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PR1 Flashcards

1
Q

Joint statement by the American thoracic society and European respiratory society 2006 – definition of pulmonary rehabilitation

A

-Evidence based
-Multidisciplinary
-Comprehensive intervention for patients with chronic respiratory disease
-Symptomatic
-Decrease daily life activity
-ID tx of the pt

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2
Q

Pulmonary rehabilitation is designed to

A
  • Reduce symptoms
  • Optimize functional status
  • Increase participation
  • Reduce healthcare cost by stabilizing or reverse and systemic manifestations of the dz
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3
Q

Why do we care about PR?

A

-ChronicPulmonary disease impact
- 12 million people diagnosed with COPD
- COPD is the third leading cause of death in the US

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4
Q

Third leading cause of death in the US is?

A

COPD

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5
Q

Demonstrated outcomes

A

Reduce symptoms, dyspnea, fatigue
- Increase exercise performance
-Increase knowledge of dz and mgmt.
- Increased ability to perform ADLs
- Improve health related quality of life
-Reduce hospitalizations use of medical resources
- Improve psychosocial symptoms, anxiety, depression
-Pt may be able to return to work

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6
Q

Candidates for rehabilitation, PR

A

Patience with functional limitations affecting quality of life.

COPD
Interstitial disease
Cystic fibrosis
PAH
Bronchiectasis
Asthma
Thoracic cage abnormalities
Each state has his own pulmonary function criteria for reimbursement for admissions to PR program.

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7
Q

Patient selection for PR

A

Consider for any patient with chronic respiratory disease
Continues to have symptoms
Reduce performance
Decrease health related quality of life despite otherwise optimal medical management

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8
Q

Patient selection, common morbidities which can benefit from PR interventions

A

Peripheral muscle disease
Cardiac dysfunction
Nutritional abnormalities
Psychosocial maladaption

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9
Q

Patient selection, Benefit

A

gain regardless of age sex lung function or smoking status

Peripheral muscle weakness is positive predictor of successful outcome

Severe nutrition depletion associated with poor response

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10
Q

Patient selection, selection Criteria

A

Abnormal pulmonary function test
Symptoms, dyspnea
Reduction in physical activity
Reduction and occupational performance
Reduction in ADLs
Increase in medical resource consumption

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11
Q

Patient selection symptoms and functional limitations become apparent with one or more of the following objective abnormalities

A

FEV1 < 80% predicted
FEV1% < 70% predicted
DLCO adjusted for Hb <OR = to 65% predicted

Exercise testing demonstrated hypoxemia < OR = 90%, Ventilatory limitation = OR > 0.8, or a raising ratio of dead space to tidal volume.

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12
Q

Conditions appropriate for PR
Obstructive

A

COPD
persistent asthma
bronchiectasis
cystic fibrosis
bronchiolitis obliterans

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13
Q

Dz appropriate for PR

Restrictive disease

A

Interstitial disease
chest wall disease
neuromuscular disease

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14
Q

Restrictive diseases appropriate for PR
Interstitial diseases

A

Interstitial fibrosis
Occupational or environmental lung disease
Sarcoidosis

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15
Q

Restrictive diseases appropriate for PR
Chest wall diseases

A

Kyphoscoliosis
Ankylosing spondylitis

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16
Q

Restrictive diseases appropriate for PR
Neuromuscular diseases

A

Parkinsons disease
Post-polio syndrome
Amyotrophic lateral sclerosis, ALS
Diaphragmatic dysfunction
Multiple sclerosis
Post-tuberculosis syndrome

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17
Q

Other conditions are perfect for pulmonary rehab

A

Lung cancer
primary pulmonary hypertension
before and after Thoracic & ab surgery
Before and after lung transplantation
Before after LVRS
Ventilator dependency
Pediatric pt with respiratory dz
Obesity related respiratory dz

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18
Q

Keys to success: Patient selection, patient motivation

A

Selection process considerations Patient motivation, hard to assess

Commitment and participation to the program

Patient initially resistant can be “converted”, and show great improvement

19
Q

Exclusions that may contradict PR

A

Significant orthopedic, neurologic or Psychiatric problems—> Prohibit ability or cooperation with physical training

Unstable cardiac dz

Severe pulmonary hypertension

Comorbidities Dash medical Director/rehab team looks at during initial

20
Q

Patient assessment
Initial patient assessment

A

Initial patient assessment basis
Interview
Medical history and physical exam
Diagnostic test
Symptom assessment
Exercise assessment
Pain assessment
ADLs assessment
Nutritional assessment
Educational assessment
Psychosocial assessment

21
Q

Patient interview includes

A

Info from the patient
Describes PR process
Discuss his patients concerns/goals

22
Q

Goal development

A

Assessment set foundation for individualized and comprehensive pulmonary rehab program
- Short and long-term goals are formulated and reflected in treatment plan
- Goal surrealistic and compatible with underlying disease
Patient must understand goals and agree to work toward attaining goals

23
Q

Medical history

A

Much obtained from patient records, comorbid conditions have direct bearing on health well-being in progress, what are components of medical history?

24
Q

Physical assessment

A

Simple, noninvasive evaluation of patient, modern chain and following of patient’s progress, chest exam, measure and evaluate vital signs, use of accessory muscles, clothing, edema, other signs of heart failure, pulse ox at rest and with exercise.

25
Q

Diagnostic test

A

ID patience disease,
establish a baseline of current clinical status,
help to evaluate outcomes,
what are essential test?,
What are test to consider for selected patient?

26
Q

Symptom assessment

A

Dyspnea and fatigue a primary symptoms

Onset, quality, quantity, frequency and duration

What are irritating factors?
Dyspnea is overriding symptom and usually reduces PR.
Disney is usually rated with 10 point Borg scale of using analog scale.
What are other symptoms?

27
Q

Muscloskeletal/exercise assessment

A

Pt exercise tolerance?
Physical limitations?
Supplemental oxygen requirements?
Establish baseline the assessment
Orthopedic limitations
Restrictions requiring modifications

28
Q

Pain assessment
Assess

A

Location
duration
intensity
character
What aggravates pain

29
Q

ADLs Assessment

A

Dyspnea Dec ADLs
-Functional task performance & work environment demands should be assessed, est. baseline
- Interview others for complementary information
- What info am be obtained in this assessment?

30
Q

Nutritional Assessment

A
  • Pts Significant alterations in nutritional status and body composition
  • Chronic disease caused increased energy expenditure during breathing, increased caloric needs
  • 40 to 60% of COPD patience, in adequate nutrition
  • Weight gain results of inactivity and medications
  • What should be included in assessment?
31
Q

What is the significant, independent predictor of mortality?

A

In adequate nutrition in COPD patients, 40 to 60%

32
Q

Patients that have weight gain from inactivity and medication as well also experience what?

A

Increase work of breathing and shortness of breath

33
Q

Educational assessment

A

Pt know about their disease and how to cope?
What should be included in an education assessment?
-Part of PR, along with log of documentation.

34
Q

Patience learn about their disease and how to cope in the education plan

A

Pretest to provide baseline for evaluating change and knowledge and method of documenting outcomes

35
Q

Psychosocial assessment

A
  • Screening questionnaire is to assess anxiety and depression
  • Failure to detect presence of dysfunction may result in poor progress in rehab
  • Patients with significant problems can be referred for further eval/treatment
  • What items should be included in this assessment?
36
Q

Goal development

A
  • Shared include short and long-term patient goals
  • Formulate goals with patient
  • Patient should have a clear understanding of goals and agreed to work toward attaining goals
37
Q

Example of formulating goals for the patient

A

Return to work, care for family, walked in mailbox, better understanding of disease

38
Q

The cornerstone of PR is

A

Assessment

39
Q

The best outcome and effectiveness a PR is?

A

Assessment

40
Q

Assessment can also prevent?

A

Potential complications of chronic disease

41
Q

Potential complications of chronic disease can be prevented by?

A

Assessment

42
Q

Assessment is the cornerstone to?

A

Best outcomes and effectiveness of PR

43
Q

Assessment can prevent

A

Potential complications of chronic disease

PR (8 decks)

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