Pulmonary Rehabilitation Flashcards
It is a program of education and exercise that focuses on restoring chronic respiratory patients to the highest functional capacity possible.
Pulmonary Rehabilitation
is a comprehensive education and exercise program designed to
improve the cardiovascular fitness of patients with known cardiac dysfunction.
Cardiac rehabilitation
Pulmonary rehabilitation differs from cardiac
rehabilitation with _________________.
Respect to the organ affected and hence to the type of program implemented
Cardiac patients, on the other hand, are able to perform greater amounts of work and are __________________.
not limited solely by dyspnea
Other differences center on patient focus and monitoring during exercise.
• Cardiac programs are more concerned with ___________
Patient’s pulse, blood pressure, and electrocardiogram via telemetry
• Pulmonary patients are monitored for __________
pulse rate, respiratory rate, oxygen saturation, and peak flow rates
The restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential of which he/she is capable. (Year)
1942
Became more specific and formed the Committee on Pulmonary Rehabilitation, which specified a medical practice that was intended to help pulmonary patients attain their optimum state of heath (Year)
1974
ACCP stands for?
American College of Chest Physicians
continue the advancement of pulmonary rehabilitation in terms of programs, services, professional practice, networking, and continuing education (Year)
1983
AACVPR released new evidence-based guidelines recommending pulmonary rehabilitation for patients with COPD indicating that pulmonary rehabilitation can:
• Improve a patient’s exercise tolerance.
• Reduce levels of perceived dyspnea.
• Improve health-related quality of life.
• Reduce hospital admissions.
• Reduce the costs of health care utilization
(Year)
2007
The major goal of pulmonary rehabilitation :
Restore the patient to the highest possible functional capacity, given the patient’s degree of pulmonary impairment and overall life situation.
Two principal objectives of pulmonary rehabilitation
• To control and alleviate as much as possible the
symptoms and pathophysiologic complications
of respiratory impairment.
• To teach patients how to achieve optimal
capability for carrying out their activities of
daily living (ADLs).
Before any testing is performed, a complete patient
workup should be completed. This includes:
- A complete patient history
- Physical examination.
- Laboratory testing
- Electrocardiogram and chest X-ray.
Factors in doing PFT to patient:
• Allow for the differentiation between obstructive
and restrictive disease.
• Establish a baseline for the patient.
• Determine the extent of pulmonary impairment
present.
• Identify the degree of reversal produced by
bronchodilator therapy.
The most important aspect of patient evaluation and testing before any pulmonary rehabilitation effort
- This is the most complex test but the most important in terms of the patient data and information it provides.
Cardiopulmonary Exercise Testing (CPX testing or stress test)
Major indications for CPX testing include:
• Patient assessment and evaluation.
• Differentiating between pulmonary or cardiac
dysfunction and overall poor physical
conditioning.
Main contraindications of CPX testing:
Acute electrocardiographic changes associated with serious cardiac dysrhythmias and angina.
The two basic components of the CPX test or evaluation are ______
- regimens determining lung function
- those measuring cardiovascular function
A CPX test should last about ______ or _______
if the patient is elderly
10–12 minutes , 6 minutes
CPX test may be terminated for a number of other reasons, including:
• Equipment or monitoring-system failure.
• Patient fatigue.
• Clinical signs and symptoms of physiological distress
(vertigo, pallor, or headache).
• Significant hypoxemia.
• Major cardiac arrhythmias.
• Or substantial changes in blood pressure.
- This type of format is more traditional than the open
format. - It uses a set period of time with a designated
number of class sessions and a specific end date. - Sessions may be conducted once, twice, or three times a
week for anywhere from 6 to 16 weeks.
CLOSED-FORMAT PROGRAMS
- This type of format have no designated number of class sessions or specific end dates.
- Patients continue in the program and progress at their own pace until they achieve specific objectives and attain prescribed performance levels
- patient who don’t achieve their goal in closed format
OPEN-FORMAT PROGRAMS
Session in which may be conducted in the hospital, at the patient’s home, or at the rehab facility, require less equipment and personnel than do group sessions
INDIVIDUAL SESSIONS
Individual programs are especially effective for _______ who are being weaned from ventilatory support or for those with neurological disorders
ventilator-dependent patients
This session involve classes of 4–12 patients, depending on space, equipment, personnel, and the number of patients who qualify.
- more cost-effective than individual sessions.
- attend rehabilitation programs more for psychosocial
than for physical reasons
GROUP SESSIONS
Facilities that offer outpatient pulmonary rehabilitation must address patient needs in terms of ____________
Accessibility, parking, and mass transit.
For an average class of 8–12 patients, a classroom that is \_\_\_\_\_\_\_\_\_\_\_\_ is adequate,
12 feet by 16 feet (192 square feet)
and an exercise area approximately twice that size up to ______________ should suffice.
(up to 400 square feet)
A typical group session should be
approximately ______, whereas individual
sessions can range from a ________.
2 hours long , half hour to an hour
Normally, ____________ of each session can be
devoted to patient education.
30–60 minutes
Each session should begin with a _______ followed by the patients’ comments on their
progress
welcoming remark
These techniques can produce profound benefits by
helping patients control their breathing, improve
ventilatory muscle endurance and strength, and reduce
the work of breathing and dyspnea.
Breathing Retraining
Considered to be the cornerstone of breathing retraining for
COPD patients in pulmonary rehabilitation
Diaphragmatic breathing with pursed lips
Retarding expiration:
• Slows their respiratory rate.
• Reduces the work of breathing.
• Creates a back pressure that prevents collapse of
the smaller airways.
• Lessens the probability of air trapping.
• Promotes more effective ventilation.
It may take ________ before some patients
breathe diaphragmatically
6–8 weeks
Incentive spirometer, should be performed for up to _______ , ________ on a regular basis to be
effective.
15 minutes,
three or four times a day
This apparatus uses a spring-loaded valve mechanism to provide a consistent inspiratory pressure training load, independent of
inspiratory flow rate.
Threshold loading
movement without
resistance or tension
- To increase stamina and endurance, improve cardiovascular
status, and increase maximum oxygen consumption
Aerobic or isotonic conditioning
movement with resistance
or tension
- To increase muscle strength
and tone for both upper and
lower body
Isokinetic techniques
resistance or tension without
movement
- To increase muscle strength
and tone
Isometric exercises
stretching and
bending
- To increase flexibility, agility, and
strength
Calisthenics
used to document a
patient’s perceived degree of dyspnea
The Borg or modified Borg
Dyspnea scale
Patients may be included in pulmonary rehabilitation when they terminate an exercise evaluation at a level less than what percentage of their maximum oxygen consumption?
75%
The most effective breathing technique a patient
with chronic obstructive pulmonary disease can
acquire is which of the following?
diaphragmatic breathing with pursed lips
Reconditioning involves the following :
- strengthening essential muscle groups,
- improving overall O2 utilization and
- enhancing the body’s cardiovascular response to physical activity
To determine the patient’s cardiopulmonary status and
exercise capacity, both __________ and a ____________ may be performed.
pulmonary function testing , cardiopulmonary exercise evaluation
With regard to test preparation, patients should fast ________
before the procedure.
8 hours
The ideal class size of Rehabilitation Program should range from _____ to _____ participants
3 to 10
The quantity of equipment needed depends on ________ , _______, and ______
class size, scheduling, and available space.
Pulmonary rehabilitation programs must include five
components which must be documented in the patient’s medical
record. The five components include the following:
- Physician-prescribed exercise, including aerobic exercise
performed during each session - Education and training that relate to an individual patient’s
needs - Psychosocial assessment
- Outcomes assessment
- Treatment plan that details how these components are used
for each individual patient
If no improvements in physical or psychosocial measures
occur within a class or group, _________ are the most
likely cause
program deficiencies
