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PT Pulmonary Pathology, Diagnosis and Management > Special Populations > Flashcards

Special Populations Flashcards

1
Q

Congestive Heart Failure

A

Hearth can’t pump blood out → blood backs up

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2
Q

With CHF the patient is at risk of:

A
  • Pulmonary edema (can be intersitital, perivascular or alveolar edema)
  • Pleural effusion
  • atelectasis

becasue fluid is backing up into the lungs

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3
Q

CHF, auscultation in stages 1, 2 and 3:

A
  1. Early (stage 1): may not hear anything
  2. Moderate (stage 2): crackles (wet), decreased BS
  3. Severe (stage 3): pleural rub (effusion), crackles, decreased BS
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4
Q

Congestive Heart Failure symptoms:

A
  • Dyspnea due to poor gas transport due to R-L
    shunting due to fluid in alveoli
  • Paroxysmal nocturnal dyspnea (wakes them up at night)/orthopnea (# of pillows)
  • Rapid RR (quick shallow breaths)
  • Cheyne-Stokes breathing
  • *Jugular dystention
  • *Peripheral edema
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5
Q

Goal of treatment of CHF:

A
  • keep pulmonary capillary pressures at lowest possible levels
  • help them breathe
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6
Q

Caused by inadequate insulin production OR ineffective insulin action

A

Diabetes

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7
Q

In diabetes, decreased elastic recoil and diffusion capacity. See more of a _________________ pattern

A

restrictive

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8
Q

In diabetes, higher incidence of __________ infections and
sleep-related breathing problems

A

pulmonary

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9
Q

Higher resting metabolic rate demands higher cardiac output and minute ventilation to meet the body’s needs

A

Obesity

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10
Q

>30 BMI (obesity) may result in a ________ resting diaphramg

A

higher

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11
Q

Diabetes, metabolic response to exercise may be altered:

A
  • Development of ketoacidosis
  • Can affect breathing pattern
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12
Q

Obesity may see:

A
  • Obstructive Sleep apnea
  • Pulmonary HTN
    • Mean pulm arterial pressure > 25 mmHg at rest
  • Obesity hypoventilation syndrome (OHS)
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13
Q

Pulmonary HTN = Mean pulm arterial pressure >

A

25 mmHg at rest

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14
Q

Obesity hypoventilation syndrome (OHS)

A

don’t take a deep enough breath

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15
Q

who has the higher diaphragm?

A

Apple

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16
Q

True or false. Obesity may cause restrictive pulmonary issues, but may see obstructive sleep apnea

A

true

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17
Q

Signs of COPD:

A
  • Hypoxemia
  • Hypercapnia
  • Increased production of mucous/impaired mucous clearance
  • Pulmonary hypertension
  • Polycythemia
  • Cor pulmonale
  • Often see productive cough
  • Decreased expiratory flow rates (FEV1)
  • Increased residual volume
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18
Q

Symptoms of restrictive pulmonary diseases:

A
  • Dyspnea
  • Cough
  • Emaciation
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19
Q

Signs of restrictive pulmonary diseases:

A
  • Tachypnea
  • Hypoxemia
  • Diminished BS
  • Adventitious BS
  • Decreased lung volumes
  • Decreased diffusion capacity
  • Cor Pulmonale (Right hearth failure): hearth overloads
20
Q

In renal failure may see:

A
  • Diaphragmatic weakness
  • Restrictive lung dysfunction
  • PH disturbances
21
Q

Renal failure

A

Fluid overload: Pulmonary edema, HTN, ascites (fluid in abdomen)

22
Q

ascites

A

the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.

23
Q

Side effects of DIALYSIS can include:

A
  • Anemia
  • Pericarditis
  • Ascites
24
Q

in CHRONIC RENAL FAILURE (CRF) can see decreased …..

A
  • exercise/functional capacity
  • May be as low as 50% of healthy age/sex matched controls
25
Q

Chest PT (breathing exercises/PD) performed at Brompton Hospital in ______ in 1934

A

England

26
Q

“Pulmonary rehabilitation is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased dailyactivities. Integrated into the individual treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease”.

A

American Association of Cardiovascular and Pulmonary Rehabilitation

27
Q

Primary Goal of Pulmonary Rehab:

A
  • Rehab: Restore patient to highest possible level of independent function
  • Do this by heling patient become more physically active, learn more about their disease, treatment options, and how to cope
28
Q

Primary goal of pulmonary in-patient (acute care):

A
  • Goals are to improve ventilation and gas exchange, secretion clearance and maintenance of functional capacity
  • Not geared toward increasing exercise capacity due to limited length of stay in acute care setting → home program
29
Q

True or false: in acute care setting, the goal for the pulmonary patient is toward increasing exercise capacity

A

FALSE

Goals are to improve ventilation and gas exchange, secretion clearance and maintenance of functional capacity

30
Q

results from decreased length of stay at the hospital

A
  • Decreased length of stay (decreased cost)
  • Reduction in post-surgical complications (ex. pna)
  • Quicker return to activity and work
31
Q

In out-patient pulmonary rehab, use__________ as a means of evaluating efficacy in lieu of physiologic parameters

A

functional outcomes

32
Q

Out-patient pulmonary rehab pragrams include

A

exercise, education and counseling

33
Q

Most pts in pulm rehab have _______, but other diagnoses can benefit too

A

COPD

34
Q

Four Domains of Outcomes Assessment (AACVPR)

A
  1. Health outcomes
  2. Clinical outcomes (dyspnea, exertional, depression, anxiety)
  3. Behavioral outcomes (smoking cessation)
  4. Service outcomes
35
Q

Health outcomes has 4 aspects:

A
  1. Physical functioning
  2. Psychological functioning
  3. Social-role functioning
  4. Disease and treatment symptoms and side effects
36
Q

“The gap between that which is desired in life and that which is achieved”

A

Heath Outcomes: Quality of Life

37
Q

Health Related Quality of Life assessments:

(generic and respiratory specific)

A
  • Generic:
    • Medical Outcomes Study Short Form SF – 36
  • Respiratory Specific:
    • Chronic Respiratory Disease Questionnaire (COPD)
    • St. George’s Health Questionnaire
    • Living with Asthma Questionnaire
    • Pulmonary Functional Status Scale
    • Pulmonary Functional Status Scale (PFSS)
38
Q

These are measures done to evaluate patient’s progress and guide development of long-term goals in d/c plan

A

Clinical Outcomes

39
Q

when are the clinical outcomes done?

A
  • At start of rehab
  • Scheduled intervals during rehab
  • End of rehab
  • May be physical tests or questionnaires
40
Q

true or false: clinical respiratory outcomes may be physical tests or questionnaires

A

true

41
Q

Reflect patient’s ability to make recommended lifestyle changes

A

Behavioral Outcomes

42
Q

Behavioral outcomes

A
  • Knowledge of educational objectives
  • Success with smoking cessation
  • Adherence to diet
  • Adherence to medications
  • Adherence to exercise prescription
  • Supplemental oxygen use
  • Success with coping mechanism, energy conservation and pacing techniques
  • Success with relaxation and stress management
43
Q

Service/Satisfaction Outcomes:

A
  • Pulmonary rehabilitation is a customer service program
    • Patient satisfaction survey
    • Utilization rates
    • Costs of providing care
44
Q

to qualify for pulmonary rehab patients must have…

A
  • Diagnosis of chronic, stable respiratory disorder with disabling symptoms that impair the patient’s function
  • PFTs need to show:
    • FEV1 < 65% predicted
    • FVC < 65% predicted
    • DLCO < 65% predicted
    • Hypoxemia at rest and with exercise testing
45
Q

Clinical outcomes for dyspnea and fatigue:

(during a specific task & during daily activity)

A
  • Exertional breathlessness during a specific task:
    • Borg, VAS.
  • Overall level of breathlessness during daily activity:
    • Dyspnea Index, UCSD SOB Questionnaire, MRC Questionnaire.
46
Q

Clinical outcomes for exercise performance:

A
  • Field tests (6MWT, shuttle walk test)
  • Laboratory tests (max and submax exercise testing)
47
Q

Clinical outcomes for a anxiety and depression:

A
  • Beck depression inventory,
  • Hospital anxiety and Depression questionnaire.

PT Pulmonary Pathology, Diagnosis and Management (10 decks)

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