PR3 Flashcards
Most common disease referred to PR
COPD
PR still offers benefits for
Non COPD diseases and poses challenges for PR therapist
PR therapist need knowledge of
Knowledge of physiology
Modification of exercise & education
Asthma management
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??
Cystic Fibrosis (see what??)
Nutrition depletion
Obstructive lung dz characteristics
Exercise tolerance
Impaired quality of life
CF Education
-Pacing & energy conservation
-Pursed lip breathing
-Strategies, active- work, school, etc.
-Medication: and, steroids, bronchodilators, a/w clearance devices
- Maintenance, adequate nutrition
ILD is and what diseases?
-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
ILD, hallmark feature of dz
Exercise induced O2 desaturation
ILD, hypoxemia leads
-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
ILD & PR (3 area focus)
-EXERCISE: Upper & lower strength & endurance training
- Strong emphasis on pacing & energy conservation
= High FiO2 may be needed
- NUTRITION: counseling prevent muscle & wt loss
-EDUCATION:
ILD & PR (3 area focus) expanded
-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
Pulmonary Hypertension is
- Mean PAP > 25 torr @ rest or
- > 30 torr during exertion
Pulmonary HTN may occur due to:
- Process affecting commentary
vascular bed - In conjunction of several respiratory
system of diseases - Idiopathic: absence of identifiable
cause or coexisting of disease
Pulmonary HTN characteristics symptoms include:
- Exertional dyspnea
- Chest pain
- Fatigue
- Palpitation
- Dizziness
- Hemoptysis
- Severe - Lead to exercise induced
syncope or sudden death.
Pulmonary HTN
Cardiocirculatory and gas exchange impairments cause
- Decrease exercise capacity
- Early onset lactic acidosis
- Increase oxygen cost to work
- Exercise induced dizziness or presyncope indicate severe disease
Pulmonary HTN
Medical therapy:
Anticoagulation therapy
Supplemental oxygen
Vasodilators
Oral
Continuous IV infusion
Lung transplantation, option.
Pulmonary HTN benefits?
Usually considered for pre-transplantation
1 study showing benefits of pulmonary rehab for pulmonary HTN pt
= NIH
= 30% increased exercise
endurance
Pulmonary HTN
Special considerations:
-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
Lung volume reduction surgery
(LVRS)
-Sx opt COPD, dz area of lung =apices
-Better life, not longer life
-GOAL:
improve expiratory flow rates
Minimize amt of a/w obstruction
Lung volume reduction surgery
(LVRS)
= 20-30% top of each lung is removed
= Rest of lung, more room to breathe
Lung by reduction surgery
Post operative
Less dyspnea
hypoxemia
work breathing
Greater exercise tolerance
Less need for a supplemental oxygen
Overall improvement and quality of life
Lung volume reduction surgery
Qualifications for surgery
Smoking cessation
PFTs
Pulmonary rehab
6MWT & exercise tests
Height/ weight
ABG
CT Scan
Cardiac function test
Lung transplantation
Pre-transplantation
Importance of pulmonary rehab
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
Lung transportation
Pt awaiting surgery should
=exercise close to highest workload they can tolerate
=Dz can progress so reassessment
Lung transplantation
post transplantation
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
Long transplantation
Pulmonary rehab Postop
- 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
Lung transplantation
Post transplantation education
-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
