pulmonary disease exercise prescription Flashcards
in mild lung disease the spirometry testing is < ____ of predictive values of FEV1 but < ___ for FEV1/FVC
80%
70%
if static lung volume is between 80% -120% this it is ___, if it < 80% then it is ___ if it is > 120% then it is ___
normal
restrictive
obstructive
for moderate lung disease ___ is < 80% if predicated value
FEV1
exercise tolerance limited due to:
abnormal ventilatory responses
patient becomes SOB with mild activity
little ventilator reserve
in what lung disease
moderate
pateints with moderate lung disease will have mid to moderate ___ at rest
hypoxemia
which vital may not be the best to assess in patients with moderate lung disease bc meds can increase it
HR
in patients with severe lung disease the fev1 is < ___ of predicted values
50%
a patient with severe lung disease may have ___ ventricular dysfunction during exercise
right
poor ___ limits exercise capacity
oxygenation
what are some sings of poor oxygenation
SOB
decreases SaO2
retained secretions
cyanosis
what are clinical examples of poor oxygenation patients
Pneumonia, chronic bronchitis, cystic fibrosis
ventilatory pump dysfunction is due to ___ mm fatigue or weakness of ____
respiratory
diaphragm
ventilatory pump dysfunction is a precursor of pump failure and characterized by increased reliance on ___ mm and ____ retraction during exercise
accessory
costal
if O2 sat is < ___ stop exercise
88%
goal of supplemental O2 is to maintain O2 saturation at lease ___ - ____ without suppression of respiratory drive from CNS
88-92
ventilatory pump failure casues what nerve damage
phrenic
what type of breathing is present with ventilatory pump failure
paradoxical breathing pattern
the abdomen moves ___ and ribcage move ___ during inspiration for paradoxical breathing
inwards
outwards
what position may help a patient with paradoxical breathing pattern
leaning forward in a chair over abdominal binder bc helps add pressure to push dia[hragm up
what is defined as a mean pulmonary arterial pressure greater than 20 mmHg at rest and greater then 30 mmHg during exercise
pulmonary hypertension
how is pulmonary hypertension measured
swan gaze catheter
pulmonary hypertension is when MAP is ___ at rest and ____ during exercise
> 20
30
what is the hallmark sign of pulmonary hypertension
chronically elevated pulmonary artery [pressure
what are clinical examples of pulmonary hypertension
Advanced stage of COPD, Cor
Pulmonale, pulmonary fibrosis
is pulmonary hypertension (MAP) is between 40-50 what should you do as a PT
water symptoms and sit them down and change intensity
what is the cascade of events that can happen w someone with pulmonary hypertension if they experience sudden decrease in exercise capacity
increase hypoxia
increase pulmonary vascular resistance
decrease right SV
decreased Oxygenated blood volume to the left heart
decreased CO
Bp drops and patient becomes dizzy and lightheaded
what are some treatment options for poor oxygenation
Supplemental O2, bronchodilators,
effective airway clearance technique, mechanical
ventilators
what are some treatment options for ventilatory pump dysfunction
Supplemental O2 ,
facilitated breathing technique, exercise training
what are some treatment options for ventilatory pump failure
Forward leaning /abdominal
binder; facilitatory/ inhibitory breathing technique,
Ventilatory muscle training, purse-lip breathing
what are some treatment options for Pulmonary Arterial Hypertension
Supplemental O2, vasodilators
(Flolan, Ventavis, Viagra, Cialis, etc), Ca channel blockers, sitting
with arms supported and semi-fowler’s position
what are the acceptable parameters from initiation of PT for RR, HR , pulse ox , and supplemental O2
RR : < 40
HR : 60-120
PUlse ox: > 90%
supplemental: Spo2 > 90%
what are the reason to stop or modify pt intervention for RR , SpO2, HR and SBP
RR: unable to speak comfortably
SpO2 : < 85%
HR: decreased in 10 BPM
SBP: drop in > 10 mmhg
Obstructive lung disease: chronic bronchitis patients will have ___ of mucus , ___ endurance, ___ on light exertion , ___ of air way wall , ___ retention
hypersecretion
low
dyspnea
thickening
CO2
obstructive lung disease: emphysema patients will have ___ and destruction fo the terminal bronchiole and/or alveolar wall , ___ of the lung due to enchanced tissue ___
dilation
hyperinflation
compliance
both chronic bronchitis and emphysema patients will have reduced ___ and ____
FEV1
FEV1/ FVC
prob wont have a decreased in FVC
T/F: emphysema patients will have increased TLC
true
___ traingin shoudl be an integral part of the exercise program for COPD patients
resistance
what may be needed for both the emphysema and chronic bronchitis patients
extra nutritional support
for patients with COPD , increased dyspnea may be found with agressive ___ aerobic exercises
UE
what scale is a reliable measure during exercise for COPD patient
dyspnea
what level of SAO2 may require supplemental O2 during exercise for COPD patients
< 88%
T/F: you cane exercise a patient during acute pulmonary exacerbation
false
what grade on the dyspnea scale is stops for breath after walking 100 yards
4
what is the main limitation at peak exercise in patients with severe COPD
ventilatory limitations
As an alternative to using peak work rate or ሶ VO2peak to determine exercise
intensity, dyspnea ratings of between __ and __ on the Borg CR10 Scale may be used for COPD patients
3-6
Maximizing pulmonary function using ____ before exercise training in those with airflow limitation can reduce dyspnea and improve exercise tolerance from COPD patients
bronchodilators
Because individuals with COPD may experience greater dyspnea while performing ADL involving the upper extremities, include resistance exercises for the muscles of the ____
upper body
Supplemental oxygen is indicated for patients with a PaO2 < __ mm Hg or an SaO2 < __% while breathing room air for COPD patients
55
88
_____ muscle weakness is a contributor to exercise intolerance and dyspnea in those with COPD.
inspiratory
what breath sound may you hear with an asthma patient
wheezing
patients that have restrictive lung disease have a ___ in lung and cheat wall compliance
reduction
in restrictive lung disease if the RR is to high that leads to ___ anatomical dead space
increased
what is the positioning in bed for an obesity patient with restrictive lung diease
semifowlers or sidelying
if you are preforming a cardiopulmonary exercise test and VE max is 70% or height then the predicted MVV that what does that mean
respiratory system is the limiting factor
here are no clear guidelines for IMT although an intensity of the training load of > ___% of maximal inspiratory pressure has been recommended.
30
IMT improves ____ muscle strength and endurance, functional capacity, dyspnea, and quality of life which may lead to improvements in exercise tolerance
inspiratory
what are some symptoms with someone with asthma
wheezing
chest tightness
SOB
decreased FEV1 greater than the reduction of FVC
asthma is inflammation of the ___ ____
airway walls
asthma ____ mucus production
increased
asthma is ___ of the airway walls and ___ mm contraction
thickening
smooth
if your pateint has asthma and they are going to exercises ____ should be used before test and achieve at least a ___% improvement of FEV1
bronchodilators
12-15%
for asthma patients the Use of heart rate to set exercise intensity may not be appropriate due to
ventilatory limitations to exercise (T/F)
true
exercise induced asthma should be assessed with ____ ex tests:
vigorous
with people with obstructive lung diease you should considers using ____ based walking program with progressive increases in ___
interval
duration
in restrictive lung disease as the compliance ___ , TV ___ as well
decreased 2x
in RLD , transoulmonary pressure is ___ which increased the work to achieve TV breathing
increased
in RLD , as RR increased , TV decreased to maintain what
minute ventilation
what are pulmonary causes of RLD
atelectasis
pneumonia
brhonchiogenic CA
in RLD, what are the 3 things exercise / activity consideration are based on
ventilatory compromise
hemodynamic stability
immunologic responses
if a patient has a C5 or higher SCI what will be weak and what kind of breathing pattern will they have
diaphragm will be weak
Paradoxical breathing pattern
what training do we do for inspiratory mm weakness with RLD
Inspiratory mm training
if your patient has ASL (RLD) you want to refrain from ___ physical exertion
excessive
what do you want to teach your pateints with ALS (RLD)
breathing techniques
what are the 3 exercises you should teach your pateint with kyphoscoliosis
breathing / chest wall expansion exercise (segmental breathing)
extension based strengthening
active breathing exercsies
what are 4 thing you want to teach your pateint wiht anklyosing Spondylitis (RLD)
patient positioning in extension
trunk extensor and scapula retractor strengthening
activit breathing exercsies
thoracic mob techniques
pateint with RA (RLD ) have may ___ and ___ complication
cardiovascular and pulmonary
pateint RA (RLD) will have ___ VC , lung compliance and diffusion gradient
decreased
patients with RA (RLD) have pleural ____ , effusion and interstitial ___
thickening
fibrosis
patients with RA may have pulmonary ___ and pulmonary ___
HTN
vasculitis
pateints with connective tissue disease for RLD may have steroid induced weakness of what mm
diaphragm
what are some symptoms of Lupes (RLD)
SOB, hypoxemia, cyanosis, tachypnea, tachycardia
Lupes (RDL) may lead to what
interstitial pulmonary fibrosis
what is Antigen-antibody reactions that affect the skin, joints, kidneys, lung, heart and nervous
system
SLE
50-90% of SLE involves the ___
lung
Lupes , SLE , RA pateints typical have ____ weakness , elevated and ___ diaphragm , and weakness in other ___ MM
diaphragmatic
shortened
inspiratory
what is a RLD that is Progressive fibrosis of lung, heart, skin, kidney, GI tract, vascular system
scleroderma
what is the pateint RX for scleroderma
IMT
Active cycle breathing
Segmental breathing
Positioning education
Thoracic mobilization
ROM and strengthening of trunk extensors , UEs and LEs
what metabolic disease Leads to hypoventilation syndrome and is also a RLD
obesity
patients wiht obesity have RLD and the diaphragm is forced ___ due to ___ abdominal pressure
upwards
increased
patients with obesity have RLD and have ___ compliance of the chest wall
decreased
pateint with obesity have RLD and this promotes early airway ___ and ___ lung expansion
closure
decreased
what is the PT RX for patients with obesity and RLD
Positioning in bed:
Semifowlers
Sidelying
Referral to dentist and physician for sleep appliance and / or CPAP machine
