Week 4 - Pulmonary rehab Flashcards
What is pulmonary rehab
Program designed to improve QoL for certain lung conditions
Lung conditions
COPD
asthma
pulmonary hypertension
cystic fibrosis
pulmonary rehab aims to
Increase awareness about chronic disease and its management/monitoring
provides education on how to achieve exercise/activities with less SOB
Reduce symptoms, leading to more active life
enable people to achieve and maintain their maximum level of independence and functioning
Pulmonary rehab team
doctors
nurses
dieticians
PTs
OTs
OTA PTA
respiratory therapists
Doctors in pulmonary rehab
diagnosis
Respiratory therapists
experts in respiratory function
O2 devices - a lot more training
decide which device is most appropriate for pt.
Settings where services are delivered
hospital
clinic
follow up at home
physical care medicine
ICU
Areas of interventions
smoking cessation
exercise
breathing training
learning to eat well
psychological counselling
ultimate goas
education
Breathing training
Pursed lip breathing
diaphragmatic breathing
distress control techniques
Psychological counselling
depression
anxiety
Ultimate goal
manage condition at home and in community
services to maximize functional independence within the context of their own homes
OT performance issues - general physical deconditioning
few days of inactivity in bed reduces skeletal muscle mass and strength
long term consequences
OT performance issues - pain and fatigue is from…
from prolonged bed rest
mild, moderate or severe fatigue
OT performance issues - impaired activity tolerance
at different levels
OT performance issues - cognitive impairments
chronic or acute
OT & OTA role in pulmonary rehab (16)
early mobilization
positioning
ADL re-training
IADL re-training
activity tolerance and energy conservation techniques
Ventilation strategies
stress management
relaxation strategies
therapeutic exercise programs
UE function
safety
home O2 management
wellness at home and in community
cognitive strategies
equipment provision, seating and mobility
Early mobilization - settings
ICU
Acute setting
subacute setting
Examples of OTA intervention - Low functioning
transfer safety
mobility indoor
basic ADLs
activity tolerance, daily and weekly schedule
Examples of OTA intervention - High functioning
Building on activity tolerance
Life balance
IADLs
could come in later in rehab plan
Supplemental Oxygen
low levels of oxygen for long periods of time can cause problems to vital organs
prolongs life
improves QoL
can be temporary or permanent
Endotracheal intubation
aren’t able to breathe
inserted into mouth down to throat
cannot talk
often not conscious
will never leave to go home intubated
Standards of practice - allowed and not allowed
Never change O2
can change if you have a serious, precise conversation
Diaphragmatic breathing
improves breathing pattern
improves SOB & fatigue
most efficient muscle for breathing
pursed lip breathing
helps control SOB
quickly slows down pace of breathing
moves old air out of lungs
reporting to therapist
use appropriate terminology and medical abbreviations
use outcome measures
Document how long
Doc difficulty
Posture
Slump vs. upright
speed of breathing
shallow/fast vs. deep/slow
regaining control of your breathing
where should breathing occur
Diaphragm
which should be longer, breathing in or out?
out
What to do if pt. shows signs of respiratory distress
stop activity
take a break
check vital signs
seek medical help if symptoms don’t improve after rest
inform OT and team
modify for future interventions to decrease intensity
Outcome measures
Borg RPE scale
VAS scale
Documenting how long…
pt. is able to tolerate each activity to show progress overtime
doc difficulty
activity and progression each session that you’re addressing activity tolerance
RR and pattern - Normal
Symmetry between movement of chest wall and abdomen
RR and pattern - apneic (apnea)
long pause after every inspiration and expiration
Apneic cause
neurodegenerative disease, obesity, narcotic use, hypoventilation syndrome
RR and pattern - Orthopnea
only able to breathe comfortably when in upright position
often measured in number of pillows required to breathe while sleeping
Respiratory rates - under 6 years
25-60 bpm
Respiratory rates - 10 years
15-20 bpm
Respiratory rates - adults
12-29 bpm
Barrel chest
large shaped chest
trapped air
usually seen with COPD
Kyphotic chest
increased curvature of spine
postural (hunched over)
reduced air flow/ineffective inspiration
seen more in frail pt.
posture education
Scoliotic chest
curvature of spine
reduced air
dysfunctional respiratory muscles
Signs of respiratory distress
increased RR
cyanosis around lips, nails
nostrils flaring
indrawing
sweating
wheezing/whistling
positioning
Cyanosis
blue lips
loss of heat from lips or nails
Indrawing
chest and neck “sing: in with each breath
Things we may feel (palpate)
vibrations
respiratory expansion
subcutaneous emphysema
skin temp
pulse
Auscultation
listening to lungs
abnormal sounds:
crackles
wheezes
decreased flow
