Pulmonary Rehabilitation Flashcards
Pulmonary Rehabilitation
-Pulmonary Rehab can be defined as, the art of medical practice wherein an individually tailored, multidisciplinary program if formulated which though acute diagnosis, therapy, emotional sup[ort, and education, stabilizes or reverses the phiso- psychopathological of pulmonary diseases and attempts to return the patient to the highest possible functional capacity allowed by his os her pulmonary handicap and overall life situation.
-Acute means temporary or curable
-Also treat incurable or permanent deceases like COPD.
Goal
-Achieving and maintaining the individual’s maximum level of independence and functioning in the community.
-This is achieved through exercise and education.
Multi Discipline (team that works together in RT)
-Respiratory Therapist
-Physical therapist
-Nutritionist
-Occupational Therapist
-Nurses
-Social Workers
-Psychologist
Types of Programs
-Intiensive: 4 to 12 weeks / 2-5 times per week
-Maintenance: Continued exercise conditioning
Perioperative: Optimized functioning prior to surgery and help patients recover from surgery.
About the RT Programs
-First suggested in 1951
-1962 study outlined values of reconditioning
-Lower pulse rate -Lower respiration rate -Lower minute volume -Lower CO2 production -Improved efficiency of movement
-Improved oxygen utilization
-Objectives: This program will enable the patients to;
-develop diaphragmatic breathing skills
-Apply appropriate airway clearance techniques as needed
-Patient education
-Family education
-Explain proper use of meds, oxygen, and equipment
-Participate in daily physical exercise regimen to condition both skeletal and respiratory related muscles
-Set individual exercise conditioning program
-Adhere to proper hygiene, diet, and nutrition
-Set individualized short and long term goals
-Psychosocial assessment / assistance as appropriate (mental health needs)
-Develop stress management and relaxation techniques
-Interact with other fellow patients in a group support
-Obtain individual and family counseling
-Determine need for chest physiotherapy
-Assessment of Patient process
-Follow Up
Patient Selection
-Patient most likely to benefit: COPD patients with persistent symptoms but does help non COPD patients as well
-Must be non smokers or participating in smoking cessation -Most beneficial if started when disease is moderate
-Patient Factors which may limit success
-Lack of motivation
-Presence of disabling disease (Such as heart failure)
-Low education level
-Lack of family and socioeconomic support
-Exclusion Factors
-Malignant Neoplasm
-Problems which preclude participation in exercise
Patient History
-Past illnesses including allergies
-Significant family history -Social Factors (Drinking smoking or drug use) -Occupational Factors -symptoms patient is experiencing -Productive cough/ sputum characteristics -Normal level of dyspnea ( Rest and activity) -Chest pain, nocturnal dyspnea, edema or extremities -Medications -Details of patients conditions -Pulmonary Function Testing -Cardiopulmonary exercise evaluation: 6 to 12 minute walk -Quantifies patients initial exercise capacity -Determines degree of hypoxemia with exercise
-Physical exam
-Overall gross exam
-Posture (tripod position) -Skin color -Audible breathing sounds -Abnormalities of Extremities (Digital Clubbing)
Physical Exam ( Close Inspection)
-Central Cyanosis
-Accessory Muscle Use ( Like using of the abdominal muscles) -Jugular Venous Distension -Respiratory rate and Pattern -Deformities of the Chest
Physical reconditioning- having target heart rate
-For most its resting heart rate plus 20 BPM
-Or 70% of max exercise rare ( 6 Min walk)
Setting up Individualized Plan
Plan set up with data collected from Patient
-Exercise Prescription
-Initial load should be low enough to be accomplished without patient experiencing discomfort
-Goal of prescription for pulmonary patient: -To achieve a work intensity, duration, and frequency that is challenging to the patient without placing them at risk for severe hypoxemia and or situation where they will experience extreme dyspnea or undue fatigue -Exercise can be Beneficial, Ineffective, or even harmful!!!!
