Exam 2: Pulmonary Rehab

Question 1

What is definition of pulmonary rehab?

Answer 1

evidence based practice, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases

Question 2

What is pulm rehab designed to do?

Answer 2

reduce symptoms, optimize functional status, increase participation and reduce health care costs

Question 3

Why do we pulmonary rehab?

Answer 3

designed to break up the vicious cycle of deconditioning, to decrease SOB with fnxl activity

Question 4

What are the benefits of pulm rehab?

Answer 4

decreased DOE, increased aerobic capacity, improved QOL

Question 5

What is important to remember about pulm rehab?

Answer 5

We are not changing lung function!

Question 6

What are we changing?

Answer 6

improving the efficiency of the muscles, aerobically training muscles so they can utilize O2 better

Question 7

What is general duration of pulm rehab?

Answer 7

4-18 weeks

2x a week for 4 weeks has shown great improvement

Question 8

What are major components of pulm rehab?

Answer 8

aerobic conditioning, whole body strengthening, breathing pattern training, inspiratory muscle training, airway clearance, Education

Question 9

In chronic obstructive diseases what are two major etiologies of impairment?

Answer 9

1. gas exchange impairments
2. ventilation impairments
3. cardiovascular impairments

Question 10

What are the gas exchange impairments?

Answer 10

decreased surface of alveoli for gas exchange

Question 11

What are ventilation impairments?

Answer 11

increased work of breathing from flattened diaphragm and weak inspiratory muscles

Question 12

What will the CP screen look like in these patients?

Answer 12

higher RR, decreased O2 sat, less PaO2, higher resting HR

Question 13

What are the cardiovascular impairments?

Answer 13

deconditioning from inactivity, decreased pulmonary blood flow due to hypoxia

Question 14

What does this hypoxia do physiologically?

Answer 14

due to low gas exchange there will be vasoconstriction of the capillaries under the alveoli

Question 15

What are other etiologies of impairments in patients with obstructive disease?

Answer 15

1. muscular impairments- reconditioning and wasting (predinisone)
2. symptomatic limitations- dyspnea
3. psychological limitations

Question 16

What are modes of exercise for pulm rehab?

Answer 16

large muscle groups, walking. cycling, swimming, elliptical, NuStep

things to stabilize trunk to increase ventilation

Question 17

What is the intensity for PR based off?

Answer 17

patients symptoms from initial exercise test

RPE: 11-13

DOE: 1-4

for treadmill walking usually 75-85% of 6MWT

Question 18

What is general guideline for heart rate intensity?

Answer 18

60-85% of max

Question 19

What is goal for duration of PR?

Answer 19

15-20 mins, increase duration before intensity

Question 20

What is frequency for PR?

Answer 20

3 times per week at least, total program should be 4-18 weeks

Question 21

What should strengths number be for PR?

Answer 21

50-85% of 1 RM, 2-4 sets, 6-12 reps

2-3 x per week

coordinate breathing with this

Question 22

What is important with pt education?

Answer 22

this engages them in their treatment and are more likely to be proactive with their treatment this also educates them about their disease

Question 23

What are two types of breathing patterns for pts to learn?

Answer 23

diaphragmatic and pursed lip breathing

Question 24

What is the benefit of diaphragm breathing?

Answer 24

improve oxygenation, improve ventilation (Vt), reduce work of breathing, alleviate dyspnea at rest, not activity

Question 25

What is semifaller position?

Answer 25

45 degrees of sitting with support

2nd option for diaphragm breathing

Question 26

What is pursed lip breathing?

Answer 26

in through nose, out through mouth like blowing out candles, easiest to teach and super effective

Question 27

What is important about pursed lip breathing physiologically?

Answer 27

it lengthens I/E ratio which allows for positive expiratory pressure that helps splint closed airways opened

always improves alveolar ventilation, decreases RR and increases Vt, improves dyspnea

Question 28

What is segmental breathing?

Answer 28

exercises to improve local ventilation and ga exchange in a specific lobe

most likely lateral costal expansion in pts with obstructive dz, used at rest not with exercise

Question 29

What is inspiratory muscle training?

Answer 29

strengthening of diaphragm and inspiratory muscles like any other skeletal muscle

shown to improve endurance, strength and decrease dyspnea

Question 30

What are normal values for maximum inspiratory pressure?

Answer 30

M- 95-130 cm H2O
F- 80-100 cm H2O

take average of 3-5 measurements

Question 31

What is intensity, duration and frequency of IMP?

Answer 31

I: 25-35% of MIP (if 100 cm then 25-35 cm)

D: work up to 15 minutes, once able to complete add intensity

F: twice a day