Pulmonary Rehab Management PT 2: Breathing Exercises & Pathology-Based Rehab Management Flashcards

1
Q

pursed lip breathing:
– ______ symptoms of dyspnea
– _____ RR and ____ wheezing
– prevents:

A

– decreases
– slows ; reduces
– alveolar collapse at end exhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when is paced breathing indicated?

A

for patients with very low endurance, anxiety, dyspnea on exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

when does inhalation and exhalation take place during paced breathing?

A

inhalation = beginning of activity
exhalation = during activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

when is inspiratory hold technique indicated?

A

for hypoventilation, atelectasis, and poor V/Q matching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does inspiratory hold technique improve?

A

air flow into poor ventilated lung regions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

inspiratory hold technique:
– what is it?
– can be used in conjunction with:

A

– prolonged breath holding for 2-3 seconds at max inspiration
– vibration techniques to aid in secretion clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when is stacked breathing indicated for?

A

hypoventilation
atelectasis
poor V/Q matching
uncoordinated breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is stacked breathing?

A

series of deep breaths that build on top of the previous breath without exhalation until max volume tolerated is reached
- inspiratory hold in between each inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does thoracic mobilization techniques improve?

A

ability of the thorax to expand via optimized biomechanics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are some ways you can accomplish thoracic mobilization techniques?

A

– towel roll or bolster along thoracic spine in supine to improve anterior chest wall mobility
– sidelying over towel roll or bolster will increase lateral chest wall mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

who is counter rotation effective in?

A

patients with high neuromuscular tone that affects normal chest wall mechanics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the position of the body in counter rotation?

A

sidelying with knees bent and arms in front
upper trunk rotates outward with inhalation, inward with exhalation
pelvis and lower trunk can stay still or rotated opposite of trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the butterfly rotation technique?

A

upright version of counter rotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is inspiratory muscle training?

A

strength training for the diaphragm in patients with decreased strength and endurance of inspiratory muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what does increased ventilatory capacity improve from inspiratory muscle training?

A

improved lung volumes
better V/Q matching
improved SpO2 and PaO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what does decreased dyspnea improve from inspiratory muscle training?

A

improved functional activity tolerance
higher QOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the two characteristics of inspiratory muscle training?

A
  1. overload – low load applied over a long time
  2. specificity – resistance needs to be applied to inspiratory muscles, rather than expiratory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

diaphragm muscle types:
slow twitch oxidative:
– _____ contraction
– uses ____ metabolism
– _____ resistant

A

– slow
– aerobic
– fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

diaphragm muscle types:
fast twitch oxidative-glycolytic:
– _____ contraction
– uses ____ metabolism initially
– can switch to ____ metabolism, then fatigues faster

A

– fast
– aerobic
– anaerobic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

diaphragm muscle types:
fast twitch glycolytic:
– _____ contraction
– uses ____ metabolism
– fatigues ____

A

– fast
– anaerobic
– quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what percentage of adult diaphragm is slow twitch muscle fibers?

A

55%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

fatigue is correlated to:
a. slow twitch fibers
b. fast twitch oxidative glycolytic
c. fast twitch glycolytic
d. b and c

23
Q

weakness of diaphragm is correlated to:
a. slow twitch fibers
b. fast twitch oxidative glycolytic
c. fast twitch glycolytic
d. b and c

A

d - fast twitch fibers

24
Q

endurance training of the diaphragm increases:

A

capillary density
myoglobin
glycogen concentration

25
what improves with endurance training of the diaphragm?
proportion of fatigue-resistant slow twitch muscle fibers
26
what is the exercise recommendation for inspiratory muscle training targeting endurance training?
30-60 minutes continuous deep diaphragmatic breathing 2-3x/day
27
strength training with inspiratory muscle training: -- involves : -- if tidal volume is far below 500 mL, start with:
-- resisted inhalation -- active breathing exercises before adding any resistance or weight
28
what is the early IMT technique to engage focused diaphragm use? -- technique for this?
sniffing -- quickly 3x with slow exhalation helps increase awareness of correct diaphragmatic engagement
29
what is a way to accomplish strength training with IMT? -- dosage?
place weights on lower chest -- 2-3 sets of 10 reps, 1-2x/day no recommendations on starting weight
30
what do IMT devices provide resistance against?
inhalation
31
what is maximal inspiratory pressure (MIP)?
measurement of the max force inspiratory muscles can generate against resistance
32
how long should you use a IMT device?
15-30 minutes 2x/day start with level of resistance that is comfortable to perform the frequency
33
what is the IMT recommendations using MIP percentages for heart failure population?
60% MIP >30% MIP sets or intervals performed to fatigue 5-7 days/week for 8-12 weeks
34
thoracotomy post-op precautions: -- in place for ____ weeks -- no: (3) -- ROM:
-- 6-8 weeks -- no lifting > 5 lbs, no twisting or rotational activities, no strenuous activity with surgical side -- encouraged as tolerated below 90-90
35
what is the primary thing we are intervening on in cystic fibrosis?
secretion clearance techniques -- postural drainage with manual airway clearance techniques, oscillation vest, acapella, flutter valve devices, active cycle of breathing, forced expiratory technique
36
during periods of SOB with cystic fibrosis, what techniques can be used?
controlled breathing techniques
37
in order to avoid worsening posture in those with cystic fibrosis, what should we do?
thoracic stretching postural re-education to avoid kyphotic posture
38
your patient has asthma and has just showed up to the clinic with uncontrolled asthma. should you work with them today?
no - activity shouldnt begin unless appropriate medications initiated to reduce bronchospasm and inflammation
39
what secretion clearance technqiues would be good for pts with asthma?
active cycle of breathing vibration techniques
40
in patients with asthma, what should you avoid when exercising?
any situation that may trigger bronchoconstriction (temperature, environmental, smells, etc)
41
transplanted lungs lose their ______ what does it result in?
autonomic innervation results in decreased mucociliary clearance, V/Q imbalance, ineffective cough, slowed receptor responses
42
what two important structures are NOT cut during lung transplant surgery?
phrenic nerve diaphragm
43
your patient just had a lung transplant. what should you focus your initial interventions on?
pulmonary toilet mobilization positioning for optimal breathing/coughing postural drainage airway clearance techniques decreased accessory breathing
44
what two interventions are very effective in early stages post-lung transplant?
active cycle of breathing vibration --> percussions will be too harsh
45
what medications should be used post-lung transplant for immunosuppression?
oral and inhaled steroids 60-90% require HTN medications
46
what pathologies are very common after a lung transplant?
steroid myopathy in proximal muscles and osteoporosis
47
when should resistance exercise be performed in a patient with a lung transplant?
prior to transplant continued at the highest level that is safe following transplant
48
what is required if you perform aerobic exercise in lung transplant patients?
adequate warm up and cool down - to compensate for the lack of autonomic innervation
49
true or false. you never treat HF along with pulmonary dysfunction
false. very challenging to fully separate HF from pulmonary dysfunction because of overlap of symptoms
50
in general, when treating patients with pulmonary dysfunction, always start with _______ intensity (___/10)
low intensity (3-4/10)
51
when performing endurance training with a pulmonary patient, you feel they can be challenged more. you should first increase ______ before increasing _______
duration intensity
52
what's the duration of endurance training for a pulmonary patient?
start with the length of time a patient can exercise until fatigued -- increase by 1-2 minutes/day
53
true or false. interval training is very effective in initial phases of treatment for pulmonary dysfunction
true
54