Lecture 24: Pulmonary Rehab Management Flashcards
importance of good activity tolerance, clinical manifestations of decreased tolerance, and how to improve
poor tolerance/inactivity = increased risk mortality
manifestations = decreased walking/standing tolerance, inability to perform ADLs
APTA guidelines recommend increased PA via increase in total daily activity, # steps, and total time out of bed
ACSM, AHA, CDC guidelines for PA
150-300 min/week moderate intensity aerobic
OR
75-150 min/week vigorous aerobic
mod intensity strength 2 or more times per week
ACSM older adults guideline
if cannot do >150 min mod intensity PA, they should be as active as their abilities allow
balance should be performed in addition to aerobic/resistance
how to best handle activity tolerance/energy conservation with pulmonary patients
low intensity high frequency
- walk shorter distances more often instead of long distance all at once
- increase duration before intensity
if you fail walkie talkie test = stop task or stop talking
things to keep in mind when completing strength training with pulmonary pts
clinical presentation of pulm pts = sarcopenia, osteoporosis, mm wasting, frailty
literature limited for mod-high risk pts
mm function (power, speed, endurance) is altered w/o normal O2 delivery over long periods of time
**consider impact of chronic steroid use in pulmonary pts (more common than with CVD)
Considerations for parameters of strength training with Pulmonary pts
ACSM/AHA recommends 10-15 reps of RPE 11-13/4-6
slower progression of exercise reps and weight
lower 1RM
decreased resistance tolerance
Things to keep in mind regarding ROM in pulmonary pts
pt has prolonged sx precautions = may have decreased ROM that can affect chest wall movement, breathing, and posture
posture = major implications on breathing mechanics, lung capacity, and functional activity tolerance
pain free ROM beneficial post thoracotomy to prevent adhesions during healing
awareness of long thoracic nn damage with posterolateral thoracotomy
potential causes of cognitive impairments in pulmonary pts and implications
cognitive impairments in COPD is higher than normal population but wide reference of prevalence (3-61%)
potential causes
- chronic hypoxemia/hypoxia
- chronic hypercapnia
- supplemental O2 non-compliance
- impaired oxygenation during sleep due to pulm dysfunction
- hospitalization can affect (especially geriatric)
implication = ability to follow instructions/precautions, medication/O2 compliance, safety, ADLs, and qualification for post acute rehab
interventions for pulmonary patients with cognitive impairments
family involvement
frequent reorientation
healthy sleep/wake cycle
structured schedule
increased mobility and ADLs
common causes of pain in pulmonary pts
large sx incisions = painful; intercostal nn pain common
parietal pleura and thoracic cavity = highly innervated = pain
post op lines may irritate parietal pleura
post op pain has major effects on respiratory function
what happens when pain levels increase
higher pain = stimulates SNS
- decreased peripheral autonomic function
- increases stress hormone release
- decreased immune function
barriers to CVP rehab
baseline functional capacity, disability, or frailty
poor exercise tolerance
decreased knowledge of condition, poor health literacy
poor medical compliance
frequent hospitalization
QOL/depression
lack of resources or access
use of APTA CPG on supplemental O2
highlights use and importance of supplemental O2
establishes guidelines and recommendations for practice based on best available info and evidence
addresses need for standardization
effects of supplemental O2
improves SOB if SpO2 or PaO2 is decreased
alleviates pulmonary vasoconstriction response to hypoxemia
improves hemodynamics
enhances exercise performance if SpO2 or PaO2 is decreased
reduces perception of dyspnea
PT role in supplemental O2 use (recs from CPG)
if pt is using O2, need order and SpO2 target/goal
“once there is a rx for specific O2 saturation target level to be maintained during rest and activity, the PT may titrate the supplemental O2 flow to maintain SpO2 at or above the specified value”
investigate if pt is using different device than that prescribed
sup. O2 can be placed without an order in emergency situations as long as primary provider is notified
following PT, pt should return to the supplemental device and flow rate used prior to intervention
precautions to supplemental O2
pts with chronic hypercapnia or obstructive lung disease (especially COPD) = overoxygenating can reduce respiratory drive, preventing CO2 from being effectively exhaled
COPD pts - be aware of lower SpO2 goals and recs to keep SpO2 below certain value
if pt cannot be returned to O2 device/flow rate used prior to PT intervention, primary provider should be notified
CPG for supplemental O2 summarized
medical providers order O2
supplemental O2 should be set at or above 90% SpO2 unless otherwise specified by MD
sup. O2 = medication
vital signs should be monitored while on sup. O2
retention of CO2 (hypercapnia) is not a contraindication to sup. O2, but those pts may have altered O2 goals
no national recommendations/guidelines, or position statements to guide safe PT practice
when/how to wean from supplemental O2
not noted in CPG
strong use of clinical judgement
titrate down 1L/min at a time
ensure clear communication with RN, MD
provide documentation of response/vitals
pursed lip breathing has what effect
decreases S&S of dyspnea
slows RR and reduces wheezing
prevents alveolar collapse at end exhalation
