PR2 Flashcards
Comprehensive Assessment
Patient Interview
Medical History
Physical Assessment
6 MWT/ Functional Testing
Psychosocial
Education/ Training
Nutritional Assessment
Goal Development
Comprehensive Assessment what do we know from
Patient’s rehab potential ascertained after assessment.
Sets foundation for PR program.
Precursor to education and training, psychosocial intervention, exercise and follow-up
Cornerstone to ultimate outcomes, program effectiveness, prevent potential complications of chronic respiratory disease.
Patient education and skills training
Goal: encourage behavioral change —> Improve health and a commitment to long-term adherence
Patient needs to understand underlying pulmonary disorder and principles of self management
Patient education primary objective
Primary objective: achieve optimal levels of understanding and self management
Patient education
Interdisciplinary team members represent a relevant information
I.e. Dietitian on nutrition
Patient education
Topics covered
Normal pulmonary anatomy & physiology
Pathophysiology lung dz
Description and interpretation of medical test
Breathing retraining
Bronchial hygiene
Medications, O2
Exercise principles
ADLs & energy conservation
Respiratory modalities
Self assessment and symptom management
Nutrition
Psychosocial issues
Advance directives
Exercise assessment
Used to
Quantify exercise capacity prior to program entrance
Establish baseline for outcome documentation
Assistant formulating exercise prescription
Text exercise induced hypoxemia an aid with those in supplemental oxygen
Evaluate non- pulmonary limitations to exercise
Helping to take the underlying cardiac abnormalities
Scream for exercise induced bronchospasm
Six minute timed WDT
Refer to form
Go over procedure
METS Calculated
METS Calculated
Level of energy expenditure at rest
Activities expressed as requiring a multiple of this resting requirement
Shuttle WDT measures
Symptom limited walking distance over a marked walking course of usually 10 meters
Shuttle WDT
Pacing timer
Patient walks according to pacing frequency until exhaustion
A test of endurance and the time WDT
Argue use less affected by the motivation, correlate better with exercise capacity it may be better indicator of functional change with exercise program.
Equipment needed for WDT assessment
Measured walking distance
manual BP equipment
stethoscope
pulse oximeter
supplemental 02 sore
stopwatch
Borg scale chart
walker, cart or wheelchair & supplies Test site personal training in BLS
Assess pt for also?
-Muscle strength and endurance
- Joint pains, limited range of motion,or both
- Oxygen needs
- Subjective of endurance and work tolerance
- Dyspnea
- Lack of understanding of fitness & exercise
- Fear of exertion
- Inability to pace activities
- Balance abnormalities
- Gait instability
- Pain level & locations
Respiratory or non-respiratory factors can decrease exercise tolerance in patient’s chronic lung disease
Cardiopulmonary or skeletal muscle dysfunction
Leg effort/ discomfort main symptoms that limits exercise in 40-50% of COPDers
Exercise Training
COPDers leg effort/ discomfort
- Characterized by reduction of muscle mass & strength
- Both resting and exercise muscle metabolism impaired
- Experience lower exercise tolerance and develop lactic acidosis
- Skeletal muscle dysfunction in COPD may cause by:
Exercise Training
COPDers leg effort/ discomfort
Skeletal muscle dysfunction caused by
Systemic inflammation
poor nutrition
aging
corticosteroids induce myopathy hypoxia
Disease affects of complicated by deconditioning
Patient assuming more sedentary lifestyle to avoid dyspnea
Dyspnea spiral affect
The conditioning leads to further the conditioning and increase exertional dyspnea
A formal access program to help
Reverse downward spiral
Improve function
address other factors limiting exercise
Other factors limiting exercise
Fear of dyspnea
psychological factors
Musicoloskeletal factors
Exercise should include
Lower & upper extremity endurance training
strength training
respiratory muscle training
Supervise exercise frequency and duration vary
3 to 5 times per week
30 to 90 minutes a session
4 to 12 weeks in duration
When are patients monitored
Beginning of session
after each exercise
conclusion of session
What is monitored during exercise training
BORG
RPE (Exertion)
Pain
SpO2, Maintain greater than or equal to 90%
HR
Exercise training techniques are based on
patient objectives and muscles needed for ADLs
Lower extremity exercise
Lower Extremity exercise
Walking
stationary cycle
Bicycling
stair climbing
swimming
Upper extremity training benefitial
COPD pt with
Altered ventilatory mechanics
Conjunction with lower extremity training
Upper extremity training benefits
Arm elevation associated with high metabolic/ ventilatory demand
Benefits usually task specific
Benefits of upper and lower exercise
Exercise
●Benefits of upper and lower exercise are multiple and can last for up to 1 year following a comprehensive program
●Upper Extremity:
●Improves arm exercise endurance
●Decreases O2 uptake during arm elevation
●Lower Extremity:
●Improves exercise performace
●Improves health-related quality of life
●Improves dypsnea
Strength Training
Strength training is beneficial and leads to greater exercise tolerance which may mean improved performance of ADLs.
●Hand and ankle weights
●Free weights
●Circuit resistance
●Therabands
