Pulmonary rehab Flashcards
Which 3 dept does gov of canada transfers funds to
- Depts of health
- ->transfer funding for
1) ministry of health and long term care
2) ministry of community and social service - The Dep’t of Indian and Northern Affairs
- ->for hospital in rural areas
- ->responsible for the health and health care costs of aboriginal populations where services are not available
- ->remote areas and drugs/supplies/glasses - The Dep’t of Veteran’s Affairs
- ->provides assistance for eligible veterans and will transfer funds as required to obtain healthcare for those individuals
What is MOHLTC?
Ministry of Health & Long Term Care
What does MOHLTC do?
funds a series of healthcare services - Assistive Devices branch -OHIP -Ontario Drug Benefit (ODB) Plan - Senior’s Care - Hospitals -Community Care
What does Ministry of
Community
and Social Services do
funds for General Welfare Benefits
- for Seniors and those eligible for a drug card
How is individual cost covered?
- costs of medication is covered through the ODB Plan,
- after co-pay for each prescription
How much of the cost of medical device is cover for eligible ontarians?
additional funds are released to cover 75% to 100%
What is the TDP
- open to all Ontarians with valid OHIP card who isn’t covered by ODP
- calculate based on total family income, family size and total drug costs
- helps people who have high prescription drug costs relative to their household income
- -> It covers all drugs approved under the Ontario Drug Benefit (ODB)
What if the drug products aren’t on the list of ODB? how can people get funded?
doctor may apply for special approval through the Exceptional Access Program (EAP).
Who can apply/eligible for the TDP?
You have/are
- a valid Ontario health card
- live in Ontario
you are not covered by the ODP AS:
- a senior over 65 years of age
- someone who receives financial help through Ontario Works or the Ontario Disability Support Program
- a resident of a Long-Term Care home or Home for Special Care
- someone who receives Home Care Services
- You don’t have private health insurance or your private insurance does not cover 100% of your prescription drug costs.
What is the discharge destination for seniors (65+)
long term care
–>more seniors are discharged to LTC compared to non seniors
home
–>more non seniors are discharged to home with supportive services compare to seniors
rehabilitation
–>seniors actually receive less rehabilitation than non seniors
What is the difference between old and new health care models of delivery
New:
- include patient in treating, preventing and management of disease
- treat the patient, not the disease
Old:
- focus only on treating the disease
What is the relationship between the new chronic disease model and health system
- health system is integrated within a bigger community
the community is consist of action that helps to manage chronic disease
- build healthy public policy
- create supportive environment
- strengthen community action
which 2 factors yield the best population health outcomes
- prepared proactive practice team
2. informed activated patient
What is the deal with the health prevention/promotion model
1) Focus is on treating the person, and not the illness
2) RT design rehabilitation plans with patients to achieve functional goals, in addition to their clinical role
What are the Broad Goals of Health Promotion?
1) Delay disability and death
2)Maximize quality of
life
3)increase longevity
What are some RT roles in rehabilitation
1) Focuses on motivation and patient helping themselves
- -> by giving the patient the knowledge, skill and ‘right’ to make decisions about their care
2)Prevention & education is provided to both the general population (masses) and the individual
What are the 3 level in the health promotion model
Primary
- Prevention of disease e.g. tobacco protection legislation
Secondary
- detection of disease
e. g. spirometry and/or CAT questionnaire for at risk population
Tertiary
- Prevent acceleration of disease
e. g.Patient education, pulmonary rehabilitation
What is RT role in disease prevention
- Individual counsellor
- Public health advocate
- Provider of care
What are the characteristic of pulmonary rehab
Multidisciplinary
- involve experts from different disciplines
- program is comprehensive
individualized:
- assessment of needs, individual attention
- program is tailored to meet realistic goal
Attention to physical and social function
- pay attention to psychological, emotional, and social problems
- optimize medical therapy to improve lung function and exercise tolerance
What is the 4 Purpose of rehabilitation?
- Takes time to recover from catastrophic illness
- Takes time to learn to adjust to disability
- Chronic illness complicates recovery
- Improved quality of life (QoL)
What is the Goal of rehabilitation? and how to achieve it?
restore the patient to the highest possible level of independent function
goal setting exercise training education nutritional intervention psychosocial support
What is the Indications for Pulmonary Rehabilitation
- Obstructive lung disease
- Restrictive lung disease
Other:
Pulmonary Vascular Disease
Lung Resection
Lung and/or Heart Transplant (Pre and post Sx)
Occupational or Environmental Lung Disease
Neuromuscular Disease
What is the Contraindications for Pulmonary Rehabilitation
- Lack of motivation
- Non-adherence
- Inadequate financial resources and/or unable to access program
- Severe cognitive dysfunction or psychiatric illness
- Unstable comorbidity e.g. angina, CHF
Severe exercise –induced hypoxemia, not correctable with O2 - Inability to exercise due to severe lung or other disease
- Cigarette smoking*
What is the Sequence for most pulmonary rehab programs?
A.Candidate Selection B.Pre exercise evaluation C.Exercise evaluation D.Determine Goals (Care Plan) E.Components of Pulmonary Rehab plan F.Reassessment G.Long Term follow-up
What are some selection criteria for pulmonary rehabilitation
- assess whether patient meet any contraindication
↓QoL ↓activity including ADL changes in occupational performance psychosocial status ↑use of medical resources
Who can refer?
Patient/self refer
Family/friend
Family doctor
Any healthcare provider
Who are suitable for Home Rehabilitation Programs?
frequent hospitalization
newly diagnosed pulmonary disease
anxiety or confusion about management of disease
multiple medications/treatments
new equipment
requiring follow-up - CTS recommends patients within 1 month of AECOPD and longer than 6 weeks
end-stage terminally ill patients
CTS recommends all mod and severe and very severe
What are the Pre-exercise evaluation
General observation Patient Environment Physical assessment Pulmonary assessment Cardiac assessment Co-morbidities Medications
What are some general observation
Communication
Mental Status
Personal Hygiene
Posture
what are Assessment of the Environment
Safety Cleanliness Allergens and Irritants (smokers) Cooking Facilities Location
What are the physical assessment
• Use of/need for aids • Physical strength • Allergies • Smoking History • Use of Alcohol and related drugs • Knowledge of pathology, medications and treatments • Psychosocial • Nutrition • LTOT • Ventilation requirements
What is the pulmonary assessment
Inspection Palpation Percussion Auscultation PFT ABG (SpO2)
What is the cardiac Assessment
Pulse Blood Pressure Heart Sounds Jugular Venous Pressure Edema
What is some medication assessment
- assess whether patient are taking medications that might lead to adverse side effect
What are some Exercise Evaluation
6 minute walk test or shuttle walk test
Modified BORG scale of dyspnea
ADL
QoL
What are some Exercise Testing
Walk test
- 6MWT
- 12MWT
- shuttle
posture
- gait
muscle
- strength
What is being monitored during exercise testing
BORG, HR, RR, SpO2
How to determine exercise goals
Specific Measurable Achievable Realistic Timely.
Wht are the 4 components of Pulmonary Rehab plan
- Physical reconditioning
- Patient specific therapies
- Patient education
- Psychosocial support
What is some Physical reconditioning
Exercise to improve endurance and strength
- Lower extremity aerobic exercise
- Upper extremity aerobic exercise
- Ventilatory muscle training
- -> Inspiratory muscle trainers
What are some patient education
- Smoking cessation
- Coping skill development
- Rationale for medical treatments
- Advanced directives &/or end-of-life issues
- Self-management
Effective inhaler technique
Decision making re: acute exacerbations
Strategies to alleviate dyspnoea
What are some Patient specific therapies
Secretion clearance techniques Home oxygen Tracheostomy care Home ventilation Psycho-social interventions
What are the Psychosocial Manifestations in COPD
Loss of: self health ability independence worth status
What can Negative” Psychological and Emotional Adjustment leads to ?
Depression Anxiety Manipulative Behaviour Non-compliance with treatment regimen Anger, irritability, and frustration Guilt Somatization
What is Reassessment done during the rehab program
During program
Immediately after program conclusion
At predetermined times
