Exercise Perscription Flashcards
Asthma, Emphysema, and Chronic Bronchitis are…..
Obstructive diseases
For mild Obstructive lung disease, FEV1 is going to be less than ____ of predicted values
FEV1/FVC is going to be less than __________
80%
70%
The vital capacity of obstructive lung patients is _______
Typically within normal range
What is the only lung volume not included in vital capacity?
Residual volume
Your lungs capacities are considered normal if you’re within _____________ of predicted
80% and 120% of what’s predicted
Any patient under __________ of FVC has a restrictive lung disease
80%
Patients with MILD lung diease will present how?
They will tolerate normal exercise perscription that healthy people can do
Patient’s with moderate lung disease have _______ ventilatory responses
abnormal
Patient becomes short of breath with mild activity
ventilation cant increase w/ exercise that well (little ventilatory reserve)
May experience mild to moderate hypoxemia at rest
T or F: Using heart rate is a good tool to measure exertion for moderate lung disease patients
False
Their HR will be very high w/ activity
In severe lung disease, FEV1 is under ________ of predictive value
50%
Pt may need continuous or intermittent oxygen
Pt may have elevated CO2 levels
Pt may have right ventricular dysfunction during exercise
What is typically the problem for patient’s with poor oxygenation and how can PTs help?
Ineffective clearance of secretions
Teach patient’s how to remove secretions
What are techniques that PTs can use to assist ventilatory pump dysfunction (precursor to pump failure, increased reliance on accessory muscles, weakness of diaphram)?
Sniffing
Diaphramatic breathing
Positioning (sidelying)
For patients with pump dysfunction, if O2sat goes below __ we stop exercise
88
The goal of supplemental oxygen is to maintain atleast 88-92% without giving TOO much oxygen which can supress the drive to breath from the CNS
Phrenic nerve damage can lead to…
Ventilatory pump dysfunction
How can PTs help ventilatory pump failure patients?
Make sure they can expand properly for breathes
try to reduce accessory muscle use (diaphramatic breathing)
What signifies the end stage of respiratory failure
paradoxical brathing (hoovers sign)
Abdomen and ribcage no longer expand together, and now theyre moving in opposite directions (one goes in while the other goes out)
For patient’s with end stage pump failure or patients experiencing dyspnia how should we position them?
Position of recovery: leaning foward
Helps move diaphram upward so diaphram can descend and draw in breath
What is the problem w/ giving patient’s too much oxygen
The lack of CO2 decreases CNS drive to breath
How else can we move the diaphgram upward for a patient experiencing pump failure?
Scooping technique
Why would a spinal cord patient use an abdominal binder
It replaces the pressure that the abdominal muscles would be providing to keep the diaphram up
w/o the abdominal binder their diaphram might rest too low
If someone has a flail segment of ribs (3 or more ribs) what is the danger?
ribs might puncture lungs
Pulmonary Artery hypertension critera
greater than 20 at rest
greater than 30 with exercise
How is pulmonary arterial pressue monitored
Swan Gantz cathered
5 groups of pulmonary hypertension
-idiopathic
-caused by R heart failure
-Caused by lung disorders
-pulmonary embolus
-other diseases
At what pulmonary hypertension level do you stop exercise
40-50 watch and pay attention to symptoms and stop the intensity of the exercise
What happens if a patient gets a spike of pulmonary artery pressure
Dizzy/light headed/ loss of conciousness
(happens very quick)
Sharp drop of SpO2
Treatment for poor oxygenaiton
Supplemental O2
Bronchodilators
Teaching airway clearance techniques
Treatment for Ventilatory pump dysfunction
Supplemental O2,
Facilitated breathing techniques (teach diaphramagtic breathing)
Exercise training
Ventilatory Pump Failure treatment
Foward lean
Facilitatory/inhibitory breathing techniques
Pursed Lip
Breathing Techniques
Ventilatory muscle training
Abdominal Binder
T or F, patients w/ pulmonary artery hypertension cannot take bronchodilators
True, because it will further raise the blood pressure
What muscles is it the hardest to get oxygen to?
Lower limbs
Acceptable Parameters for PT intervention:
Under RR over 40 at rest (dont work with patients 40+ RR)
HR 60-120 at rest, able to speak comfortably (120+ no go)
Pulse oximetry over 90
Need for supplemental O2 to keep SPO2 over 0
Reasons to stop or modify PT intervention
Unable to speak comfortably
SPO2 under 85
HR drops more than 10BPM
SBP drops over 10mmHG
Guy’s i promise you this is going to be the majority of the questions lmao (no promises!)
Giving a patient too much O2 can do what?
Reduce drive to breathe by CNS
What is the preferable method of training respiratory patients
Short bursts of activity with many rest breaks, activity becomes longer overtime
(interval walking)
What preformance tests are good for establishing someone’s muscular endurance?
6MWT
2MWT
30Second STS for LE muscular endurance
Overall Exercise Perscription for non-acute COPD patient
Strength training 2 times a week
60-70% 10-15 reps
Aerobic 3-5x a week
Emphasis on interval training using BORG scale
Why is it important to work on muscular strength with lung patients
Muscles become more efficient at using oxygen
What kind of exercises should we use to help a patient correct posture after a lot of sitting and hunching over
Upper back
an RPE of __________ is good for patients with COPD/lung problems
3-6
15-20 reps
Why cant you use heartrate as a gauge of exertion for COPD patients?
HR is already very high at rest
It is important to have a patient on _____________ for initial exercise training sessions
Pulse Ox
What is MVV
Maximum ventilatory volume
Amount of air in and out in 1 minute
MMV should never be more then __% of predicted MMV for a patient
70%
If you see an exercise test with more than 70% that means that respiratory system was the limiting factor
If a patient is less than __% of predicted inspiration muscle strength, this indicates clinical weakness of respiratory muscles
50%
