Week 3 Flashcards
Pulmonary rehab often deals with
chronic diseases
Pulmonary rehab can be delivered in a…
hospital,
clinic,
follow up at home,
physical care medicine,
ICU
Ultimate goal with pulmonary rehab is to
help pt manage condition at home/community to prevent further complications/readmissions
Main lifestyle modification for lung disease
smoking
Very common symptom of lung disease is
SOB/dyspnea
–> depends on the severity how many activities SOB impacts
Why is cognitive impairments a symptom of lung disease?
having low oxygen for prolonged period of time this has an impact on the brain possibly causing these cognitive impairments
Is SOB common in patients with lung conditions or heart conditions?
Both
T/F those without lung diseas can still have SOB, why?
True
lung function changes with age – lung muscle strength decreases (such as seniors with SOB who don’t have lung condition)
Lung Disease - cycle of inactivity
1) SOB, accomplishing activities difficulty
2) Poor confidence, less P.E
3) Muscle lose strength, heart function decreases
4) Fitness declines, social isolation
5) Worsening SOB, anxiety/depression
6) loss of independence, symptoms worsen
What should pts with lung conditions be doing instead of resting?
low or high functioning activities
Low functioning: mobilization, safety w/transfers, basic ADLs, activity tolerance
High functioning: building on activity tolerance (ADLs, IADLs), life balance, IADLs
Supplemental oxygen
prolongs life, improves quality of life, can be temporary or permanent
Endotreacheal intubation
goes through the mouth/nose and down the throat and to the lungs
pt with this will not be awake, will be unconcious and wont be able to speak/interact
will be doing positioning, but won’t do transfers or mobility
Tracheostomy
goes directly into throat
can be awake and talk
Endotreacheal intubation VS Tracheostomy
Endotreacheal intubation:
goes through the mouth/nose and down the throat and to the lungs
pt with this will not be awake, will be unconcious and wont be able to speak/interact
will be doing positioning, but won’t do transfers or mobility
Tracheostomy:
goes directly into throat
can be awake and talk
Scope of practice for assistants with supplemental oxygen
assistants are allowed to change mode of oxygen delivery (wall, portable, tank)
assistant NOT allowed to “titrate”
Target Pulse Oximeter in COPD pts
target pulse oximetry in pts = 88% to 92%
Diaphragmatic breathing
improves breathing pattern
helps with building activity tolerance
improves SOB & fatigue
Pursed Lip Breathing
Controls SOB by quickly slowing down pace of breathing
prolongs exhalation time by moving old air out of lungs
Energy Conservation Techniques for Pulmonary Conditions
Position: sitting when possible, limit bending/reaching, upright posture
avoiding carrying heavy objects
resting at least 60 mins after a meal
using warm not hot water (in shower)
Posture slump vs upright for pulmonary condition pts?
Upright
Speed of breathing to regain control of your breathing, shallow/fast VS deep/slow breathing
deep/slow breathing
Where should breathing occur
Abdomen
Which should be longer? Breathing in or breathing out?
Breathing out
Can you feel breathless even with normal oxygen levels in the blood?
Yes
Does everyone with a chronic lung condition require oxygen at home?
No
Tests are needed so your doctor can tell if you need home oxygen. True or False?
True
Prescribed oxygen is used only when the person feels they need it. True or False?
False
It is important to keep active even though someone has oxygen. True or False?
True
Apneic (Apnea)
a long pause after every inspiration and expiration; usually occurs during sleep
Orthopnea
only being able to breathe comfortably when in an upright position – often measured in number of pillows required to breathe (or Lazyboy) while sleeping
Dyspnea
subjective feeling of not being able to breathe comfortably
Average respiratory rates depending on age:
Under 6 years = 25-60bpm
10 years = 15-20bpm
Adults = 12-20 bpm
Barrel Chest
large shaped/rounded chest
trapped air
Usually seen with COPD, emphysema
Kyphotic Chest
increased curvature of spine (sunken in/bent over old lady)
Postural/age
Reduced air flow/ineffective inspiration
Scoliotic chest
curvature of the spine
Reduced air, dysfunctional respiratory muscles
Why do people lean/bend forward when in respiratory distress?
stabilizes ribs and supports chest wall
Some signs of respiratory distress
cyanosis (blue-ish) around lips, nails
Positioning/leaning forward
Accessory muscle use (increase use of neck muscles and absence of diaphragm use, common in those with COPD)
Auscultation
Listening to lungs
Covid-19
ACUTE
Atelectasis
Segmental/full lung has collapsed
ACUTE
manual therapy
breathing/mobility
Pneumonia
Infection of the air sacs in the lungs
ACUTE
can be very mild with few symptoms to life threatening
anti-biotics
manual therapy
breathing/mobility
Chronic obstructive pulmonary disease (COPD)
Signs?
Group of lung diseases that block airflow due to narrowing of the bronchial tree.
CHRONIC
Caused mainly by smoking or exposure to second-hand smoke or severe pollution
Medications to manage wheezing
Lifestyle modifications
Signs:
Clubbing – thumbnails are humps
Increased SOB
Barrel chested
Auscultation (listening to breathing) decreased breathing sounds
Cystic Fibrosis:
CHRONIC
Genetic disorder that shortens lifespan and results in copious secretions
lots of manual therapy
Contradictions to manual cardiorespiratory therapy:
Active hemoptysis (coughing up blood)
Pulmonary emboli (blood clot that can get caught either in heart and cause heart attack or brain and cause stroke)
Spinal injury
Pleural effusion
Agitated patient
Rib fracture
Treatment options for cardiorespiratory patient:
secretion clearance
cough assist
breathing exercises
incentive spirometry
relaxation strategies
exercises
Percussion
Uses cupping or clapping of the hands to loosen mucous
Goals - move the mucous from smaller to larger airways to be coughed or suctioned out
Use a cupped hand
Vibrations
technique that gently shakes the mucus so it can move into the larger airways
Use a flattened hand
For a strong cough you need two things:
1) To be able to completely fill your lungs
2) To be able to breathe out forcefully
