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RSRS > Pulmonary rehab > Flashcards

Pulmonary rehab Flashcards

1
Q

Which 3 dept does gov of canada transfers funds to

A
  1. Depts of health
    - ->transfer funding for
    1) ministry of health and long term care
    2) ministry of community and social service
  2. 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
  3. The Dep’t of Veteran’s Affairs
    - ->provides assistance for eligible veterans and will transfer funds as required to obtain healthcare for those individuals
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2
Q

What is MOHLTC?

A

Ministry of Health & Long Term Care

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3
Q

What does MOHLTC do?

A 
funds a series of healthcare services
- Assistive Devices branch
-OHIP
-Ontario Drug
Benefit (ODB) Plan
- Senior’s Care
- Hospitals
-Community Care
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4
Q

What does Ministry of
Community
and Social Services do

A

funds for General Welfare Benefits

- for Seniors and those eligible for a drug card

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5
Q

How is individual cost covered?

A
  • costs of medication is covered through the ODB Plan,

- after co-pay for each prescription

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6
Q

How much of the cost of medical device is cover for eligible ontarians?

A

additional funds are released to cover 75% to 100%

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7
Q

What is the TDP

A
  1. open to all Ontarians with valid OHIP card who isn’t covered by ODP
  2. calculate based on total family income, family size and total drug costs
  3. helps people who have high prescription drug costs relative to their household income
    - -> It covers all drugs approved under the Ontario Drug Benefit (ODB)
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8
Q

What if the drug products aren’t on the list of ODB? how can people get funded?

A

doctor may apply for special approval through the Exceptional Access Program (EAP).

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9
Q

Who can apply/eligible for the TDP?

A

You have/are

  1. a valid Ontario health card
  2. live in Ontario

you are not covered by the ODP AS:

  1. a senior over 65 years of age
  2. someone who receives financial help through Ontario Works or the Ontario Disability Support Program
  3. a resident of a Long-Term Care home or Home for Special Care
  4. someone who receives Home Care Services
  5. You don’t have private health insurance or your private insurance does not cover 100% of your prescription drug costs.
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10
Q

What is the discharge destination for seniors (65+)

A

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

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11
Q

What is the difference between old and new health care models of delivery

A

New:

  • include patient in treating, preventing and management of disease
  • treat the patient, not the disease

Old:
- focus only on treating the disease

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12
Q

What is the relationship between the new chronic disease model and health system

A
  • 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
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13
Q

which 2 factors yield the best population health outcomes

A
  1. prepared proactive practice team

2. informed activated patient

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14
Q

What is the deal with the health prevention/promotion model

A

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

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15
Q

What are the Broad Goals of Health Promotion?

A

1) Delay disability and death

2)Maximize quality of
life

3)increase longevity

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16
Q

What are some RT roles in rehabilitation

A

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

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17
Q

What are the 3 level in the health promotion model

A

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
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18
Q

What is RT role in disease prevention

A
  1. Individual counsellor
  2. Public health advocate
  3. Provider of care
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19
Q

What are the characteristic of pulmonary rehab

A

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
20
Q

What is the 4 Purpose of rehabilitation?

A
  1. Takes time to recover from catastrophic illness
  2. Takes time to learn to adjust to disability
  3. Chronic illness complicates recovery
  4. Improved quality of life (QoL)
21
Q

What is the Goal of rehabilitation? and how to achieve it?

A

restore the patient to the highest possible level of independent function

goal setting
exercise training
education
nutritional intervention
psychosocial support
22
Q

What is the Indications for Pulmonary Rehabilitation

A
  1. Obstructive lung disease
  2. 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

23
Q

What is the Contraindications for Pulmonary Rehabilitation

A
  • 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*
24
Q

What is the Sequence for most pulmonary rehab programs?

A 
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
25
Q

What are some selection criteria for pulmonary rehabilitation

A
  • assess whether patient meet any contraindication
↓QoL
↓activity including ADL
changes in occupational performance
psychosocial status
↑use of medical resources
26
Q

Who can refer?

A

Patient/self refer
Family/friend
Family doctor
Any healthcare provider

27
Q

Who are suitable for Home Rehabilitation Programs?

A

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

28
Q

What are the Pre-exercise evaluation

A 
General observation
Patient Environment
Physical assessment
Pulmonary assessment
Cardiac assessment
Co-morbidities
Medications
29
Q

What are some general observation

A

Communication
Mental Status
Personal Hygiene
Posture

30
Q

what are Assessment of the Environment

A 
Safety
Cleanliness
Allergens and Irritants (smokers)
Cooking Facilities
Location
31
Q

What are the physical assessment

A 
• 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
32
Q

What is the pulmonary assessment

A 
Inspection
Palpation
Percussion
Auscultation
PFT
ABG (SpO2)
33
Q

What is the cardiac Assessment

A 
Pulse
Blood Pressure
Heart Sounds
Jugular Venous Pressure
Edema
34
Q

What is some medication assessment

A
  • assess whether patient are taking medications that might lead to adverse side effect
35
Q

What are some Exercise Evaluation

A

6 minute walk test or shuttle walk test
Modified BORG scale of dyspnea
ADL
QoL

36
Q

What are some Exercise Testing

A

Walk test

  • 6MWT
  • 12MWT
  • shuttle

posture
- gait

muscle
- strength

37
Q

What is being monitored during exercise testing

A

BORG, HR, RR, SpO2

38
Q

How to determine exercise goals

A 
Specific
Measurable
Achievable
Realistic
Timely.
39
Q

Wht are the 4 components of Pulmonary Rehab plan

A
  1. Physical reconditioning
  2. Patient specific therapies
  3. Patient education
  4. Psychosocial support
40
Q

What is some Physical reconditioning

A

Exercise to improve endurance and strength

  • Lower extremity aerobic exercise
  • Upper extremity aerobic exercise
  • Ventilatory muscle training
  • -> Inspiratory muscle trainers
41
Q

What are some patient education

A
  • 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
42
Q

What are some Patient specific therapies

A 
Secretion clearance techniques
Home oxygen
Tracheostomy care
Home ventilation
Psycho-social interventions
43
Q

What are the Psychosocial Manifestations in COPD

A 
Loss of:
 self
 health
 ability
 independence
 worth
 status
44
Q

What can Negative” Psychological and Emotional Adjustment leads to ?

A 
Depression
Anxiety
Manipulative Behaviour
Non-compliance with treatment regimen
Anger, irritability, and frustration
Guilt
Somatization
45
Q

What is Reassessment done during the rehab program

A

During program
Immediately after program conclusion
At predetermined times

RSRS (16 decks)

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