Pulmonary/cancer Flashcards
What does exercise do to AVO2?
Exercise increases arteriovenous oxygen (AVO2) Difference by increasing oxygen extraction from arterial circulation
What are the goals of pulmonary rehabilitation?
- Improvement cardio pulmonary function
- Prevention treatment complication
- Increased understanding Of the disease
- Increased patient responsibility for self-care and compliance with medical treatment
- Improvement in quality of life, capacity for activities of daily living, and return to work
Who benefit the most from pulmonary rehabilitation?
Patient to benefit the most from Pulmonary rehabilitation program have one of the following:
- respiratory limitation of exercise at 75% of predicted maximum O2 Consumption
- Obstructive airway disease with forced expiratory volume in one second (FEV1) < 2000 mL or FEV1/FVC Ratio of less than 60%, restrictive lung disease, or pulmonary vascular disease with carbon monoxide diffusion capacity <80% of predicted value.
51. How do you produce vibration to talk after a laryngectomy with tracheoesophageal fistula? A) prosthetic reed B) esophagus C) trachea D) pharynx
Answer: B
A voice disorder can be one of the first symptoms of laryngeal cancer. These patients may need to undergo partial or total laryngectomy. A partial laryngectomy may or may not affect vocal quality, however a total laryngectomy results in sudden and complete loss of voice. The post laryngectomy patient has several speaking and nonspeaking options.
Speaking Options
Tracheoesophageal shunt (invasive)
• one way valve permits air to pass from trachea into esophagus
• esophageal sound produced by aerodyanmics in the esophagus
Esophageal voice
• oral injection of air followed by vibrating expulsion
Electrolarynx prosthesis
Nonspeaking Options Writing Gestures Communication board Portable computer
- Which of the following are positive pressure ventilators?
Answer- Pneumobelts
When motor weakness or deformity sufficiently limits the pts. Ability to ventilate, mechanical ventilatory assistive devices are needed to allow for adequate ventilation. Early signs and symptoms of hypoxia include difficulty with sleping, nighttime dypnea, nightmares, and somnolence during the day. As these signs appear, appropriately prescribed ventilatory aids such as a cuirass or plastic wrap enhance gas exchange in the recumbent position. In the later stages of motor neuron disease, oral positive pressure ventilation, a pnemobelt or cuirass ventilators can be used throughout the day. Reference- Braddom, 2nd ed., pg 1017.
- When would you use non-continuous oxygen supplementation in a COPD patient?
Answer- when PO2 is less than 55 while exercising
Medicare will reimburse for oxygen use during exercise if SaO2 £ 88% or PaO2 £ 55 mm Hg with exercise or activity or if there is demonstration of increased exercise tolerance or endurance with oxygen in conjunction with a rehabilitation program.
See chart below for criteria regarding other non-continuous (i.e. noctural, stand-by) and continuous oxygen supplementation.
Medicare Guidelines for Home Oxygen Reimbursement
Type of Use Criteria
-Exercise / Activity-
(non-continuous)-
-SaO2 £ 88% with exercise or activity
-PaO2 £ 55 mm Hg with exercise or activity
-Demonstration of ¬exercise tolerance with oxygen use
-Nocturnal-
(non-continuous)
-Cor pulmonale or erythrocytosis with
• SaO2 £ 88% during sleep
• PaO2 £ 55 mm Hg during sleep
-Sleep-related hypoxemia is improved with oxygen use
-Intermittent / Stand-by
(non-continuous)-
- Bronchospasm, CHF, or other cardiopulmonary disease with
• SaO2 £ 88%
• PaO2 £ 55 mm Hg
-Long-Term
(continuous)-
- SaO2 £ 88% on room air
-PaO2 £ 55 mm Hg on room air
(document with 2 ABGs on RA at rest as an outpatient)
Reference- Practical Manual of PM&R (Tan): p 679-680
- Best treatment for mets. To the spine?
Answer- Radiation
Radiotherapy remains the mainstay of treatment for spinal metastatic disease. Most of the lymphoreticular tumors and prostate carcinoma are radiosensitive; lung and breast are less sensitive. Tumors of the gastrointestinal system and kidney are resistant to radiotherapy, as are melanomas. Nevertheless, radiotherapy has been offered to the latter group of patients and has demonstrated some response. The radiation port normally includes 2
vertebral bodies above and below the diseased segment. About 80% of patients with pretreatment pain have symptomatic relief; 48% of patients with motor or
sphincter dysfunction respond to treatment Reference, E-medicine- Metastsasis to the Spine.
- Which type of cancer most commonly metastasizes to the brain?
Answer- Skin melanoma
Primary Tumor Site Percent Lung 21% Breast 9% Melanoma, 40% Lymphoma, mainly non-Hodgkin 1% GI tract 3%, Genitourinary tract 11% Osteosarcoma 10% Head and
What organ has the highest rate of oxygen extraction?
Oxygen extraction can be assessed by ratio consumption in any organ in the body. The heart has the highest percentage of oxygen extraction.
How do you define cardiac output?
Heart rate times stroke volume. Evidence shows that cardiac rehabilitation increases maximum cardiac output overtime.
Describe total lung capacity
Volume at maximal inspiration to expand the lungs.
Describe functional residual capacity
Volume of air remaining at the end of normal exhalation
Residual volume
Well you were meeting in the lungs after maximal exhalation
Vital capacity
Volume of air that can be exhaled after maximal inspiration.
Expiratory residual volume
The amount of air that can be exhaled after normal expiration
