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DPT 770 - Cardiopulmonary II & Lymphatics > Pulmonary Rehab > Flashcards

Pulmonary Rehab Flashcards

1
Q

What is Pulmonary Rehabilitation (PR)?

A

Pulmonary Rehabilitation (PR) is a comprehensive intervention for patients with chronic respiratory diseases aimed at improving exercise tolerance, reducing symptoms, and enhancing quality of life.

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2
Q

Define COPD.

A

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease characterized by chronic airflow limitation, typically caused by smoking or long-term exposure to irritants.

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3
Q

What is the 6-Minute Walk Test (6MWT)?

A

The 6-Minute Walk Test (6MWT) is a standardized test to assess functional exercise capacity by measuring the distance a patient can walk on a flat surface in six minutes.

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4
Q

What does Dyspnea mean?

A

Dyspnea refers to the sensation of shortness of breath or difficulty breathing, commonly experienced by patients with pulmonary diseases.

  • Working up to 3-5/10
  • Not past 5/10
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5
Q

Define Hypercapnia.

A

Hypercapnia is an elevated level of carbon dioxide (CO2) in the blood.

  • Resulting from inadequate ventilation in patients with pulmonary conditions.
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6
Q

What is the purpose of airway clearance techniques?

A

Airway clearance techniques aim to remove mucus and other secretions from the airways, improving lung function and reducing infection risk in pulmonary patients.

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7
Q

What is a contraindication for pulmonary exercise?

A

Contraindications include

  • chest pain
  • severe dyspnea (Dyspnea score of 5 or more)
  • dizziness
  • muscle pain that does not improve with rest
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8
Q

Define Energy Conservation in pulmonary rehab.

A

Energy conservation involves techniques that minimize fatigue by planning activities and using proper body mechanics to reduce energy expenditure.

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9
Q

What are accessory muscles in breathing?

A

Accessory muscles in breathing (sternocleidomastoid and intercostal muscles) assist respiration when primary muscles (e.g., diaphragm) are insufficient.

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10
Q

Define Valsalva Maneuver and why it should be avoided.

A

The Valsalva Maneuver is a forceful exhalation against a closed airway, which can cause a dangerous spike in blood pressure and should be avoided during exertion.

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11
Q

What are the main objectives of pulmonary rehabilitation?

A
  • improve exercise tolerance
  • reduce symptoms (e.g., dyspnea)
  • enhance quality of life
  • increase functional mobility
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12
Q

What are the common clinical indications for pulmonary rehabilitation?

A

Indications include

  • COPD
  • respiratory impairment with dyspnea (at rest or exertion)
  • hypoxemia = low blood oxygen levels
  • hypercapnia = high blood CO2
  • reduced exercise tolerance
  • decreased ability to perform ADLs
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13
Q

What does a typical patient assessment in pulmonary rehab involve?

A
  • reviewing medical history
  • assessing cardiopulmonary function (e.g., vitals, breathing patterns)
  • ROM
  • MMT
  • edema
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14
Q

What are the core components of exercise prescription in pulmonary rehab?

A
  • aerobic exercises (low, moderate, high intensity)
  • resistance training
  • flexibility exercises
  • interval training

All tailored to individual tolerance and goals.

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15
Q

What are the primary roles of physical therapy in pulmonary rehab?

A
  • administering tests like the 6MWT
  • creating individualized exercise prescriptions
  • teaching airway clearance techniques
  • promoting energy conservation strategies
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16
Q

What are the contraindications for exercise in pulmonary rehab?

A

Symptoms such as:

  • chest pain
  • severe dyspnea (Dyspnea score ≥ 5)
  • dizziness
  • non-resolving muscle pain
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17
Q

What is the significance of interval training in pulmonary rehab?

A

Interval training allows patients who cannot tolerate sustained high-intensity exercise to still gain benefits like increased VO2 max and efficient breathing patterns.

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18
Q

How is self-management education integrated into pulmonary rehab?

A

It includes teaching patients about their condition, breathing strategies, airway clearance, medication use, energy conservation, and recognizing exacerbation signs.

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19
Q

Why is goal setting important in pulmonary rehab, and what are standard goals?

A
  • Goal setting provides clear targets for progress.
  • Standard goals include performing activities for longer durations, achieving 150 minutes of activity per week, and improving oxygen needs through activity.
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20
Q

Exercise prescription - Aerobic exercise:

  • Frequency = ?
  • Intensity = ?
  • Time = ?
  • Type = ?
A

Exercise prescription - Aerobic exercise:

- Frequency:

  • 3-5 days/week

- Intensity:

  • Target HR is typically not used as individuals tend to stop at low HR due to ventilatory limits
  • Base off patient tolerance
  • Using dyspnea rating reported at submax exercise level during exercise test
  • Maintain O2 sat >90%
  • Work up to a RPE of 12-16

- Time:

  • Minimum of 30 minutes of accumulated exercise per session
  • Interval training may be appropriate for patients who cannot continuously exercise

- Type:

  • Walking, running, bucycling, swimming
21
Q

Exercise Type for Conditioning in Pulmonary Rehab

  • Upper body = ?
  • Lower body = ?
  • Combined = ?
A
22
Q

High intensity interval training in pulmonary rehab guidelines

A

- High Intensity (60-80%) used to gain:

  • Increased VO2max
  • Decreased HR for any given work rate
  • Lower ventilatory requirement for a given task
  • More efficient pattern of breathing

- Interval training is a good option for patients who cannot tolerate sustained high-intensity training

- Important to know:

  • Lower intensity aerobic exercise in patients with COPD can still lead to significant improvements in exercise endurance
23
Q

.

A

.

24
Q

Resistance Exercise Guidelines

A

Frequency:

  • 2-3 days/week

Intensity:

  • Strength: 60-70% of 1-RM for beginners
  • Experienced weight trainers >/= 80% 1-RM
  • Endurance: < 50% of 1-RM
  • Assessment of dyspnea or RPE

Time:

  • Strength: 2-4 sets, 8-12 reps
  • Endurance: </= 2 sets for 15-20 reps

Type:

  • Weight machines, free weight, body weight exercises
25
Q

How would you differentiate between hypoxemia and hypercapnia?

A
  • Hypoxemia refers to low oxygen levels in the blood
  • Hypercapnia is an elevated level of carbon dioxide (CO2) in the blood, often due to inadequate ventilation.
26
Q

Flexibility Exercise Guidelines

A

Frequency:

  • 2-3 days/week
  • Daily is the most effective

Intensity:

  • Stretch to the point of feeling tightnes or slight discomfort

Time:

  • 10-30 seconds for static stretching, 2-4 reps of each exercise

Type:

  • Staticc, dynamic, or PNF
27
Q

When would you decide to stop exercise in a pulmonary rehab session?

A

Exercise should be stopped if the patient experiences

  • severe dyspnea (score ≥ 5)
  • chest pain
  • dizziness
  • fainting
  • muscle pain that does not resolve
  • unusual sweating
28
Q

How do airway clearance techniques improve pulmonary function?

A
  • helps remove mucus and secretions
  • improving ventilation
  • reducing infection risk
  • enhancing overall lung function.
29
Q

Differentiate between aerobic and resistance exercises in pulmonary rehab.

A
  • Aerobic exercises improve cardiovascular endurance and VO2 max
  • Resistance exercises target muscle strength and support functional tasks.
30
Q

Exercise Condsiderations

Aerobic Activity

A

Aerobic Activity:

  • Patients will start with poor activity tolerance
  • Start low, goal is to walk for longer periods of time
  • Manage SpO2 and dyspnea levels throughout
  • Walking may be most beneficial in improving functional mobility
  • LE training results in most dramatic increase in exercise tolerance
31
Q

Exercise Condsiderations

Strengthening & Flexibility

A

Strengthening & Flexibility:

  • Controlled breathing with each repetition
  • Resistive exercise are beneficial in improving QoL
  • Flexibility is important in improve posture, ROM
32
Q

How would you tailor a pulmonary rehab program for a patient with severe COPD?

A
  • focus on lower-intensity aerobic exercises
  • interval training
  • breathing techniques
  • gradually increase activity tolerance with close monitoring of symptoms
33
Q

Explain the relationship between oxygen titration and activity in pulmonary rehab.

A

Oxygen titration ensures adequate oxygen delivery during activity, helping to maintain saturation levels and reduce dyspnea as tolerance improves.

34
Q

What are the components of a cardiopulmonary assessment for pulmonary patients?

A

Vitals, breathing patterns, use of accessory muscles, chest examination (palpation, percussion, symmetry), and cardiac function (rate, rhythm).

35
Q

What factors determine the intensity of an aerobic exercise prescription?

A
  • patient tolerance
  • baseline functional capacity
  • symptom management (e.g., dyspnea)
  • target heart rate zones
36
Q

Differentiate between the Valsalva maneuver and normal exhalation during exercise.

A
  • The Valsalva maneuver involves forceful exhalation against a closed airway, risking blood pressure spikes
  • Normal exhalation allows steady airflow and oxygen exchange.
37
Q

How would you modify exercise prescription for a patient experiencing significant fatigue?

A
  • lower the intensity
  • incorporate interval training
  • include frequent rest breaks to manage fatigue while maintaining engagement
38
Q

Why is patient goal-setting critical in pulmonary rehab?

A

It motivates patients by providing measurable milestones and ensures interventions align with individual needs and functional goals.

39
Q

How would you assess the effectiveness of a pulmonary rehab program?

A

By tracking outcomes such as improvements in 6MWT distance, reduced dyspnea scores, enhanced quality of life metrics, and patient-reported activity levels.

40
Q

A patient with COPD reports increased dyspnea during low-intensity exercise.

  • What steps should you take?
A
  • Stop the exercise, monitor vitals, assess oxygen saturation, and provide breathing techniques to reduce dyspnea.
  • Consider adjusting the exercise intensity or incorporating more rest periods.
41
Q

You observe a patient using accessory muscles during breathing during a 6MWT.

  • What does this indicate?
A
  • This indicates increased respiratory effort and potential ventilatory limitation.
  • Adjust exercise intensity and teach diaphragmatic breathing techniques.
42
Q

During a pulmonary rehab session, a patient complains of chest tightness and dizziness.

  • What is your immediate response?
A

Stop the session immediately, assess vitals, monitor for signs of cardiac distress, and seek medical assistance if symptoms persist.

43
Q

A patient with severe COPD struggles to complete the 6MWT due to fatigue.

  • How would you modify their exercise program?
A

Incorporate interval training with frequent rest periods, lower exercise intensity, and introduce light resistance training to build endurance gradually.

44
Q

A patient with pulmonary fibrosis demonstrates poor oxygen saturation (< 88%) during exercise.

  • What adjustments would you make?
A
  • Titrate supplemental oxygen as needed, lower exercise intensity, and prioritize endurance exercises within a safe oxygen saturation range.
45
Q

How would you educate a patient on energy conservation techniques for ADLs?

A

Teach them to plan activities, use assistive devices, take frequent rest breaks, and avoid overexertion to manage fatigue effectively.

46
Q

A patient with COPD reports difficulty using their inhaler.

  • What would you do?
A
  • Assess their technique, provide a demonstration, and educate them on proper inhaler use.
  • Consider alternative devices if challenges persist.
47
Q

During a group pulmonary rehab class, a patient experiences leg cramping and sweating.

  • How should you proceed?
A
  • Pause the exercise, assess hydration status, monitor vitals, and provide rest.
  • Adjust the exercise program to prevent recurrence.
48
Q

A patient has difficulty performing diaphragmatic breathing.

  • What strategies can you use to help them improve?
A

Provide visual and tactile feedback, practice in a supported position (e.g., semi-reclined), and use verbal cues to guide breathing patterns.

49
Q

A patient’s dyspnea score increases to 5 during moderate exercise.

  • What is your next step?
A

Stop the exercise, implement recovery techniques like pursed-lip breathing, and reassess before resuming activity at a lower intensity.

DPT 770 - Cardiopulmonary II & Lymphatics (14 decks)

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