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Cardio/Pulm/Peds Part I > Pulmonary Rehab > Flashcards

Pulmonary Rehab Flashcards

1
Q

Pulmonary rehab is a _____ based, _____ and _____ intervention for clients

A

evidenced based
multidisciplinary
comprehensive

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2
Q

Evidence-based, multidisciplinary, and comprehensive intervention for clients with: (2)

A

Evidence-based, multidisciplinary, and comprehensive intervention for clients with:
symptomatic chronic respiratory diseases
decreased daily life activities

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3
Q

Individualized treatment in pulmonary rehab is designed to

  1. reduce ____
  2. Optimize ____
  3. Increase participation in _____
  4. Reduce _____
A

reduce symptoms,
optimize functional status
increase participation in functional activities
reduce health-care costs through stabilizing or reversing systemic manifestations of the disease

**INDIVIDUALIZED

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4
Q

Comprehensive pulmonary rehab programs include (4)

A

patient assessment
exercise training
education
psychosocial support

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5
Q

Successful pulmonary rehab programs are ____ and ____ and includes both ____ and ____ function.

A

Multidisciplinary: Programs utilize expertise from various disciplines (PT, OT, RT, psychology, dietary)
integrated into a cohesive, comprehensive program.

Individualized:
Individual assessment of needs
individual attention, with realistic individual goals.

Include both physical and social function:
Pay attention to psychological, emotional, and social problems
Optimize medical therapy to improve lung function and exercise tolerance

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6
Q

What are the two ways that pulm rehab helps with 1A evidence?

A

improves symptoms of dyspnea

improves health related quality of life

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7
Q

pulm rehab reduces # of hospital days and other measures of healthcare utilization

what level of evidence?

A

2B

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8
Q

Pulm rehab is cost effective

what level of evidence?

A

2C

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9
Q

Pulm rehab shows psychosocial benefits

what level of evidence?

A

2B

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10
Q

What are the two general types of breathing problems in pulm disease?

A

restrictive or obstructive
difficulty getting all the air in (restrictive)
Difficulty getting all the air out (obstructive)

These terms refer only to how a respiratory problem affects a patient’s breathing pattern;
they say nothing about cause, treatment, X­ray appearance, or prognosis

Obstructive and restrictive problems are frequently seen together in one disease

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11
Q

Definition FVC

A

The summation of Inspiratory reserve volume (IRV), Tidal volume (TV), and Expiratory reserve volume (RV)

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12
Q

What are the three most important measures on the PFT

A

FVC
FEV1
FEV1/FVC ratio

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13
Q

FEV1 definition

A

Forced expiratory volume in 1 second. FEV1

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14
Q

What will the FEV be compared to FVC
Obstructive:
Restrictive:

A

Obstructive: small FEV compared to FVC

Restrictive: Both small but comparable to one another

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15
Q 
Obstructive pattern: 
FVC: 
FEV1: 
FEV1/FVC
Total lung capacity:
A

decreased or normal
decreased
decreased
normal or increased

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16
Q 
Restrictive pattern
FVC: 
FEV1: 
FEV1/FVC
Total lung capacity:
A

decreased
decreased or normal
normal
decreased

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17
Q

Pathology?

Patient is unable to take a full deep breath and fully expand the lungs

A

restrictive lung disease

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18
Q

Restrictive lung disease:

Pathology lies in: (3)

Once air is inhaled, patients with restrictive disease can _____ without any trouble.

A

lung, chest wall, neuromuscular system

exhale without any impediment

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19
Q

Name 4 common causes for restrictive lung disease in the rehab world

A

pulm fibrosis
scoliosis
kyphosis
neuromuscular disease

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20
Q

What are 6 common intrinsic causes of restrictive lung disease?

3 extrinsic?

A 
Intrinsic
Idiopathic pulmonary fibrosis
Idiopathic interstitial pneumonia
Sarcoidosis
Asbestosis
ARDS - Adult Respiratory Distress Syndrome
Drug toxicity: Amiodarone, Methotrexate

Extrinsic
Neuromuscular diseases: Myasthenia gravis, GBS
Kyphosis
Obesity

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21
Q

Pathology?

Patient may be unable to take in a full, deep breath and fully expand the lungs – usually due to air “trapped” in the lungs at end inspiration (elevated FRC –functional residual capacity)

A

obstructive lung disease

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22
Q

Obstructive lung disease is due to ______

A

lung parenchymal disease (loss of elastic recoil)

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23
Q

In obstructive lung disease, once air is inhaled, patients can _____

A

CANNOT exhale completely due to airway collapse and trapping of air.

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24
Q

What are three causes of COPD

A

1 emphysema

  1. chronic bronchitis
  2. alpha 1-antitrypsin deficiency
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25
______ is a dilatation of airway due to inflammation and destruction of the bronchi. what type of lung disease?
bronchiectasis obstructive
26
______ Autosomal recessive disease characterized by abnormal chloride/sodium transport – characterized by thick viscous secretions what type of lung disease?
Cystic fibrosis commonly obstructive and restrictive
27
_____ is a inherited protein that is made by the _____ and is a "lung protector"
alpha 1 antitrypsin (AAT) liver
28
alpha 1 antitrypsin (AAT) is responsible for ______ % of emphysema in the US
2-3%
29
alpha 1 antitrypsin (AAT) emphysema of americans: ____ descent ______ americans carry a single deficient gene _______ carriers
100,000 Americans - northern European descent 20 million Americans carry a single deficient gene may pass the gene onto their children 116 million carriers among all racial groups
30
two main symptoms of alpha 1 antitrypsin emphysema: Rarely appear before ____ In smokers, symptoms occur between ______ and ____ years ______ significantly increases the severity
Symptoms - shortness of breath and decreased exercise capacity rarely appear before 25 years of age in nonsmokers In smokers, symptoms occur between 32 and 41 years Smoking significantly increases the severity
31
COPD is a disease state characterized by ______ Usually _______ Usually associated with an abnormal ______ response of the lungs ______ with bronchodilator meds Commonly associated with ______ Usually seen in _____ life
COPD - a disease state characterized by airflow limitation that is: Usually progressive Usually associated with an abnormal inflammatory response of the lungs (infection or noxious particles or gases) Not fully reversible with bronchodilator meds Commonly associated w/ long smoking history Usually seen in mid-life Assoc. with emphysema and chronic bronchitis
32
Name the four common changes in lung parenchyma in COPD
1. destruction of pulm capillary bed 2. alveolar wall destruction 3 loss of elasticity 4 increased inflammatory cells: macrophages, CD8 lymphocytes
33
Four most common symptoms of COPD
Chronic cough Sputum production Dyspnea on exertion (DOE) Decreased O2 via pulse oximetry with exertion (this may not routinely be measured by individuals at home) NOTE: Not all people with cough and sputum production go on to develop airflow limitation and therefore COPD
34
What does GOLD stand for?
Global INitiative for Chronic obstructive lung disease
35
GOLD formed in _____
1998
36
GOLD did what 5 things
``` Offered a framework for management of COPD for healthcare professionals Increased awareness Educational source Promote research Encourage collaboration ```
37
what is the GOLD definition of airflow limitation
FEV1/FVC <70%
38
symptoms (3) + exposure to risk factors (3) = spirometry
S: cough, sputum, SOB RF: tobacco, occupation, indoor/outdoor polution
39
FEV1 and FVC in COPD patients is _____ compared to normal patients
higher "trapped air in"
40
_____ is improvement in airflow limitation in response to a bronchodilator or oral inhaled corticosteroid
reversibility
41
What is the gold definition of reversibility?
increase in FEV1 by 12% after treatment with a bronchodilator or corticosteroid
42
``` Test question A patient recently seen for evaluation for outpatient pulmonary has an FEV1 of 35% According to to the GOLD classification criteria she is considered a Stage I mild Stage II moderate Stage III severe Stage IV very severe ```
stage III severe
43
what is the GOLD classification criteria for COPD
Stage I: Mild FEV1 > 80% predicted w/ symptoms Stage II: Moderate 50% > FEV1 < 80% predicted Stage III: Severe 30% > FEV1 < 50% predicted Stage IV: Very Severe FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure
44
Test question: Chronic Obstructive Lung Disease (COPD) is: A Characterized by airflow limitation B Associated with an abnormal inflammatory response C Not fully reversible D Associated with long smoking history E All of the above
E
45
COPD is the _____ leading cause of death in the world (2012)
3rd | behind stroke and ischemic heart disease
46
Name the 10 leading causes of death in the world
``` ischemic heart disease stroke COPD Lower resp infection trachea/bronchitis HIV/AIDS diarrheal diseases DM road injury HTN ```
47
COPD killed ______ americans in 2010
134,676
48
Prevalence of COPD in 2011 (age > 18)
12.7 million US adults
49
COPD is significantly ______
underdiagnosed 24 million have evidence of impaired lung function
50
what region is leading the US in prevalence of COPD? (percentage?)
east south central (KY, TN, MS, AL) 7.5%
51
Who is the lowest prevalence of COPD (percentage?)
pacific (WA, OR, CA, HA, Alaska) 3.9%
52
Prevalence of COPD among adults > 18 yoa by sex:
Women > Men EXCEPT in age 75-84 when men predominate
53
Risk factors for COPD (10)
1. genetic 2. exposure to particles (tobacco smoke, occupational dusts organic and inorganic, indoor air pollution from heating/cooking in poorly ventilated dwellings, outdoor air pollution) 3. Lung growth and development 4. Oxidative stress (production of free radicals) 5. Gender 6. AGe 7. Respiratory infections 8. Socioeconomic status 9. Nutrition 10. Co-morbidities (asthma)
54
what is the primary risk factor for COPD? _____% of COPD deaths due to this.
smoking 80%
55
female smokers _____ times as likely to die as non smokers male smokes ____ times as likely to die as non-smokers _____ is becoming much more of a concern
13 12 second hand smoke
56
Occupational exposure to _____ increases risk for COPD _____% overall and _____% among never smokers
industrial pollutants 19. 2% overall 31. 1%
57
of hospital discharges in 2010 associated with COPD
715000 65% of discharges > 65 years and older population
58
what dx? ``` Onset early in life (often childhood) Symptoms vary from day to day Symptoms at night/early morning Allergy, rhinitis, and/or eczema Family history of asthma Largely reversible airflow limitation ```
asthma Note: 40% COPD patients amy have asthmal dual dx of COPD and asthma increases with age
59
Dx? ``` Onset in mid-life Symptoms slowly progressive Long smoking history Dyspnea during exercise Largely irreversible airflow limitation ```
COPD
60
______ is also a risk factor for COPD!
asthma
61
COPD patients are at increased risk for (6)
``` Myocardial infarction, angina Osteoporosis Respiratory infection Depression Diabetes Lung cancer ```
62
COPD has significant extra-pulmonary systemic effects including: (3)
weight loss nutritional abnormalities skeletal muscle dysfunction
63
two ways to measure severity of disease clinically
Pulm fuction tests (FEV1) | Six minute walk test
64
What is the Borg Dyspnea scale?
``` 0 Nothing at all  0.5 Very, very slight (just noticeable)  1 Very slight  2 Slight 3 Moderate  4 Somewhat severe  5 Severe  6- 7 Very severe  8- 9  Very, very severe (almost maximal) 10 Maximal   ```
65
Goals of COPD management (7)
``` Relieve symptoms Reduce disease progression Improve exercise tolerance Improve health status Prevent and treat complications Prevent and treat exacerbations Reduce mortality ``` varying emphasis with differing severity
66
_____ plays an important role in COPD management.
health education
67
______ has 1A evidence for health education and management of stable COPD
smoking cessation
68
Health education for COPD plays an important role in (2)
smoking cessation (Evidence 1A) ability to cope with illness and health status - proper use of meds, breathing techniques
69
Existing medications for COPD have not been shown to: evidence?
modify long-term decine in lung function 1a
70
Pharmacotherapy decreases ______ in COPD
symptoms/compications
71
Benefits of exercise in COPD patients: 1A evidence (3) 1B evidence (1) 2C evidence (1)
Training muscles of ambulation is a critical component (1A) Strength training increases strength and muscle mass in this patient population (1A) Both low and high intensity leg exercise training results in physiologic improvement (1B) Unsupported endurance training in upper extremities is beneficial (1A) Supplemental oxygen may improve gains in exercise endurance (2C)
72
Most common cause of COPD exacerbations: 3
infection of the tracheo-bronchial tree air pollution one-third cannot be identified (Evidence 1B) Patients with clinical signs of airway infection (increased sputum purulence) may benefit from antibiotic treatment (Evidence 1B).
73
What are the three treatments of COPD exacerbaations?
1 Inhaled bronchodilators (1A) ß2-agonists (w/ and w/o anticholinergics) Short acting: i.e. DuoNebs Long acting: i.e. Advair diskus 2 Oral glucocortico-steroids 3 Antibiotics when appropriate
74
Rehabilitation: All COPD patients benefit from exercise training programs, improving:
exercise tolerance | symptoms of dyspnea and fatigue (1A).
75
What does 1A evidence regarding Oxygen therapy say
``` Oxygen Therapy: (> 15 hours per day) in patients with chronic respiratory failure increases survival (1A). ```
76
Rehab of vent dependent cervical SCI: Initiate rehab and wean vent when:
as soon as they are clinically stable.
77
survival rate for vent dependent SCI patients is ____%
33
78
Survival rate for SCI patients who are weaned from vent is _____%
84%
79
How does pulmonary rehab contribute to vent weaning (3)
Evidence based resistance and endurance protocol (REP) Resistance training - strength Strengthens ventilatory muscles, decreases restrictive impairment Endurance training – stamina Improves ventilatory endurance, increases aerobic exercise performance Respiratory muscle training using fixed resistance devices Improves max inspiratory press, max expiratory press and dyspnea
80
Pretaining optimization while mechanically ventilating: _____ position: Also ____ and ____
Pretraining optimization while mech. ventilating Postiion – Fowler’s at 450, stabilize with splints Suction Aerosolize – bronchodilators (Duonebs) reverse pronounced bronchoconstriction in SCI pts.
81
When in trendelenburg, lungs move: increasing: what is the position?
Postiion – Trendelenberg at 150 for 15-20 min | Lungs move cephalad increasing transpulmonary pressures in areas where atelectasis predominates.
82
in vent dependent SCI patients, secretions are increased due to
Increased secretions due predominate parasympathetic activity in cervical spine lesions
83
In evidence based resistance and endurance protocol, should _____ the lungs increasing the TV by ______ and decreasing rate by ______ theory?
hyperinflate 200cc 2br/min Stretch increases lung compliance - offsets the chest wall restriction and intercostal spasticity commonly seen in cervical SCI pts.
84
what is inspiratory/expiratory resistance training in resistance and endurance protocol (REP)
Inspiratory/expiratory trainer - in Fowlers’s position Patients allowed to perform a specified number of breathing maneuvers thru a fixed resistance device (1 of 4 orifices each w/different resistances) inspir/expir exercises are performed separately after 10 mins rest on vent.
85
On-vent endurance training Synchronized intermittent mandatory ventilation _______, PEEP _____ Pts allowed to spontaneously ventilate at a comfortable rate maintaining TV at ______. Pt can see their SpO2 and ETCO2 on bedside monitors for feedback. Patients gradually increase their endurance training times. Off-vent endurance training _______ – delivery of air or oxygen into trachea to reduce / displace CO2 _____ trials during day until weaned from vent when appropriate.
1-2 br/min, PEEP settings: 5cm H2O 400 Tracheal gas insufflation trach capping trials

Cardio/Pulm/Peds Part I (7 decks)

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