Pulmonary Dysfunction

Question 1

Bacterial pneumonia

Answer 1

1. an intra-alveolar bacterial infection
2. aquired in community; pneumococcal pneumonia (streptococcal)-most common
3. developed in a host with chronic condition, acute illness, recent antibiotic therapy; usually reults in early tissue necrosis and abscess formation

acute diseases

Question 2

Viral pneumonia

Answer 2

1. an interstitial or interalveolar inflammatory process caused by viral agents
2. influenza, adenovirus, cytomegalovirus, herpes, parainfluenza, respiratory syncytial virus, measles

Question 3

Aspiration pneumonia

Answer 3

1. aspirated material causes an acute inflammatory reaction within the lungs
2. usually in person with dysphagia (impaired swallow)

Question 4

SARS

Answer 4

severe acute respritory syndrome; atypical respriatory illness caused by a cornavirus

Question 5

Tuberculosis (TB)

Answer 5

1. an airborne infection caused by a bacterium (mycobacterium tb)
2. 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
3. young/old higher risk, drug users
4. dx with chest x-ray; takes 10-12 wks after exposure to tB for a skin test to detect infection

Question 6

Symptoms of TB

Answer 6

1. bad cough for 2 weeks +
2. chest pain
3. blood-tinged sputum or phlegm
4. weakness/fatigue
5. weight loss
6. loss of appetite
7. chills/fever
8. night sweats

Question 7

COPD

description, S&S

Answer 7

1. peripheral airways disease inflammation of the distal conduting airways
2. 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

Question 8

chronic bronchitis

Answer 8

1. chronic inflammation of the tracheobronchial tree with cough and sputum production lasting at least 3 monts for two consevutive years

bronchial airway inflamed

Question 9

emphysema

Answer 9

1. condition in which** alveoli are gradually damaged**
2. affects gas exchange in lungs, losing their elasticity, becomes clogged, making it hard to breathe
3. ADL and IADLs affected

Question 10

Evaluation in Pulmonary Rehab

Answer 10

1. 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

Question 11

Intervention in pulmonary rehab

Answer 11

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

Question 12

Intervention for COPD

Answer 12

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

Question 13

pulmonary edema

Answer 13

Excessive of fluid from pulmonary vascular system into the interstitial space; may eventually cause alveolar edema

Question 14

Pulmonary emboli

Answer 14

A thrombus from the peripheral venous circulation **becomes embolic **and lodges in the pulmonary circulation

Question 15

Pleural effusion

Answer 15

Excessive fluid between the visceral and parietal pleura, caused mainly by increased pleural permeability to proteins from inflammatory disease…

Question 16

Atelectasis

Answer 16

**Collapsed or airless alveolar unit caused by hypoventilation **secondary to pain during the ventilator cycle, internal bronchial obstruction, …

Question 17

Cardiopulmonary Rehab
(Acute phase)

Answer 17

1. Occurs when pt. is medically stable from surgery
2. Monitor; asssess self care/mobility
3. If pain free with no arrhythmia, and has reg pulse (<100), initate activity program (education, EC, stress, prevent risk factors)
4. MET level=1-2; bed mobility, static standing; transfers, ADLs, sitting while groom at sink, W/C)
5. EC, breating ex. vitals
6. Precautions

3-5 days/up to 2-wks with complications

Phase 1: Acute Inpatient Rehab/Hospital sage

Question 18

Precautions

Answer 18

1. Avoid isometric muscle work, straining, breath holding (Valsalva)
2. Avoid overhead exercises or holding UEs over head for extensive time periods
3. Avoid lateral arm movements and exercises that stretch chest and pull incision
4. 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

Question 19

Outpatient Rehab

Answer 19

1. D/C from acute care at MET level 3.5
2. Educate
3. Build tolerance to activities
4. IADL/community/work
5. Home eval
6. Graded exercises
7. begin activity at MET 4-5, gradually
8. Contraindication: Acute MI (w/i 2 days); Acute PE, unstable angina; HTN, heart issues; tachyarrhythmiasbradyarrhytmias

Phase 2: Outpatient rehab

Question 20

Maintenance/Training Stage (Community Exercises Programs)

Answer 20

1. once per week following phase 2
2. Group exercises
3. IADL/leisure, work
4. Gym (weight training, cardio

Phase 3: Maintence/training

Question 21

Phase 1 intervention:

Answer 21

1. manage edema 2ndary to lymphatic dysfunction (short-stretch compression bandages 24hr/day)
2. Manual lymph drainage (MLD) with complete decongestive therapy (prox/trunk quadrant, then UE/LE) distal to prox
3. exercise/stretch low>mod intensity (aerobix ex) combined with rest; taichi/yoga (supports lymphatic drainage)
4. Relaxtion/EC
5. 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)

Question 22

Phase II intervention:

Answer 22

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)