Special Populations and Pulmonary Rehabilitation Flashcards
CHF goal of treatment
Keep pulmonary capillary pressures at lowest possible levels
Diabetes
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
Obesity
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)
Renal Failure
Fluid overload - pulmonary edema, HTN, ascites
Pleural effusions, pulmonary calcification
Diaphragmatic weakness
Acid-base disturbances
Dialysis SE
Anemia
Pericarditis
Ascites
Ascites
Fluid build up in your abdomen
CRF
Decreased exercise/functional capacity
May be as low as 50% of healthy age/sex matched controls
Goals of INPATIENT pulmonary rehab
Reduce symptoms
Optimize functional status
Increase participation
Reduce health care costs
Improve ventilation
Improve gas exchange
Improve secretion clearance
Maintain functional capacity
OUTPATIENT pulmonary rehab
Use functional outcomes as a means of evaluating efficacy in lieu of physiologic parameters
Program includes…
EXERCISE
EDUCATION
COUNSELING
Essential components of Pulmonary Rehab
Psychosocial Intervention Assessment Therex Promotion of LT Adherence Patient Education and Training
Respiratory therapy
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
Pulmonary Rehab Benefits
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
Patient Selection
MUST have dx of chronic, stable respiratory disorder with disabling symptoms that impair the patient’s function
Values to show…
FEV1
Four domains of outcomes assessment
Health outcomes
Clinical outcomes
Behavioral outcomes
Service outcomes
Health outcomes
Health related quality of life
Physical functioning Psychological functioning Social-role functioning Disease and treatment symptoms and SEs Morbidity and mortality
Clinical outcomes
Physical and psychological changes
Dyspnea and fatigue
Exercise performance
Anxiety and depression
Behavioral outcomes
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
Service/satisfaction outcomes
Pulmonary rehabilitation is a customer service program
Patient satisfaction survey
CHF
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
