Special Populations and Pulmonary Rehabilitation

Question 1

CHF goal of treatment

Answer 1

Keep pulmonary capillary pressures at lowest possible levels

Question 2

Diabetes

Answer 2

Metabolic disorder characterized by hyperglycemia

Metabolic response to exercise may be altered

Higher incidence of pulmonary infections and sleep related breathing problems
-Diminshed pulmonary fx in a restrictive pattern

Decreased elastic recoil and diffusion capacity

Development of ketoacidosis

• Kussmaul’s breathing
• HYPERventilation to give off

Question 3

Obesity

Answer 3

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

May have higher resting diaphragm

With exercise, demands are even greater

May see…
Obstructive sleep apnea
Pulmonary hypertension
Obesity hypoventilation syndrome (OHS)

Question 4

Renal Failure

Answer 4

Fluid overload - pulmonary edema, HTN, ascites

Pleural effusions, pulmonary calcification

Diaphragmatic weakness

Acid-base disturbances

Question 5

Dialysis SE

Answer 5

Anemia
Pericarditis
Ascites

Question 6

Ascites

Answer 6

Fluid build up in your abdomen

Question 7

CRF

Answer 7

Decreased exercise/functional capacity

May be as low as 50% of healthy age/sex matched controls

Question 8

Goals of INPATIENT pulmonary rehab

Answer 8

Reduce symptoms
Optimize functional status
Increase participation
Reduce health care costs

Improve ventilation
Improve gas exchange
Improve secretion clearance
Maintain functional capacity

Question 9

OUTPATIENT pulmonary rehab

Answer 9

Use functional outcomes as a means of evaluating efficacy in lieu of physiologic parameters

Program includes…
EXERCISE
EDUCATION
COUNSELING

Question 10

Essential components of Pulmonary Rehab

Answer 10

Psychosocial Intervention
Assessment
Therex
Promotion of LT Adherence
Patient Education and Training

Question 11

Respiratory therapy

Answer 11

Perform examinations, diagnose pulmonary disorders, and recommend tx

Consult with physicians to recommend a change in therapy

Analyze breath, tissue, and blood specimens

Manage ventilators and artificial airway devices

Respond to Code Blue or other urgent calls for care

Educate patients and families

Question 12

Pulmonary Rehab Benefits

Answer 12

Decreased…

Respiratory symptoms
Depression and anxiety
Pulmonary exacerbations
Use of medical resources

Increased…

Mm strength and endurance
Knowledge about management
Ability to perform ADLs
QOL
Ability to return to work and/or leisure activities

Question 13

Patient Selection

Answer 13

MUST have dx of chronic, stable respiratory disorder with disabling symptoms that impair the patient’s function

Values to show…

FEV1

Question 14

Four domains of outcomes assessment

Answer 14

Health outcomes
Clinical outcomes
Behavioral outcomes
Service outcomes

Question 15

Health outcomes

Answer 15

Health related quality of life

Physical functioning
Psychological functioning
Social-role functioning
Disease and treatment symptoms and SEs
Morbidity and mortality

Question 16

Clinical outcomes

Answer 16

Physical and psychological changes

Dyspnea and fatigue
Exercise performance
Anxiety and depression

Question 17

Behavioral outcomes

Answer 17

Knowledge of education 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

Question 18

Service/satisfaction outcomes

Answer 18

Pulmonary rehabilitation is a customer service program

Patient satisfaction survey

Question 19

CHF

Answer 19

Can see pulmonary edema (interstitial, perivascular, and alveolar)

May have pleural effusion and atelecstasis

Symptoms...
Dyspnea due to poor gas transport
Paroxysmal nocturnal dyspnea/orthopnea
Rapid RR
Cheyne-Stokes breathing