way talking valve taht open on inhalation and close during exhalation to produce phonation
74
Which patients are candidates for Speaking tracheal tubes?
Alert and motivated patients, who require an inflated cuff for ventilation and who have intact vocal cords and the ability to mouth words
75
What are indications for one-way speaking valves?
■Alert, awake ■ Medically stable, able to exhale efficiently ■ Tolerate complete cuff deflation an speaking valve trial
76
What are contraindications for one-way speaking valves?
``` ■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
What are complications of trach suctioning?
Bleeding, infection, atelectasis, hypoxemia, CV instability, elevated ICP, cause lesions to the tracheal mucosa

BR 3rd Ed (92 decks)

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