Pulmonary system, vital signs, eval and cardiopulmonary rehab

Question 1

pneumonia

Answer 1

• bacterial: acute disease, intra-aveolar infection
• viral
• aspiration

Question 2

Tuberculosis

Answer 2

airborne infection from a bacteria
s/s: bad cough, chest pain, blood sputum, weakness/fatigue, weight loss, chills/fever
tx: drug therapy (prolonged)

Question 3

possible outcomes with TB

Answer 3

• compromised spinal integrity
• spinal lesions –> motor and sensory impairments
• brain lesions –> stroke like symptoms

Question 4

COPD

Answer 4

• poor expiratory flow rates
  1. peripheral airway disease: smoking
  2. chronic bronchitis
  3. emphysema (enlargement and destruction of air spaces)

s/s: dyspnea, wheezing, cough and sputum
interventions: bronchodilators, steroids for anti inflammatory effects, preventative vaccination, O2 therapy

OTs do not change their O2

Question 5

other chronic obstructive diseases

Answer 5

asthma
cystic fibrosis
hyaline membrane disease

Question 6

chronic restrictive diseases

Answer 6

difficulty expanding lungs
can be from bony/muscular/organ changes: bony thorax, ankylosing spondylitis, scoliosis, pectus excavatum, burns, muscular degeneration, SCI, etc

Question 7

pulmonary edema

Answer 7

seepage of fluid from vascular system in interstitial space

Question 8

pulmonary emboli

Answer 8

thrombus from vein becomes embolic and lodges in pulmonary circulation, can cause infarction

Question 9

pleural effusion

Answer 9

excessive fluid between the pleura from inflammatory conditions

Question 10

atelectasis

Answer 10

collapsed or airless alveolar unit

Question 11

claudication, angina, and dyspnea scales

Answer 11

0 - no pain
1 - light/mild
2 - moderate/bothersome
3 - moderate/severe
4 - severe/most pain

Question 12

vital signs

Answer 12

measured before, during, and after activity
note side effects from medications may impact vital signs

Question 13

HR for infants/adults

Answer 13

infant: 120 bpm
adult: 60-100 bpm

Question 14

BP for infants/adults

Answer 14

infant: 75/50 mm Hg
adult: <120/80 mm Hg

Question 15

RR for infants/adults

Answer 15

infant: 40 br/min
adult: 12-20 br/min

Question 16

diaphoresis

Answer 16

excessive sweating with decreased cardiac output

Question 17

pulses

Answer 17

decreased or absent associated with PVD

Question 18

skin color and vascular status

Answer 18

cyanosis: bluish color
pallor: turning white (limited blood flow)
rubor: redness (PVD)
temp
skin pale, shiny dry, ulcers, gangrene
claudication: pain/cramping/fatigue typically in calves
edema

Question 19

Phase 1 of cardiopulmonary rehab

Answer 19

hospitalization (acute)/inpatient rehab
- usually 24 hours after being stable for 24 hours
- bedside eval, MET level 1-2
- educate on energy conservation, cardiac precautions, BREATHING exercises
- monitor vital signs always
- can go to phase 2 when they are at 3.5 mets

Question 20

cardiac precautions

Answer 20

• no holding breath/straining
• no overhead exercises
• no lateral arm movements/stretch the chest

Question 21

absolute contraindications to go to cardiac rehab (inpatient and outpatient)

Answer 21

acute MI (within 2 days)
unstable angina
uncontrolled cardiac arrhythmias
acute PE or pulmonary infection
acute myocarditis or pericarditis or aortic dissection

Question 22

Phase 2

Answer 22

outpatient rehab (subacute)
start at 3.5 METs
- as early as 24 hrs after d/c from hospital
- build up activity tolerance
- ADLs, IADLs, work activities
- lifestyle change support
sex 5-6 mets

Question 23

Phase 3

Answer 23

maintenance/training
community exercise programs
gym programs (weight and cardiovascular training)

Question 24

cystic fibrosis

Answer 24

pediatric pulmonary disorder
- genetically inherited (both parents are carriers)
- production of abnormal mucous
- chronic, progressive
- exercise intolerance
- poor nutrition, developmental delays

Question 25

respiratory distress syndrome (RDS)

Answer 25

pediatric pulmonary disorder - premature birth
- insufficient production of surfactant (coating on the lungs to keep alveoli open)
- lung collapses after each breath
- supplemental O2 with CPAP, intubation with PEEP
- mother is treated with steroid meds 24-36 hours proper to premature delivery to stimulate surfactant production
- baby at risk for hemorrhage, dysplasia, developmental delay

Question 26

bronco pulmonary dysplasia (BPD)

Answer 26

• result of barotrauma (from ventilation, high inflating pressures, infection, aspiration, asphyxia - deprived of O2)
• prematurity
• lung walls thicken, making O2 exchange difficult
• oxygen therapy, ventilation, bronchodialtors
• risk for hypotonia, gross motor delays, feeding problems, CNS problems

Question 27

when are vital signs monitored during acute phase

Answer 27

prior to activity, at the peak, immediately upon cessation, and 4-5 min after activity

Question 28

internal bleeding s/s

Answer 28

ecchymosis (black and blue)
swollen, tender, firm (abdomen especially)
different skin color/temp
increased breathing and pulse
low BP
nausea/vom
restlessness/anxiety

minor: RICE
major: alert medical personnel

Question 29

shock s/s

Answer 29

pale gray or blue cool skin
increased, weak pulse
increased RR
decreased BP
irritability
diminishing level of consciousness
nausea or vommitting

• capillary refill test
• elevate legs
• no food/drink