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Cardiopulmonary > Pulmonary Rehab > Flashcards

Pulmonary Rehab Flashcards

1
Q

Describe restrictive lung disease in general

A
  • Alveoli unable to expand due to lung scarring, fibrosis or mechanics resulting in inability to “get air in”
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2
Q

Common symptoms of restrictive lung disease

A
  • Shortness of breath (especially during exertion)
  • Limited chest wall mobility
  • Dry cough
  • Rapid, shallow breathing
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3
Q

Generally describe obstructive lung disease

A
  • Airways become narrow & blocked due to a thickening of the tissues, inflammation, alveolar hyperinflation and/or secretions resulting in air trapping & difficulty “getting air out”
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4
Q

Common symptoms of obstructive lung disease

A
  • Shortness of breath
  • Wheezing
  • Chronic cough
  • Prolonged exhalation
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5
Q

Why do pulmonary rehab or physical therapy

A
  • Loss of muscle mass
  • Decrease in function
  • Increase in body fat (associated with comorbid conditions)
  • Dyspnea/breathlessness
  • Cognitive deficits
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6
Q

Benefits and downfalls of pulmonary rehab

A
  • Improves patient outcomes & reduces hospital readmissions
  • Less than 2% of pts receive PR within 6 mo after a hospitalization
  • Only 6% of Medicare beneficiaries actually attend PR programs
  • Race/socioeconomic status are strongly associated with PR participation
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7
Q

What are the 4 essential areas of pulmonary rehab that require outcome measurements

A
  • Exercise capacity
  • Symptoms (dyspnea and fatigue)
  • Health related QoL
  • Psychosocial status
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8
Q

A physical therapist makes the greatest contributions in which areas of pulmonary rehab

A
  • Evaluation
  • Outcome measurement
  • Exercise & functional training
  • Airway clearance
  • Education
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9
Q

What are the most commonly used exercise tests for pulmonary rehab

A
  • CPET
  • Shuttle test
  • 6 minute walk test
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10
Q

What to look for on a breathing pattern assessment

A
  • Nose or mouth breathing: nasal health and structural issues
  • Apical (upper chest) vs diaphragmatic
  • Hyperventilation
  • Breath holding
  • Frequent yawning, sighs
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11
Q

Describe a breathing check in

A
  • When in doubt, breathe out
  • Posture check: jaw open, shoulders down, and belly relaxed
  • One hand on chest, one hand over belly button
  • Try breathing in through your nose, out through the mouth
  • Which hand moves more, top hand, bottom hand
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12
Q

Absolute contraindications to exercise testing

A
  • Acute MI within 2 days
  • Ongoing unstable angina
  • Uncontrolled cardiac arrhythmia with hemodynamic compromise
  • Active endocarditis
  • Symptomatic severe aortic stenosis
  • Decompensated HF
  • Acute PE, pulmonary infarction, or DVT
  • Acute myocarditis or pericarditis
  • Acute aortic dissection
  • Physical disability that precludes safe and adequate exercise testing
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13
Q

Is oxygen within the physical therapy scope to titrate as needed in order for patients to safely perform exercise (True/False)

A
  • True
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14
Q

Intervention strategies for pulmonary rehab

A
  • Breathing pattern re-training: nose, low and slow; focus on exhale vs inhale
  • Airway clearance: active cycle of breathing; flutter valve
  • CV exercise
  • Inspiratory muscle training
  • Functional resistance training: STS, push/pull, and lift/carry
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15
Q

Educational topics for pulmonary rehab patietns

A
  • Disease specific information (basic pathophysiology)
  • medication adherence
  • Symptom monitoring
  • Smoking cessation
  • Mental heath resources
  • Nutritional support
  • Local or web-based support groups
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16
Q

Risk factors for long covid

A
  • Lower socioeconomic positioning
  • Inability to convalesce (recover)
17
Q

What is included in the post acute sequelae of covid-19 (PASC)

A
  • Hx of probable or confirmed SARS-CoV-2 infection
  • Usually 3 mo from the onset of covid-19
  • Sx that last for at least 2 mo
  • Cannot be explained by an alternative diagnosis
18
Q

Hypothesized mechanisms of long covid

A
  • Immune dysregulation
  • Microbiota dysbiosis
  • Autoimmunity and immune priming
  • Blood clotting and endothelial abnormalities
  • Dysfunctional neurological signaling
19
Q

Describe post exertion symptom exacerbation (PESE) and post exertion malaise (PEM)

A
  • Sx are made worse by physical, cognitive, or emotional effort
  • Sx include: fatigue, exhaustion, pain, exercise intolerance, brain fog
  • May occur immediately or within 24072 hrs of activity/event
  • Recovery may take days/weeks
  • Results from the energy systems’ inability to recover/replenish after an effort
  • Screening for PEM/PESE is crucial in determination of safe rehab strategies
20
Q

What are the key symptoms of immediate, short term, and long term post exertion symptoms

A
  • Immediate: out of breath
  • Short term: brain fog
  • Long term: flu-like sx
21
Q

Using CPET to reliably detect small changes in cardiac, pulmonary, and metabolic status between days has been demonstrated in the following clinical populations:

A
  • PAH
  • HF
  • Cystic fibrosis
  • Stable angina
  • End stage renal disease
  • Fibrotic interstitial pneumonia
  • Valvular heart disease
22
Q

Post-Exertional Physiology in People with PESE all of the following decrease at peak exertion and at ventilatory anaerobic threshold

A
  • Volume of O2 consumed
  • Workload
  • Heart rate
  • volume of air cleared per minute
23
Q

Screening tools for PEM/PESE

A
  • DePaul Symptom Questionnaire
24
Q

Screening tools for dyautonomia

A
  • Malmo POTS Symptom Score
  • Compass 31
  • 10 minute stand test
  • Tilt table test
25
Q

Screening tools for joint hypermobility

A
  • Beighton assessment tool
26
Q

Diagnostic criteria for POTS

A
  • Sustained HR increase of ≥30 bpm or ≥40 bpm if pt is 12-19 y/o within 10 min of upright posture
  • Absence of significant OH Drop in BP by ≥20/10)
  • Frequent sx of OH that are worse while upright with rapid improvement upon return to supine
  • Sx duration ≥3 mo
  • Absence of other conditions that could explain sinus tachycardia
27
Q

PTOS management

A
  • 3L of water per day
  • 8-12g of sodium chloride per day
  • 30-40 mmHg waist high compression garments
  • 10 mmHg abdominal binder
  • Recumbent exercise and strength training
  • Mdications
28
Q

PT interventions for POTS

A
  • Energy conservation strategies
  • Symptom journals
  • HR biofeedback is available to determine energy envelope
  • Patient education: path to improvement may not be linear
29
Q

Describe how to stay in your energy envelope

A
  • Pace: to have better energy, protect energy systems that don’t appear to be working well
  • Project: determine top 3 sx limiting you, monitor them, and pay attention to your triggers
  • Plan: call for support, modify your ADLs, and break tasks into smaller parts all to conserve your energy

Cardiopulmonary (18 decks)

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