pulmonary rehabilitation Flashcards
1
Q
lung disease is a
A
- downward spiral
- breathless, fearful of activity, avoid activities, less activity, muscle atrophy, weak muscles use more oxygen, breathless
2
Q
pulmonary rehab
A
- a comprehensive intervention based on patient assessment followed by patient tailored therapies including (but not limited to) exercise training, education, behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote long-term adherence to health-enhancing behaviors
- education
- disease process, medications (including oxygen), risk factor education (smoking, vaccines, nutrition, occupational/environmental exposures), relaxation and stress management, pacing and energy conservation
- exercise training
- LE exercise, UE exercise, flexibility/posture, strength/resistive exercise, balance retraining, inspiratiory muscle training (IMT)
- breathing retraining and airway clearance techniques
- psychosocial assessment and treatment (depression screen)
- nutritional assessment and treatment
3
Q
smoking cessation
A
- stopping smoking improves FEV1
- medications
- chantix/varenicline: partial nicotinic receptor agonist
- zyban/wellbutrin (bupropion): nicotinic receptor agonist
- side effects: GI, suicidal thoughts, mood change
4
Q
peak inspiratory flow rate at rest is typically
A
15-30 L/min
5
Q
what is considered high flow O2
A
> 15 L/min
6
Q
nasal cannula used for
A
- adults
- 0-6 L/min
- > 4 L required himidification (for patient comfort)
- can cause irritation dryness, bleeding, etc
- 24-44%
- pediatrics (> 1 month)
- low flows if possible
- ALWAYS humidified
- neonate
- 0-2 L/min
- ALWAYS humidified
7
Q
venturi system
A
- supplies given FiO2 at flow higher than respiratory demand
- uses entrainment
8
Q
non-rebreather mask
A
- reservoir with one way valve
- 60-100% FlO2 delivered
- > 70% is rare - hard to provide leak-free system
- gets lots of O2 quicly to someone breathing
9
Q
high flow and high humidity devices
A
- flow rates that exceed patient’s inspiratory flow rates (> 30 L/min)
- prevents dryness of nasal mucosa by warming adn humidifying inhaled gas
- allows “blending” of room air and oxygen to provide a precise FlO2
- need to consider differece between flow and FlO2
10
Q
aim for the ____ possible FlO2 with SpO2 > 89-93%
A
lowest
11
Q
inidication for O2 therapy (per medicare)
A
- subjects: stable COPD with resting hypoxemia
- PaO2 < 55 mmHg or SpO2 < 88%
- caution with advanced COPD
- especially with “CO2 retainers”
12
Q
long-term oxygen for COPD with moderate desaturation
A
- patients with COPD with moderate resting desaturation had no significant difference in time to death, time to 1st hospitalization, rates, QOL, lung function 6MWT
- no significant difference between supplemental oxygen group and no oxygen group
13
Q
oxygen (O2) therapy
A
- goals
- correct hypoexemia
- decrease symptoms associated with hypoexmia
- decrease workload on cardiopulmonary system with correction of hypoexemia
- precautions
- oxygen toxicity (inflammation, surfactant dysfunction) - with > 60% for weeks
- atelectasis
- infections with “unclean” equipment
- retinopathy of prematurity in babies
- depression of ventilation (“bunch of hooey”
14
Q
benefits of O2 therapy
A
- survival advantage for resting hypoxemia with COPD (severe desat, SpO2 < 88%)
- possible short term benefit in exercise performance but not long term evidence
- decreased DOE and desat
15
Q
pulmonary rehab prescription
A
- should exercise “like normal”
- F: daily or 3-5x/week
- I: RPE goal 3-5 (moderate to severe)
- assuming all other VS are ok
- T: variable but progress to > 150 minutes/week of moderate intensity activity
- T: progressive mobilization and ALD retraining, aerobic, AROM with resistance, inspiratorty muscle training (IMT)
- most people with lung problems are symptom limited
- HR/BP/pulse ox fine
- SOB limits performance
- talk test
