Med Rehab Flashcards
Benefits of pulm rehab?
- Improves exercise tolerance, work output, mech efficiency, symp-limited O2 consumption
- Increased AVO2 difference by increasing O2 extraction from arterial circulation
- Improved QOL, capacity to perform ADL’s
Ideal pulm rehab candidate?
Resp limitation of exercise at 75% predicted max O2 consumption;
Obstructive airway disease with FEV1 less than 2000 mL or FEV1/FVC less than 60%;
Restrictive lung disease with CO diffusion capacity less than 80% predicted
Moser classification
- Normal at rest
- Normal ADL performance (dyspnea on stairs/incline)
- Dyspnea with certain ADL’s (can walk 1 block at slow pace)
- Dependent with some ADLs; dyspnea with minimal exertion
- Dyspnea at rest
Definition of VO2 max? How to calculate?
Max volume of O2 that can be utilized in 1 minute during max or exhaustive exercise;
VO2max = (HR x SV) x AVO2 difference
Types of COPD
Chronic bronchitis;
Emphysema
For emphysema, what is only proven therapy to improve mortality in hypoxemic patients? What is the pathology in emphysema?
O2;
destruction of alveolar walls due to elastase; air spaces distended
For CF patients, what does aerobic exercise help with?
Increasing sputum expectoration
What predicted FEV1 would result in patient not having history of significant exercise impairment?
4 L or higher
Causes of restrictive pulmonary lung disease?
Instrinsic: Asbestosis, sarcoid, silicosis, IPF;
Extrinsic: DMD, ALS, GBS, MG, thoracic deformity, AS, cervical SCI
Respiratory complications with DMD?
Atelectasis 2/2 hypoventilation;
pneumonia
Normal rate of decrease in FEV1 is approx
30 ml/yr
For C5 tetraplegics, what happens with all lung volumes except RV?
Decrease;
RV is only one increasing
When appropriate to provide ventilatory support for DMD?
Dyspnea at rest;
45% predicted VC;
Max inspiratory pressure less than 30% predicted;
Hypercapnia
Best prognostic indicator for non-invasive ventilation in patients with ALS?
FVC
Young patients with moderate asthma not responding to beta-2 agonists, mast cell stabilizers, or leukotriene inhibitors could benefit from what?
Theophylline
Some benefits of home O2 use:
- Reduced polycythmia
- Improved pulm HTN
- Prolonged life expectancy
- Improvement in cognitive function
- Decreased BP and pulse in patients with COPD
- Reduction of perceived effort during exercise
Benefits of diaphragmatic breathing
Increased TV;
decreased FRC;
increased max O2 uptake
Benefits of pursed-lip breathing
Prevents air trapping due to small airway collapse during exhalation;
promotes greater gas exchange in alveoli;
increases TV;
reduces work of breathing in COPD
What happens to dependent alveoli when changing from sitting to supine position?
Expand in size, with increased ventilation at base of the lung
Of three zones of lung, what is relationship of ventilation to perfusion?
Zone 1 (apex): Ventilation occurs in excess of perfusion;
Zone 2: Perfusion and ventilation are fairly equal;
Zone 3: Pulmonary artery pressure > pulm venous pressure > alveolar pressure
When changing from sitting to supine position, what happens to venous pressure relative to arterial pressure?
Increases
Particular advantages to pre-op and post-op chest therapy program?
- Decrease pneumonia incidence
2. Reduce prob of developing post-op atelectasis after thoracic/abdo surg
Benefits for CF patients in structured running program?
Improvements in 1. Exercise capacity 2. Respiratory muscle endurance 3. Reduction in airway resistance; in kids, can see improved lung function, increased sputum expectoration
Uses of glossopharyngeal breathing
- Pt breathes w/o mechanical ventilation
- Improve volume of voice and rhythm of speech
- Prevent microatelectasis
- Patient can take deeper breaths for more effective cough
- Improve or maintain pulm compliance
