Pulmonary Rehab Management

Question 1

what are mechanical coughing aids?

Answer 1

devices and techniques that apply manual or mechanical forces to the body or intermittent pressure changes to the airway to assist with coughing or talking

Question 2

what population are mechanical coughing aids particularly common in?

Answer 2

neuromuscular disorders
ex. GBS, SCI

Question 3

what do inspiratory aids provide?

Answer 3

adequate pressure during attempts at inhalation

Question 4

what do expiratory aids provide?

Answer 4

negative pressure via vacuum to the airway during attempts to cough, along with manual abdominal thrust

Question 5

if secretions CAN be cleared into the mouth, oral suctioning can be performed to ____

Answer 5

prevent aspiration of them back into the airways

Question 6

if secretions CANNOT be cleared into the mouth, suctioning can be performed to ____

Answer 6

rid the deeper airways of retained material

Question 7

what method of tracheal suctioning is preferred?

Answer 7

least invasive method

Question 8

true or false. tracheal suctioning can stimulate a cough reflex

Answer 8

true

Question 9

oral suctioning:
– _____ device attached to suction used for _____
– can pt use independently?
– does not go past ____

Answer 9

– wand like ; mouth
– yes
– back teeeth

Question 10

deep in line suctioning:
– incorporated into ________ to maintain ______
– __(inc./dec.)__ risk of infection
– can go from mouth/throat to ____

Answer 10

– artificial airway (ETT or trach) to maintain sterile suction catheter
– decreased
– carina

Question 11

deep sterile suctioning:
– _______ suction device that is passed through ______
– must maintain ___
– ____ must be used for nasotracheal suction

Answer 11

– stand alone ; an airway opening to the carina
– sterile technique
– lubrication

Question 12

what is the correct suctioning technique?

Answer 12

– keep sterile & clean
– ensure negative pressure is engaged or turned on
– advance gently but quickly WITHOUT applying suction yet
– stop if resistance is felt
– smoothly withdraw catheter with constant suction

Question 13

how long should you perform suction?
– why?
how long should you allow between trials?

Answer 13

no more than 10 seconds total
(deep suctioning occludes airway)
allow > 1 min between trials

Question 14

when removing suction, what should you always do?

Answer 14

always maintain suction

Question 15

during catheter advancement, what should you do/

Answer 15

apply suction

Question 16

what are some medical considerations to take into account when selecting the appropriate airway clearance?

Answer 16

GERD –> pt needs to be upright
osteoporosis or osteopenia
bronchospasm
hemoptysis
severity of pulmonary disease

Question 17

if your patient has an acute exacerbation, what do they need first before attempting an ACT?

Answer 17

medical/pharm intervention first

Question 18

what does the APTA CPG recommend to address impairments in CVP dysfunction?

Answer 18

increase physical activity levels by increase total daily activity
# of steps
total time out of bed

Question 19

ASCM activity guidelines:

Answer 19

150-300 minutes/week mod. intensity aerobic exercise OR 75-150 minutes/week vigorous exercise
mod. intensity strength training >/= 2 days/week

Question 20

what if your patient can’t meet the ASCM activity guidelines because of a chronic condition?

Answer 20

should be as physically active as their abilities and conditions allow
– also include balance training

Question 21

** See rehab management from CV section**

Question 22

in pulmonary dysfunction and strength training, you need to take into account what?
**this needs to be considered more in pulmonary population vs. CV*

Answer 22

consider impact of chronic steroid use

Question 23

strength training in patients with CVP dysfunction:
– ____ reps of RPE 11-13/4-6
– ______ progression of exercise reps and weight
– ____ 1RM
– _____ resistance tolerance

Answer 23

– 10-15 reps
– slower
– lower
– decreased

Question 24

ROM considerations in pt with pulmonary dysfunction:
– posture has implications on:
– ________ post thoracotomy to prevent adhesions during healing
– awareness of ______ with posterolateral thoracotomy

Answer 24

– breathing mechanics, lung capacities, functional activity tolerance
– pain free ROM
– long thoracic nerve damage (scapular winging)

Question 25

in what population is cognitive impairment higher in?

Answer 25

COPD – between 3-61%

Question 26

what are potential causes of impaired cognition in all pulmonary diseases?

Answer 26

chronic hypoxemia/hypoxia
chronic hypercapnia
supplemental O2 non-compliance

Question 27

what are some reasons we need to be aware of if our pulmonary patients have cognitive deficits?

Answer 27

ability to follow instructions with rehab and precautions
medication/O2 compliance
safety
performing ADLs
qualification for post acute rehab

Question 28

what plays a major part in long term cognitive function in pulmonary disease?

Answer 28

impaired oxygenation during sleep and interrupted sleep patterns due to pulmonary dysfunction

Question 29

what are some interventions to be used to help cognition in pulmonary patients?

Answer 29

family involvement
frequent reorientation
healthy sleep/wake cycles
structured schedule
increased mobility and ADLs

Question 30

pain considerations in pts with pulmonary dysfunction:
– large ____ and extensive _____
–> ______ pain is common with thoracotomy
– post op lines may irritate _______
– post op pain has huge effects on _______

Answer 30

– surgical incisions ; surgeries
–> intercostal nerve pain
– parietal pleura
– respiratory function

Question 31

why do many pulmonary pathologies cause pain?

Answer 31

due to the extensive innervation of the parietal pleura and thoracic cavity

Question 32

Which of the following is NOT a common barrier to pulmonary rehabilitation?
A) Poor exercise tolerance
B) Baseline functional capacity or frailty
C) Excellent health literacy
D) Frequent hospitalization

Answer 32

C) excellent health literacy

Question 33

which of the following is NOT an effect of supplemental O2 for pulmonary rehab?
A) improvement in SOB if SpO2 or PaO2 is decreased
B) alleviates pulmonary vasoconstriction response to hypoxemia
C) reduces hemodynamics
D) enhances exercise performance if SpO2 or PaO2 is decreased
E) reduces perception of dyspnea

Answer 33

C) reduces hemodynamics
–> improves hemodynamics

Question 34

your patient is on supplemental O2. what would you expect to find in the chart?

Answer 34

an order
SpO2 goal/target

Question 35

once there is a prescription for O2, and there are goals established, what can the PT do?

Answer 35

may titrate the supplemental O2 flow to maintain SpO2 at or above specified value

Question 36

if you walk into the patient’s room and the O2 is set at a substantially different level, what should you do?
a. nothing - continue on
b. ask the patient if they know what happened
c. investigate the situation
d. change it back to what it said in the chart

Answer 36

c. investigate the situation

Question 37

if there is an emergency situation and there is no O2 order, can the PT place supplemental O2?
a. yes
b. no
c. it depends
d. yes but the primary/ordering provider must be notified

Answer 37

D

Question 38

following the PT session, what must the PT remember to do regarding O2?

Answer 38

pt should be returned to the supplemental O2 device and flow rate used prior to interventions

Question 39

with what conditions can you over-oxygenate a person?

Answer 39

chronic hypercapnia or obstructive lung disease
– over-oxygenating them can reduce their respiratory drive, preventing CO2 from being effectively exhaled

Question 40

what might be a common finding regarding SpO2 goals in COPD patients?

Answer 40

lower SpO2 goals and recommendations to keep SpO2 below a certain value

Question 41

you cannot get your patient to return to their supplemental O2 device and flow rate used prior to the PT intervention. what should you do?
a) notify primary/ordering provider
b) keep trying
c) leave it, it’s fine
d) call a code

Answer 41

a)

Question 42

supplemental O2 delivery should be set to keep SpO2 ____, unless otherwise specified

Answer 42

> /= 90%

Question 43

if your patient is on supplemental O2, what should you always monitor?

Answer 43

vitals

Question 44

your patient has hypercapnia (retention of CO2). what’s expected to be found regarding supplemental O2 in these patients?
a) absolutely no use - contraindication
b) they can use it but may have altered O2 goals/targets
c) no precaution or contraindication associated - normal use

Answer 44

b)

Question 45

how do PT’s play a role in weaning supplemental O2?

Answer 45

strong use of clinical judgement combined with vital sign assessment

Question 46

what is a safe starting point when attempting to wean supplemental O2?

Answer 46

titrate down by 1L/min at a time

Question 47

when you attempt to wean your patient from supplemental O2, what should you be sure to do?

Answer 47

communicate with RN, MD
provide documentation of response/vitals