Pulmonary Dysfunction Flashcards
Bacterial pneumonia
- an intra-alveolar bacterial infection
- aquired in community; pneumococcal pneumonia (streptococcal)-most common
- developed in a host with chronic condition, acute illness, recent antibiotic therapy; usually reults in early tissue necrosis and abscess formation
acute diseases
Viral pneumonia
- an interstitial or interalveolar inflammatory process caused by viral agents
- influenza, adenovirus, cytomegalovirus, herpes, parainfluenza, respiratory syncytial virus, measles
Aspiration pneumonia
- aspirated material causes an acute inflammatory reaction within the lungs
- usually in person with dysphagia (impaired swallow)
SARS
severe acute respritory syndrome; atypical respriatory illness caused by a cornavirus
Tuberculosis (TB)
- an airborne infection caused by a bacterium (mycobacterium tb)
- Risk factors: HIV/AIDS, substance abuse, diabetes, scoliosis, cancer of head/neck, lukemia/Hodgkin’s disease, severe kidney disease, low body weight, steroid users/organ recipients
- young/old higher risk, drug users
- dx with chest x-ray; takes 10-12 wks after exposure to tB for a skin test to detect infection
Symptoms of TB
- bad cough for 2 weeks +
- chest pain
- blood-tinged sputum or phlegm
- weakness/fatigue
- weight loss
- loss of appetite
- chills/fever
- night sweats
COPD
description, S&S
- peripheral airways disease inflammation of the distal conduting airways
- associated with smoking
S&S
1. dyspnea on exertion
2. Enlarged anterior/posterior dimensions of chest wall “BARREL CHEST”, hypertrophied asccessory muscles for breathing forward learning posture
3. Chronic cough; sputum production
4. Disease advancement:
5. Cachectic; signs of R heart failure d/t 2ndary pulmonary HTN
chronic bronchitis
- chronic inflammation of the tracheobronchial tree with cough and sputum production lasting at least 3 monts for two consevutive years
bronchial airway inflamed
emphysema
- condition in which** alveoli are gradually damaged**
- affects gas exchange in lungs, losing their elasticity, becomes clogged, making it hard to breathe
- ADL and IADLs affected
Evaluation in Pulmonary Rehab
- patient’s medical history (diagnosis, severity,associated conditions, and secondary diagnoses), social history, diagnostic test results, medications, and precautions.
2.** Analysis of occupational performance: **identify impact on OP, pain/ angina (location/severity/type; Intermittent Claudication Rating Scale 0-4, 4 max pain); dyspnea (severity, position, or # of times experience of discomfort; fatigue/perceived exertion (severe, # of times with what activities; palpitations (awareness of heart rhythm abnormalities; dizziness (time/at what postural change); edema (measure, time if day, loc); activity tolerance
3.Vitals at rest
Intervention in pulmonary rehab
Intervention:
1. Relaxation/stress management
2. EC
3. Lifestyle changes
4. Education (disease process, managing symptoms ect)
5. Exercise (high and low intensity exercises; higher intensity is better; unsupported arm ex.; leg; O2 supplement)
6. Psychosocial (isolation, anxiety, depression, and passive acceptance)
7. mobility/transfers
Goal: stabilize or reverse disease process and return the patient’s function and participation to the highest capacity.
Vitals taken, before, during, after activity
Intervention for COPD
Smoking cessation
Short-acting and long-acting B2 agonist bronchodilators
Anticholinergic drugs to block bronchoconstriction; not first line of meds
Atrovent, Ventolin, Proventil, Maxair
Xanthine derivatives for bronchodilation, limitation of inflammatory response
theophylline
Corticosteroids for anti inflammatory effects
Vaccination against influenza and pneumoncoccus
Oxygen therapy (reduce SOB, dec pulm HTN, etc
Surgery
pulmonary edema
Excessive of fluid from pulmonary vascular system into the interstitial space; may eventually cause alveolar edema
Pulmonary emboli
A thrombus from the peripheral venous circulation **becomes embolic **and lodges in the pulmonary circulation
Pleural effusion
Excessive fluid between the visceral and parietal pleura, caused mainly by increased pleural permeability to proteins from inflammatory disease…
Atelectasis
**Collapsed or airless alveolar unit caused by hypoventilation **secondary to pain during the ventilator cycle, internal bronchial obstruction, …
Cardiopulmonary Rehab
(Acute phase)
- Occurs when pt. is medically stable from surgery
- Monitor; asssess self care/mobility
- If pain free with no arrhythmia, and has reg pulse (<100), initate activity program (education, EC, stress, prevent risk factors)
- MET level=1-2; bed mobility, static standing; transfers, ADLs, sitting while groom at sink, W/C)
- EC, breating ex. vitals
- Precautions
3-5 days/up to 2-wks with complications
Phase 1: Acute Inpatient Rehab/Hospital sage
Precautions
- Avoid isometric muscle work, straining, breath holding (Valsalva)
- Avoid overhead exercises or holding UEs over head for extensive time periods
- Avoid lateral arm movements and exercises that stretch chest and pull incision
- S&S that would make therapy a contraindication:
-uncontroled arrththmias, recent emobilism/thrombophlebitis; dissecting aneursym, severe aortic stenosis, acute systemic illness, acute MI (2 days), digoxin toxicity, acute hypoglycemia or metabolic disorder, 3rd degree heart block and unstable agnia
Outpatient Rehab
- D/C from acute care at MET level 3.5
- Educate
- Build tolerance to activities
- IADL/community/work
- Home eval
- Graded exercises
- begin activity at MET 4-5, gradually
- Contraindication: Acute MI (w/i 2 days); Acute PE, unstable angina; HTN, heart issues; tachyarrhythmiasbradyarrhytmias
Phase 2: Outpatient rehab
Maintenance/Training Stage (Community Exercises Programs)
- once per week following phase 2
- Group exercises
- IADL/leisure, work
- Gym (weight training, cardio
Phase 3: Maintence/training
Phase 1 intervention:
- manage edema 2ndary to lymphatic dysfunction (short-stretch compression bandages 24hr/day)
- Manual lymph drainage (MLD) with complete decongestive therapy (prox/trunk quadrant, then UE/LE) distal to prox
- exercise/stretch low>mod intensity (aerobix ex) combined with rest; taichi/yoga (supports lymphatic drainage)
- Relaxtion/EC
- Custom compression garment when limb reduction platues (4-6 months)
OT:
1. ADL, IADL, work leisure with adaptation PRN, EC to min. swelling, education, psychosocial)
Phase II intervention:
Self-management and daily home program
1. skin care
2. compression ban; lymp ban at night
3. exercise
4. MLD PRN
5. compression pumps: used with caution (limited benefits)
6. Education (infection, EC, skin nail care, self-ban)
