Special Populations Flashcards
Congestive Heart Failure
Hearth can’t pump blood out → blood backs up
With CHF the patient is at risk of:
- Pulmonary edema (can be intersitital, perivascular or alveolar edema)
- Pleural effusion
- atelectasis
becasue fluid is backing up into the lungs
CHF, auscultation in stages 1, 2 and 3:
- Early (stage 1): may not hear anything
- Moderate (stage 2): crackles (wet), decreased BS
- Severe (stage 3): pleural rub (effusion), crackles, decreased BS
Congestive Heart Failure symptoms:
- 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
Goal of treatment of CHF:
- keep pulmonary capillary pressures at lowest possible levels
- help them breathe
Caused by inadequate insulin production OR ineffective insulin action
Diabetes
In diabetes, decreased elastic recoil and diffusion capacity. See more of a _________________ pattern
restrictive
In diabetes, higher incidence of __________ infections and
sleep-related breathing problems
pulmonary
Higher resting metabolic rate demands higher cardiac output and minute ventilation to meet the body’s needs
Obesity
>30 BMI (obesity) may result in a ________ resting diaphramg
higher
Diabetes, metabolic response to exercise may be altered:
- Development of ketoacidosis
- Can affect breathing pattern
Obesity may see:
- Obstructive Sleep apnea
- Pulmonary HTN
- Mean pulm arterial pressure > 25 mmHg at rest
- Obesity hypoventilation syndrome (OHS)
Pulmonary HTN = Mean pulm arterial pressure >
25 mmHg at rest
Obesity hypoventilation syndrome (OHS)
don’t take a deep enough breath
who has the higher diaphragm?
Apple
True or false. Obesity may cause restrictive pulmonary issues, but may see obstructive sleep apnea
true
Signs of COPD:
- 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
Symptoms of restrictive pulmonary diseases:
- Dyspnea
- Cough
- Emaciation
Signs of restrictive pulmonary diseases:
- Tachypnea
- Hypoxemia
- Diminished BS
- Adventitious BS
- Decreased lung volumes
- Decreased diffusion capacity
- Cor Pulmonale (Right hearth failure): hearth overloads
In renal failure may see:
- Diaphragmatic weakness
- Restrictive lung dysfunction
- PH disturbances
Renal failure
Fluid overload: Pulmonary edema, HTN, ascites (fluid in abdomen)
ascites
the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
Side effects of DIALYSIS can include:
- Anemia
- Pericarditis
- Ascites
in CHRONIC RENAL FAILURE (CRF) can see decreased …..
- exercise/functional capacity
- May be as low as 50% of healthy age/sex matched controls
Chest PT (breathing exercises/PD) performed at Brompton Hospital in ______ in 1934
England
“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”.
American Association of Cardiovascular and Pulmonary Rehabilitation
Primary Goal of Pulmonary Rehab:
- 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
Primary goal of pulmonary in-patient (acute care):
- 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
True or false: in acute care setting, the goal for the pulmonary patient is toward increasing exercise capacity
FALSE
Goals are to improve ventilation and gas exchange, secretion clearance and maintenance of functional capacity
results from decreased length of stay at the hospital
- Decreased length of stay (decreased cost)
- Reduction in post-surgical complications (ex. pna)
- Quicker return to activity and work
In out-patient pulmonary rehab, use__________ as a means of evaluating efficacy in lieu of physiologic parameters
functional outcomes
Out-patient pulmonary rehab pragrams include
exercise, education and counseling
Most pts in pulm rehab have _______, but other diagnoses can benefit too
COPD
Four Domains of Outcomes Assessment (AACVPR)
- Health outcomes
- Clinical outcomes (dyspnea, exertional, depression, anxiety)
- Behavioral outcomes (smoking cessation)
- Service outcomes
Health outcomes has 4 aspects:
- Physical functioning
- Psychological functioning
- Social-role functioning
- Disease and treatment symptoms and side effects
“The gap between that which is desired in life and that which is achieved”
Heath Outcomes: Quality of Life
Health Related Quality of Life assessments:
(generic and respiratory specific)
-
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)
These are measures done to evaluate patient’s progress and guide development of long-term goals in d/c plan
Clinical Outcomes
when are the clinical outcomes done?
- At start of rehab
- Scheduled intervals during rehab
- End of rehab
- May be physical tests or questionnaires
true or false: clinical respiratory outcomes may be physical tests or questionnaires
true
Reflect patient’s ability to make recommended lifestyle changes
Behavioral Outcomes
Behavioral outcomes
- 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
Service/Satisfaction Outcomes:
- Pulmonary rehabilitation is a customer service program
- Patient satisfaction survey
- Utilization rates
- Costs of providing care
to qualify for pulmonary rehab patients must have…
- 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
Clinical outcomes for dyspnea and fatigue:
(during a specific task & during daily activity)
-
Exertional breathlessness during a specific task:
- Borg, VAS.
-
Overall level of breathlessness during daily activity:
- Dyspnea Index, UCSD SOB Questionnaire, MRC Questionnaire.
Clinical outcomes for exercise performance:
- Field tests (6MWT, shuttle walk test)
- Laboratory tests (max and submax exercise testing)
Clinical outcomes for a anxiety and depression:
- Beck depression inventory,
- Hospital anxiety and Depression questionnaire.
