General Medical Rehab Flashcards
Total Lung Capacity Vital Capacity Forced Vital capacity FEV1 Residual volume Minute voume
TLC: Total amount of air in lungs after max inspiration
VC: The amount of air that can be expelled after a deep breath
FVC: same as above but after maximal exhalation
FEV1: amount exhaled in first second (decreases over time, way faster in smoker)
RV: amount of air in lungs at end of large exhalation
MV: Amount of air inhaled/exhaled in 1 min
Pulmonary rehab
increases AVO2 difference
Most common brain tumor
Cerebellar astrocytomas the most common CNS tumor in young adults, over the age of 7.
astrocytoma (glibolastoma)
Most common metastatic
lugng, breast, GI
Most common brain tumor in children
Cerebellar astroyctoma (better prognosis), medulloslbastoma
most common primary osseous tumor
osteosarcoma (knee-sital femur, proximal tibia)
Most common metastatic cancers to bone
lung, breast, prostate, MM (prostate is the oosteoblastic one best seen with bone scan)
Most common pediatric cancer
Leukemia
most common solid pediatric cancer
Brain tumors- pilocytic astrocytoma, medulloblastoma, ependymoma (posterior fossa tumors)
Pediatric burn percents
18% head, 14% each limb, every year after 1 subtract 1% from the head and add 0.5% to each leg
Pts who benefit most from pulm rehab
- resp limitation of exercise 75% of predicted max O2 consumption
- Obstructive airway disease with FEV1 <2,000mL or FEV1/FVC ratio <60%
- Restrictive lung disease with CO diffusion capacity <80% of predictive value
Pulmonary disability Moser Classification (stages 1-4 do not have dyspnea at rest)
1) normal at rest, dyspnea with strenuous exercise
2) Normal ADL performance- dyspnea on stairs/incline
3) Dyspnea with some ADLs; able to walk 1 block slow pace
4) Dependent with some ADLs; dyspnea with minimal exertion
5) Dyspnea at rest, housebound
Vo2 max equation
VO2 max= (HR x SV) x AVO2 difference
VO2 depends on body weight , age, sex, genetics (most important).
Obstructive disease
Air trapping, low max mid-expiratory flow rate, and normal to increased compliance, increased total and residual lung volumes
Chronic bronchitis
Emphysema
Cystic Fibrosis
Asthma
Chronic bronchitis- tracheobronchial mucous gland enlargement
Emphysema- distention of terminal nonrespiratory bronchioles with destruction of alveolar walls (secondary to neutrophil derived elastase); destruction of alveolar wall elasticity results in loss of lung recoil leading to excessive airway collapse on exhalation and chronic air obstruction/trapping.
CF: AR Cl- ion channels, failure to remove secretions from bronchioles, causing obstruction, bronchiectasis, overinflation and infection, aerobic exercise
Asthma- hypertrophy of bronchial muscle, mucosal edema, infiltration of eosinophils and mononuclear cells. Chronic bronchitis can result from asthma
FEV in COPD patients
FEV1 of 4L, no exercise impairment
FEV1 2-3 L, mild exercise limitation
FEV1 1-2 L moderate exercise impairment
FEV1 <1 L severe exercise impairment
Restrictive Lung Disease Intrinsic vs extrinsic
Intrinsic- asbestosis, sarcoidosis, silcosis, idiopathic pulmonary fibrosis
Extrinsic: NM dz, Thoracic deformities (>90 deg of scoliosis then have dyspnea, >120 deg scoliosis hypoventilation/cor pulmonale), Pleural dz, AS, Cervical SCI, obesity, surgical removal of lung tissue
DMD lung
resp muscle weakness -> Hypoventilation-
Chronic alveolar hypoventilation with hypoxemia
Reduced arterial oxygen tension (PaO2) and increased Carbon diooxide tension (PaC02) leading to daytime sleepiness.
ALS lung
Measure FVC at diagnosis and then every 3 months to monitor disease progression (FVC best prognostic indicator)
Earliest changes are decr in max inspir/expir muscle pressures, followed by reduced VC and maximum breathing capacity,
A vital capacity less than 25 ml/kg would have an impaired ability to cough
Active expiration
Abdominal muscles, internal intercostals
Aging PFTs
Restrictive Lung PFTs
Obstructive Lung PFTs
Aging:
Decrease: VC, FEV1 (30 mL/year), PO2, MVV
Increase: RV, FRC
No changes in : TLC, PCO2
Restrictive:
Decrease: VC, TLC, RV, FRC, FVC, MVV
FEV1 IS NORMAL!!!!
Obstructive:
Decrease: VC, FEV1 (45-75 mL/year) , FVC, MVV
Increase: RV, FRC, TLC
Ventilatory support for DMD
No clear guidelines but : dyspnea at rest, 45% of predicted VC, max inspiratory pressure <30% predicted, hypercapnia
Young pts with moderate asthma who have tried B2 agonists during exercise as well as mast cell stabilizers or LT inhibitors may benefit from
Theophylline for exercise induced asthma/bronchospasm
Inheritance pattern of CF
Autosomal Recessive- involving Chloride ion channels found in exocrine glands. Failure to remove secretions- obstruction, bronchiectasis, overinflation and infection
Therapy for CF
Aerobic exercise helps increase sputum production, increase ciliary beat
Asthma
Hypertrophy of bronchial muscle , mucosal edema, infiltration with eosinophils and mononuclear cells which causes changes in the basement membrane.
SCI respiratory dysfunction related to 3 factors
1) Reduced VC
2) Retention of secretions
3) Autonomic dysfunction
Complete lesions above C2 result in loss of function of
Diaphragm and intercostal muscles
What increases in C spine injury
residual volume
PFT of C5 injury
Expiratory muscles paralyzed- retain 60% of inspiratory capacity and ventilate well, but have weak cough and difficulty clearing secretions during respiratory infections; All volumes are greatly reduced because of limited expansion of chest wall; decr TLC and VC, incr RV
Nutrition status COPD
- decr serum albumin levels, supplement with 1.7 g/kg body weight per day
- Pseudomonas colonize poor nutrition ppl
- Affects surfactant synthesis
- Incr fluid intake in COPD
Supplental oxygen
reduce polycythemia, improve pHTN, prolongs life expectancy, improved cognition, decr blood pressure
Controlled breathing techniques
Used to reduce dyspnea, reduce work of breathing, and improve respiratory muscle function and pulm function
Diaphragmatic breathing
Used to reverse altered pattern of resp muscle recruitment; hand under thorax and on abdomen and try too expand abdomen; benefits : increased tV, decr FRC, increase in Max O2 uptake
Techniques to reduce dyspnea and work of breathing
Pursed lips
Airway secretion mgmt techniques
Controlled cough, Huffing pg 660
Electrolyte impairment in acute DMD respiratory exacerbation
Hypokalemia