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PR > PR3 > Flashcards

PR3 Flashcards

1
Q

Most common disease referred to PR

A

COPD

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2
Q

PR still offers benefits for

A

Non COPD diseases and poses challenges for PR therapist

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3
Q

PR therapist need knowledge of

A

Knowledge of physiology
Modification of exercise & education

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4
Q

Asthma management

A

Goal: preserve lung function

Well controlled asthma = May, normal response to exercise

Evaluate for exercise induced bronchospasm

Warmup & cool down

Medication pre-exercise

Upper & lower extremity strength & endurance exercise

?Appropriate education topics for pt. & family??

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5
Q

Cystic Fibrosis (see what??)

A

Nutrition depletion
Obstructive lung dz characteristics
Exercise tolerance
Impaired quality of life

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6
Q

CF Education

A

-Pacing & energy conservation
-Pursed lip breathing
-Strategies, active- work, school, etc.
-Medication: and, steroids, bronchodilators, a/w clearance devices
- Maintenance, adequate nutrition

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7
Q

ILD is and what diseases?

A

-Group of disorders
-Characterized by: degree of inflammation, fibrosis or both in the interstitial or alveoli

-IPF
-Sarcoidosis
-Occupational dz
-Hypersensitivity pneumonitis; NSIP
-ARDS
-BOOP
-Drug induced lung dz

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8
Q

ILD, hallmark feature of dz

A

Exercise induced O2 desaturation

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9
Q

ILD, hypoxemia leads

A

-Increased PVR
-Increased work of heart
-Decreased O2 delivery to tissues
=Further impairs cardiac function &
& can lead to exertional dizziness
or syncope
=Pt. both circulatory & ventilatory
limitations to exercise

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10
Q

ILD & PR (3 area focus)

A

-EXERCISE: Upper & lower strength & endurance training
- Strong emphasis on pacing & energy conservation
= High FiO2 may be needed
- NUTRITION: counseling prevent muscle & wt loss
-EDUCATION:

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11
Q

ILD & PR (3 area focus) expanded

A

-EXERCISE: Upper & lower strength & endurance training
- Strong emphasis on pacing & energy conservation
= High FiO2 may be needed

  • NUTRITION: counseling prevent muscle & wt loss

-EDUCATION:
=Course if dz
=Supplemental O2
=Symptoms & 2ndry infection
=Prevention strategies
=Coping mechanisms

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12
Q

Pulmonary Hypertension is

A
  • Mean PAP > 25 torr @ rest or
  • > 30 torr during exertion
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13
Q

Pulmonary HTN may occur due to:

A
  • Process affecting commentary
    vascular bed
  • In conjunction of several respiratory
    system of diseases
  • Idiopathic: absence of identifiable
    cause or coexisting of disease
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14
Q

Pulmonary HTN characteristics symptoms include:

A
  • Exertional dyspnea
  • Chest pain
  • Fatigue
  • Palpitation
  • Dizziness
  • Hemoptysis
  • Severe - Lead to exercise induced
    syncope or sudden death.
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15
Q

Pulmonary HTN

Cardiocirculatory and gas exchange impairments cause

A
  • Decrease exercise capacity
  • Early onset lactic acidosis
  • Increase oxygen cost to work
  • Exercise induced dizziness or presyncope indicate severe disease
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16
Q

Pulmonary HTN
Medical therapy:

A

Anticoagulation therapy
Supplemental oxygen
Vasodilators
Oral
Continuous IV infusion
Lung transplantation, option.

17
Q

Pulmonary HTN benefits?

A

Usually considered for pre-transplantation

1 study showing benefits of pulmonary rehab for pulmonary HTN pt
= NIH
= 30% increased exercise
endurance

18
Q

Pulmonary HTN
Special considerations:

A

-Close supervision
BP
SpO2
-Optimize medical tx
-Close communication with patients, family, physicians
-O2 Sats > 90%
-Special steps to prevent falls
-Avoid high intensity exercise & Increase intrathoracic pressure

19
Q

Lung volume reduction surgery
(LVRS)

A

-Sx opt COPD, dz area of lung =apices
-Better life, not longer life
-GOAL:
improve expiratory flow rates
Minimize amt of a/w obstruction

20
Q

Lung volume reduction surgery
(LVRS)

A

= 20-30% top of each lung is removed
= Rest of lung, more room to breathe

21
Q

Lung by reduction surgery
Post operative

A

Less dyspnea
hypoxemia
work breathing
Greater exercise tolerance
Less need for a supplemental oxygen
Overall improvement and quality of life

22
Q

Lung volume reduction surgery
Qualifications for surgery

A

Smoking cessation
PFTs
Pulmonary rehab
6MWT & exercise tests
Height/ weight
ABG
CT Scan
Cardiac function test

23
Q

Lung transplantation
Pre-transplantation
Importance of pulmonary rehab

A

Optimize functional status before sx
Understand dz & tx regimen
Use of supplemental O2
Learn risk/benefits of transplantation
Exercise capacity predictor of outcome
PR, ID Sub optimal candidate for sx

24
Q

Lung transportation

A

Pt awaiting surgery should
=exercise close to highest workload they can tolerate
=Dz can progress so reassessment

25
Q

Lung transplantation

post transplantation

A

Functional disability exist due to skeletal muscle dysfunction

Muscle weakness persist up to 3 years

Peak exercise capacity decreased 40-60% predicted to 2 yrs

Muscle function improved with exercise training

26
Q

Long transplantation
Pulmonary rehab Postop

A
  • 24 hr post-op
    -Range of motion
    -Transfer activities, I.e. sit to stand
    -Breathing efficiency
    -A/w clearance techniques
    -Ambulation
    = Imp stability with correct posture
27
Q

Lung transplantation
Post transplantation education

A

-Maintenance of regular exercise
-Proper nutrition
-Recognition of symptoms and signs of infection or organ rejection (Piko spirometer)
-Long term adverse effects of immunosuppression
Neuropathy
Gait disturbances
Osteoporosis

PR (8 decks)

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