Week 11 Restrictive Disease

Question 1

what happens when a patient is already deconditioned from a chronic condition and develops another issue superimposed on the chronic condition?

Answer 1

their baseline of function is already low when adding additional issues then the level of function becomes even lower (usually below the level needed for independence in ADLs)

Question 2

what are some causes of restrictive disease?

Answer 2

chest wall stiffness
acute or chronic interstitial or infiltrative disease
N-M disease, severe obesity, pleura disease, kyphoscoliosis

Question 3

what is restrictive lung dysfunction?

Answer 3

difficulty in bringing O2 in due to decreased lung compliance or impaired ability of the thorax to expand
increased stiffness of lungs or chest wall
respiratory muscle weakness
pulmonary edema

Question 4

what are the 3 main characteristics of RLD?

Answer 4

decreased pulmonary compliance, resistance to lung expansion is increased
increased work of breathing
on PFT all lung volumes and capacities are decreased

Question 5

what is pulmonary fibrosis?

Answer 5

inflammatory process of alveolar wall
decreased lung compliance, lung volume, surface area for gas exchange, diffusion area
increased V/Q mismatch, work of right ventricle, WOB

Question 6

what are the signs and symptoms of pulmonary fibrosis?

Answer 6

Chest x-ray, ABGS: pO2 decreased/pCO2 normal, breath sounds are decreased, Cor pulmonale, clubbing, cyanosis, DOE then SOB at rest, nonproductive cough, weight loss

Question 7

what treatment is used for pulmonary fibrosis?

Answer 7

corticosteroids only for acute inflammatory stage, O2, nutrition, pulmonary rehab

Question 8

what are the signs and symptoms of pneumonia?

Answer 8

crackles over consolidation
infiltrate on chest x-ray
hypo-resonance on percussion
DOE/SOB
tachypnea

Question 9

what medical treatment is used for pneumonia?

Answer 9

antibiotics
bronchodilators/steroids

Question 10

what PT intervention is used for pneumonia?

Answer 10

breathing Ex
mobilization
strengthening
PD/Chest PT

Question 11

what are the effects of restrictive disease?

Answer 11

reduced chest wall mobility created a vicious cycle: disease –> dyspnea –> poor posture & chest wall mobility –> disuse –> disease

use of corticosteroids to tx dz may lead to osteoporosis, steroid myopathy, reduced immunity, etc.

Question 12

what are the risk factors for pneumonia?

Answer 12

interstitial fibrosis with little respiratory reserve, bad breathing mechanics, poor airway clearance

Question 13

what is bronchopneumonia?

Answer 13

widespread inflammation of distal airways

Question 14

what is epiglottitis?

Answer 14

life-threatening infection of young children
obstruction, cyanosis, and stridor

Question 15

what is croup?

Answer 15

upper airway infection that blocks the breathing and has a distinctive barking cough
inspiratory stridor, cough, and hoarseness
occurs secondary to epiglottitis or laryngotracheobronchitis

Question 16

what are the classic signs and symptoms of restrictive lung dysfunction?

Answer 16

tachypnea, cyanosis, dry cough, dyspnea, alveolar hyperventilation/decreased CO2, V?Q mismatch, hypoxemia, clubbing, decreased lung volumes and capacities, decreased diffusion capacity, pulmonary HTN

Question 17

what may treatment include for RLD?

Answer 17

supplemental O2, antibiotics, chest tube, Rx for some conditions, supportive until condition resolved, breathing exercises, chest expansion, postural correction, conditioning: mobility and strengthening

Question 18

what are the typical walking speed times for common activities
> ___ m/s to safely manage city crosswalk
> ___ m/s typically able to complete household chores
> ___ m/s able to carry groceries and complete light yard work
> ___ m/s able to climb several flights of stairs

Answer 18

> 0.49
0.89
1.11
1.33

Question 19

walking speed of <0.59 m/s is predictive of:

Answer 19

increased risk for adverse outcomes, such as falls

Question 20

walking speed of <0.4 is predictive of:

Answer 20

less likely to be d/c to home from acute care
limited to household ambulation
requires assistance to enter and exit
difficulty negotiating stairs in the home