Week 4: Rehabilitation and Life Limiting Illnesses

Question 1

What is a life limiting illness?

Answer 1

Illness where it is expected that death will be a direct consequence of the specified illness

Question 2

What are some examples of life limiting illnesses?

Answer 2

Cancer
Heart disease
Chronic obstructive pulmonary disease
Dementia
Heart failure
Neurodegenerative disease
Chronic liver disease
Renal disease

Question 3

Why is illness trajectory important for patient-centred care?

Answer 3

Each phase of an illness trajectory can bring its own challenges for the person.
Understanding the likely course of a disease can help guide clinical assessment and choice of treatment options.
Important to address patients holistically
The end-phase of life may become apparent when particular changes in the status of a person’s functions or symptom profile occurs however, this is not always the case –for e.g. COPD

Question 4

What are the types of a care for a person with a life limiting illness?

Answer 4

Active therapy
Active therapy with treatment limitations
Palliative and supportive care
Terminal care

Question 5

What is palliative care?

Answer 5

An approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems

Question 6

What is rehabilitation?

Answer 6

A set of measures that assist individuals, who experience or are likely to experience disability, to achieve and maintain optimum functioning in interaction with their environments

Question 7

What information should be provided for patient/carer empowerment?

Answer 7

Understand how to optimise health
Treat exacerbations / understand symptom management
Disease trajectory –patients don’t see their disease as life threatening

Question 8

What is COPD?

Answer 8

A common preventable and treatable disease, is characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particle or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients

Question 9

What is the aetiology of COPD?

Answer 9

Cigarette smoking
Occupational dust and fume exposure
Outdoor and indoor air pollution (bio fuels)
Alpha-1-antitrypsin deficiency
Genetic predisposition
Recurrent respiratory infections in childhood

Question 10

What are the non-respiratory features of COPD?

Answer 10

Muscle wasting and cachexia
May initiate or worsen IHD,
Heart failure,
Osteoporosis,
Anaemia,
Diabetes, metabolic syndrome and
Depression

Question 11

What are the priority areas of symptom management for COPD?

Answer 11

Breathlessness
Cough and sputum
Anxiety
Depression
Lethargy
Fatigue
Pain
Insomnia
Anorexia

Question 12

What is the goal of O2 therapy in COPD?

Answer 12

The goal of supplemental oxygen is to raise the concentration of oxygen in the arterial blood and thus increase the concentration of oxygen in the tissues and prevent hypoxia
Breathlessness does not necessarily mean hypoxaemia (and hypoxaemia does not necessarily result in breathlessness)

Question 13

What are interventions for breathlessness?

Answer 13

O2 therapy
Reassurance, rest, relaxation
Positioning: leaning forward
Controlled breathing, purse lipped breathing
Fan

Question 14

What is pulmonary rehabilitation?

Answer 14

A comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education and behaviour change, designed to improve the physical and emotional condition of people with chronic respiratory disease and to promote the long term adherence of health-enhancing behaviours

Question 15

What are the goals of pulmonary rehabilitation?

Answer 15

Reduce symptoms -dyspnoea, anxiety, depression
Optimise functional status
Improve exercise capacity
Increase participation
Improve quality of life
Reduce healthcare costs

Question 16

What are the major aspects of pulmonary rehabilitation ?

Answer 16

Comprehensive program of exercise, education and psychosocial support
Addresses the disease PLUS its comorbidities PLUS complications
Often multidisciplinary
Always multifaceted
True care integration

Question 17

What are the components of pulmonary rehabilitation?

Answer 17

Pre and post assessment
Development of goals
Exercise training (endurance & strength training; individually prescribed)
Disease education / Self management (including managing exacerbations, nutrition, medications and psychosocial support)
Maintenance program

Question 18

How do you set a SMART goal?

Answer 18

S –specific, significant
M –measurable, meaningful
A –agreed, attainable, achievable
R –realistic, relevant
T –time based, trackable

Question 19

Up to page 24

Answer 19

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