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Rehab
Exam 3
| Question | Answer |
|---|---|
| What percent of COPD patients present with depressive symptoms? | 40% |
| What percent of ILD patients present with depressive symptoms? | 23% |
| What percent of pulmonary hypertension present with depressive symptoms? | 55% |
| What percent of bronchiectasis patients present with depressive symptoms? | 20% |
| What are the most common symptoms of depression? | - persistent depressed mood - lack of pleasure - feelings of worthlessness - difficulty with concentration - sleep disturbance appetite disturbance |
| What is the mortality in patients with severe COPD and depression symptoms? | 3 years |
| What are the single factor screening tools for depression? | - Beck Depression Index - PHQ-9 (Physician Health Questionnaire) |
| What are the multi factor screening tools for depression? | - HADS (hospital anxiety and depression scale) - PRFS (psychosocial risk factor survey) |
| What percent of COPD patients present with anxiety? | 32% |
| What percent of ILD patient present with anxiety? | 31% |
| What percent of pulmonary hypertension patients present with anxiety? | 46% |
| What is the relationship between patients with COPD and panic disorder? | rates are 10 times higher than the general population |
| General anxiety disorder: | significant worry across multiple domains |
| Specific phobia: | fear of a particular experience (avoid experience) |
| Panic disorder: | recurrent panic attacks - intense episodes of anxiety |
| Post traumatic disorder: | anxiety disorder experienced following a traumatic event with significant fear related to that event |
| Social phobia: | fearful of being judged by others |
| What is considered the affective and emotional component of hostility? | anger |
| What is considered the behavioral or acting out component of hostility? | aggression |
| What is considered the attitudinal or cognitive component of hostility? | hostility |
| What are the single factor screeners for hostility? | - state trait anger - expression inventory 2 |
| What are the multi factor screeners for hostility? | - psychosocial risk factor survey (PRFS) |
| What are the single factor screeners for social support? | - MOS social support survey (MOS-SSS) - ENRICHD social support instrument (ESSI) |
| What are the multi factor screeners for social support? | - psychosocial risk factor survey (PRFS) |
| What are the substance abuse screening tools? | - CAGE questionnaire - CAGE AID - alcohol use disorder identification test (AUDIT) |
| What influences the level of cognitive impairment? | degree of hypoxemia |
| As COPD progresses, what happens to cognitive impairment? | increases |
| What is the prevalence rate for cognitive impairment? | 16-20% |
| What percent of COPD patients have moderate to severe cognitive dysfunction? | 42% |
| T/F: depression can be associated with memory difficulties. | True |
| T/F: exercise has been proven to help cognitive function in hypoxic COPD patients. | False - has not* |
| What are the screening tools for cognitive impairment? | - montreal cognitive assessment (MOCA) - mini mental status exam (MMSE) |
| T/F: you do not have to be trained to screen for cognitive impairment. | False - you must be trained personnel* |
| What are the levels of cognitive impairment? | mild, moderate, severe |
| Method of therapy that focuses on developing an awareness of our cognitive distortions, including unrealistic perspectives or expectations of ourselves or others, and then practicing those tools to correct these distortions. | cognitive behavioral therapy (CBT) |
| T/F: CBT should be utilized by a trained professional. | True |
| What type of psychotropic medication is typically used for insomnia, depression, and anxiety? | Benzodiazepines (ativan, xanax, valium, klonopin) |
| What does the motivational interviewing OARS stand for? | open ended questions, affirming, reflecting, and summarizing |
| Who is considered a psychosocial provider? | - psychologist - social worker - counselor - addictions counselor (all with a masters degree or higher) |
| T/F: patients do not need to be taught proper breathing techniques. | False - every patient must be taught* |
| Duration: | how long a patient does an exercise |
| Frequency: | How many times per week |
| Mode: | what type of exercise |
| Intensity: | effort of each exercise, workload |
| Warm up exercises allow for a gradual increase in... | - HR - BP - ventilation - blood flow |
| Cool down exercises reduce the risk of... | - arrhythmias - orthostatic hypotension - syncopal episodes - bronchospasms |
| What is the most beneficial exercise for ADLs? | upper and lower extremity training |
| T/F: advantages and disadvantages of high vs low intensity training is not yet known. | True |
| What must be evaluated before starting strength/resistance training? | joint/musculoskeletal abnormalities or discomforts |
| Breathing through smaller and smaller orifice: | flow resistive training |
| Type of respiratory muscle training with a preset inspiratory pressure: | threshold loading training |
| What is the suggested guidelines for respiratory muscle training? | 4-5 times/week (either a 30 min session or two 15 min sessions) |
| What are SpO2 limits for exercise induced hypoxemia? | 88-93%` |
| T/F: Depression in patients with COPD is greater than with other chronically ill groups. | False - is not* |
| T/F: Correlation between depression and disease severity is strong. | False - not strong* |
| T/F: teaching relaxation skills is vital. | True |
| The expectation of ones own ability to complete a task: | self efficacy |
| Number of social relationships and the connections between individuals in the network: | Structural Support |
| The support role of the social relationships (companionship, instrumental or material assistance, and information providing): | Functional support |
| What is the average medications per day for a COPD patient? | 6.3 |
| What are the four domains or self management that influence oxygen use? | - functional mgmt - health mgmt - social mgmt symptom mgmt |
| Primary invention strategies include: | - smoking cessation - health education - components of comprehensive pulmonary rehabilitation |
| Secondary prevention strategies include: | - smoking cessation, - spirometric measurements of expiratory flowrates - alpha1 antitrypsin replacement therapy - components of comprehensive pulmonary rehabilitation programs - nutritional support - pulmonary hygiene |
| Tertiary prevention strategies include: | - smoking cessation - vaccination - oxygen supplementation - nutritional support - pulmonary hygiene - treatment of exacerbations |
| Adherence rates tend to be low in what type of patients? | patients with pulmonary disease, diabetes, and sleep disorders |
| Obstructive lung disease include | - COPD/Emphysema - Alpha 1 antitrypsin deficiency |
| Restrictive lung disease include | - pulmonary fibrosis - sarcoidosis |
| Septic lung disease include | - cystic fibrosis - bronchiectasis |
| Vascular lung disease include | - pulmonary hypertension - eisenmengers syndrome - scleroderma |
| Restrictive disease measurements indicating transplant: | - post BD FVC < 60-70% predicted - DLCO < 50-60% - PaCO2 > 45mmHg - secondary pulmonary hypertension |
| Obstructive disease measurements indicating transplant: | - post BD FEV1 < 25% predicted - PaCO2 > 55 mmHg - increased pulmonary artery pressures with progressive deterioration |
| Pulmonary vascular disease measurements indicating transplant: | - poor function despite optimal treatment |
| Septic lung disease measurements indication transplant: | - post BD FEV1 < 30% - FVC < 40% - PaCO2 > 45 mmHg - progressive decline in clinical course - better to refer sooner than necessary |
| Absolute contraindications of lung transplant | - current tobacco use (must be 6 months free) - current marijuana use (must be 6 months free) |
| Expectations for transplant list patients: | - maintain goal weight - maintain rehab - maintain social support - notify any changes in medication/condition - prelung transplant clinic - live within 4 hours of center |
| Expectation for transplant patients in pulmonary rehab: | - complete 30 days - remain in maintenance - walk 3-5 days/week - maintain/improve 6MW |
| What is the lung allocation based on? | net benefit (patients most likely to do the best after transplant) |
| What is the lung allocation score range? | 0-100 (higher the number, more likely for transplant) |
| Complications of lung transplant: | - technical - infection - acute rejection - medication related - malignancy - chronic rejection |
| Immediate post op concerns: | - immunosuppression - infection - reperfusion injury - hemodynamic stability - ability to wean from ventilator - pain management - anxiety control for effective pulmonary toilet |
| Discharge Education includes: | - take your meds - exercise daily (30 min) - call for questions, concerns, problems |
| Out patient follow up includes: | - clinic - bronchoscopy - pulmonary rehab - physical therapy |
| What is the out patient clinic follow up schedule? | - weekly: 4-6 weeks - biweekly: until 3 months - monthly: until 12 months - lifelong: every 3-6 months |
| When are surveillance bronchs scheduled? | 1 month, 3 months, 6 months, 9 months, and 12 months post transplant |
| What medications are used to block the body's ability to recognize non-self? | immunosuppressives |
| What medications immediately suppress the immune system with the initial dose? | - campath - simulect - solu medrol |
| Campath dosage and timing? | 30 mg subcutaneous within 12 hours of surgery |
| Simulect dosage and timing? | 20 mg intra-op and post-op day 4 |
| Solu Medrol dosage and timing? | 500-1000 mg intra-op 125 mg every 12 hours x 4 doses |
| Maintenance immunosuppression with a black box warning for causing delayed healing and airway deterioration: | m-TOR inhibitor Rapamune (sirolimus) |
| Standard medications for rejection include: | - prograf (tacrolimus) - prednisone: life-long - cellcept (mycophenalate mofetil) |
| Standard medications for infection include: | - septra: pneumocystis - valcyte (valganciclovir): CMV - vfend (voriconazole) or cresemba (isavuconazonium): aspergillus - nystatin: thrush |
| Signs and symptoms of acute rejection | - cough, dyspnea, fatigue, fever, flu like symptoms - decreased PFTs - decreased oxygen saturations - decreased activity tolerance |
| Diagnosis of acute rejection | - chest xray (pleural effusion; early after transplant) - transbronchial biopsy (GOLD STANDARD) |
| Treatmet for acute rejections | - solu medrol - campath - thymoglobulin |
| Descriptor of sustained lack of normal function of the transplanted lung: | chronic lung allograft dysfunction (CLAD) |
| Inflammation of the small airways leading to the obstruction and destruction of pulmonary bronchioles. Progresses to impairment of large airways | bronchiolitis obliterans syndrome (BOS) |
| Pleural fibrosis | restrictive allograft syndrome (RAS) |
| Chronic rejection etiology (cause) includes: | - possible association with number and severity of acute rejection episodes - episodes of CMV infection - GERD (reflux) - permanent decline from baseline spirometry |
| Treatment for chronic rejection | - optimal immunosuppression - close surveillance of PFTs and CXR - prompt treatment of infection and rejection episodes - zithromax (azithromycin) - statin - extracorporeal photopheresis (ECP) - retransplant |
| Common infections after transplant | - bacterial pneumonia - CMV (early and late) - aspergillus |
| T/F: lung transplant coordinators are the first point of contact for lung transplant recipients (LTRs). | True |
Created by:
lexleis
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