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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
Q

______ is a dilatation of airway due to inflammation and destruction of the bronchi.

what type of lung disease?

A

bronchiectasis

obstructive

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26
Q

______ Autosomal recessive disease characterized by abnormal chloride/sodium transport – characterized by thick viscous secretions

what type of lung disease?

A

Cystic fibrosis

commonly obstructive and restrictive

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27
Q

_____ is a inherited protein that is made by the _____ and is a “lung protector”

A

alpha 1 antitrypsin (AAT)

liver

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28
Q

alpha 1 antitrypsin (AAT) is responsible for ______ % of emphysema in the US

A

2-3%

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29
Q

alpha 1 antitrypsin (AAT) emphysema

of americans:
____ descent
______ americans carry a single deficient gene
_______ carriers

A

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

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30
Q

two main symptoms of alpha 1 antitrypsin emphysema:

Rarely appear before ____
In smokers, symptoms occur between ______ and ____ years

______ significantly increases the severity

A

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

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31
Q

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

A

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

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32
Q

Name the four common changes in lung parenchyma in COPD

A
  1. destruction of pulm capillary bed
  2. alveolar wall destruction
    3 loss of elasticity
    4 increased inflammatory cells: macrophages, CD8 lymphocytes
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33
Q

Four most common symptoms of COPD

A

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

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34
Q

What does GOLD stand for?

A

Global INitiative for Chronic obstructive lung disease

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35
Q

GOLD formed in _____

A

1998

36
Q

GOLD did what 5 things

A 
Offered a framework for management of COPD for healthcare professionals
Increased awareness
Educational source
Promote research
Encourage collaboration
37
Q

what is the GOLD definition of airflow limitation

A

FEV1/FVC <70%

38
Q

symptoms (3) + exposure to risk factors (3) = spirometry

A

S: cough, sputum, SOB
RF: tobacco, occupation, indoor/outdoor polution

39
Q

FEV1 and FVC in COPD patients is _____ compared to normal patients

A

higher

“trapped air in”

40
Q

_____ is improvement in airflow limitation in response to a bronchodilator or oral inhaled corticosteroid

A

reversibility

41
Q

What is the gold definition of reversibility?

A

increase in FEV1 by 12% after treatment with a bronchodilator or corticosteroid

42
Q 
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
A

stage III severe

43
Q

what is the GOLD classification criteria for COPD

A

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
Q

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

A

E

45
Q

COPD is the _____ leading cause of death in the world (2012)

A

3rd

behind stroke and ischemic heart disease

46
Q

Name the 10 leading causes of death in the world

A 
ischemic heart disease
stroke
COPD
Lower resp infection
trachea/bronchitis
HIV/AIDS
diarrheal diseases
DM
road injury
HTN
47
Q

COPD killed ______ americans in 2010

A

134,676

48
Q

Prevalence of COPD in 2011 (age > 18)

A

12.7 million US adults

49
Q

COPD is significantly ______

A

underdiagnosed

24 million have evidence of impaired lung function

50
Q

what region is leading the US in prevalence of COPD? (percentage?)

A

east south central (KY, TN, MS, AL)

7.5%

51
Q

Who is the lowest prevalence of COPD (percentage?)

A

pacific (WA, OR, CA, HA, Alaska)

3.9%

52
Q

Prevalence of COPD among adults > 18 yoa by sex:

A

Women > Men EXCEPT in age 75-84 when men predominate

53
Q

Risk factors for COPD (10)

A
  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
Q

what is the primary risk factor for COPD?

_____% of COPD deaths due to this.

A

smoking 80%

55
Q

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

A

13

12

second hand smoke

56
Q

Occupational exposure to _____ increases risk for COPD

_____% overall and _____% among never smokers

A

industrial pollutants

  1. 2% overall
  2. 1%
57
Q

of hospital discharges in 2010 associated with COPD

A

715000

65% of discharges > 65 years and older population

58
Q

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
A

asthma

Note: 40% COPD patients amy have asthmal dual dx of COPD and asthma increases with age

59
Q

Dx?

 Onset in mid-life
  Symptoms slowly progressive
  Long smoking history
  Dyspnea during exercise
  Largely irreversible airflow 
    limitation
A

COPD

60
Q

______ is also a risk factor for COPD!

A

asthma

61
Q

COPD patients are at increased risk for (6)

A 
Myocardial infarction, angina
Osteoporosis
Respiratory infection
Depression
Diabetes
Lung cancer
62
Q

COPD has significant extra-pulmonary systemic effects including: (3)

A

weight loss
nutritional abnormalities
skeletal muscle dysfunction

63
Q

two ways to measure severity of disease clinically

A

Pulm fuction tests (FEV1)

Six minute walk test

64
Q

What is the Borg Dyspnea scale?

A 
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
Q

Goals of COPD management (7)

A 
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
Q

_____ plays an important role in COPD management.

A

health education

67
Q

______ has 1A evidence for health education and management of stable COPD

A

smoking cessation

68
Q

Health education for COPD plays an important role in (2)

A

smoking cessation (Evidence 1A)

ability to cope with illness and health status
- proper use of meds, breathing techniques

69
Q

Existing medications for COPD have not been shown to:

evidence?

A

modify long-term decine in lung function

1a

70
Q

Pharmacotherapy decreases ______ in COPD

A

symptoms/compications

71
Q

Benefits of exercise in COPD patients:

1A evidence (3)

1B evidence (1)

2C evidence (1)

A

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
Q

Most common cause of COPD exacerbations: 3

A

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
Q

What are the three treatments of COPD exacerbaations?

A

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
Q

Rehabilitation: All COPD patients benefit from exercise training programs, improving:

A

exercise tolerance

symptoms of dyspnea and fatigue (1A).

75
Q

What does 1A evidence regarding Oxygen therapy say

A 
Oxygen Therapy:  (> 15 hours per day) in patients with chronic respiratory failure 
increases survival (1A).
76
Q

Rehab of vent dependent cervical SCI:

Initiate rehab and wean vent when:

A

as soon as they are clinically stable.

77
Q

survival rate for vent dependent SCI patients is ____%

A

33

78
Q

Survival rate for SCI patients who are weaned from vent is _____%

A

84%

79
Q

How does pulmonary rehab contribute to vent weaning (3)

A

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
Q

Pretaining optimization while mechanically ventilating:

_____ position:

Also ____ and ____

A

Pretraining optimization while mech. ventilating

Postiion – Fowler’s at 450, stabilize with splints

Suction

Aerosolize – bronchodilators (Duonebs) reverse
pronounced bronchoconstriction in SCI pts.

81
Q

When in trendelenburg, lungs move: increasing:

what is the position?

A

Postiion – Trendelenberg at 150 for 15-20 min

Lungs move cephalad increasing transpulmonary pressures in areas where atelectasis predominates.

82
Q

in vent dependent SCI patients, secretions are increased due to

A

Increased secretions due predominate parasympathetic activity in cervical spine lesions

83
Q

In evidence based resistance and endurance protocol, should _____ the lungs increasing the TV by ______ and decreasing rate by ______

theory?

A

hyperinflate

200cc

2br/min

Stretch increases lung compliance - offsets the chest wall restriction and intercostal spasticity commonly seen in cervical SCI pts.

84
Q

what is inspiratory/expiratory resistance training in resistance and endurance protocol (REP)

A

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
Q

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.

A

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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