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Special Topics

Pulmonary Rehab

QuestionAnswer
Pulmonary terms -Diseases/Conditions: -RDS/ARDS -Asthma -COPD -Cystic Fibrosis -Restrictive lung disease
Pulmonary S&S -Apnea -Cyanosis -Dyspnea -Hypoxemia -Hyperpnea -Respiratory Acidosis -Respiratory Alkalosis -SOB
Apnea -Serious sleep disorder in which breathing repeatedly stops and starts
Cyanosis -Bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood
Dyspnea -Difficult or labored breathing
Hypoxemia -Abnormally low concentration of oxygen in the blood
Hyperpnea -Increased depth of breathing when required to meet metabolic demand of body tissues, such as during or following exercise, or when the body lacks oxygen (hypoxia), for instance in high altitude or as a result of anemia
Respiratory Acidosis -Medical emergency in which decreased ventilation (hypoventilation) increases the concentration of carbon dioxide in the blood and decreases the blood's pH
Respiratory Alkalosis -Disturbance in acid and base balance due to alveolar hyperventilation -Alveolar hyperventilation leads to a decreased partial pressure of arterial carbon dioxide (PaCO2)
Functional terms/conditions -Accessory muscles -Atelectasis -Respiration -Ventilation -Pneumothorax
Pulmonary deformities -Barrel chest -Digital clubbing
Pattern 6C-1 -Pattern 6C-1: Impaired ventilation, respiration and aerobic capacity associated with airway clearance dysfunction
Pattern 6F -Pattern 6F: Impaired ventilation, respiration and aerobic capacity and endurance associated with ventilatory pump dysfunction
Overall goal for Pulmonary Rehab -To achieve and maintain a maximum level of independence & functioning in the community -Work on improving the respiratory as well as the cardiovascular & muscular systems. Encourage the patient to take a more active part in their own care
Goals cont... -Until mid-60s, pts told to avoid anything that stressed them; studies say benefit from exercise, but they still then to avoid it due to dyspnea -Focus is on being able to do their ADL’s rather than making them an “athlete” due to years of deconditioning
Pre-Rehab requirements -Involved initial physical & medical diagnostic eval. is used to determine a specific diagnosis & what the rehab intervention should be
Parts of Assessment -Observation -Inspection/palpation -Breath sounds -Meds -Prevention
Observation -Posture:size,shape, symmetry of chest -Scoliosis/kyphosis -Upright vs forward lean
Observation cont... -Breathing Pattern -Use of accessory muscles or abdominal -Jugular distention, flared nostrils -Peripheral edema -Skin and nail bed color -Digital deformities
Inspection/Palpation -Subcutaneous emphysema causes skin crackles when pressed -Skin texture changes -Hair growth changes -Cough: ability to do and productivity -Sputum: amount, thickness, color, smell
Auscultation -Aka breath sounds
Vesicular breath sounds -Soft rustle during inhalation & beginning of exhalation to silent by end of exhalation
Bronchial breath sounds -Louder, more hollow and echoing
Decreased breath sounds -Barely audible
Vocal fremitus -Vibration
Adventitious breath sounds: Wheezes -Stridor= air passing thru narrow branches -Associated with asthma, bronchitis, tumors -Rhonchi= lower wheezing
Adventitious breath sounds: Crackles -Rales= collapse of alveoli that suddenly pop open -Associated with pneumonia, pulmonary edema, & pulmonary fibrosis -Sounds like the rustling of cellophane
Medical treatment -Appropriate medication are determined -Preventative care measure are implemented such as smoking cessation, immunizations, proper hydration, and nutrition
Oxygen Saturation Tests -Performed to determine if supplemental O2 is needed
Pulse oximeter -Normal= 95+% Respiratory Disease= 90%
Serial Arterial Blood Gases (ABGs) -Serial Arterial Blood Gases (ABGs)= measure PaO2 / PaCO2 -PaO2 indicates O2 dissolved in blood plasma, directly proportional to hemoglobin saturation. -PaCO2 directly proportional to alveolar ventilation
Lab values: pH -Infant: 7.35-7.45 -Child: 7.35-7.45 -Adult: 7.35-7.45
Lab values: PaO2 -Infant: 50-70 -Child: 80-100 -Adult:95-100
Lab values: PaCO2 -Infant: 35-45 -Child: 35-45 -Adult: 35-45
Pulmonary Function Test -Done to determine a safe activity level
Tidal Volume (TV) - Normal in/out
Inspiratory & Expiratory Reserve Voulme (IRV & ERV) -Extra in/out
Residual Volume (RV) -Amount left in lungs after maximal expiration -Decreases with age and restrictive lung dz and increases with obstructive lung dz
Vital Capacity (VC) -TV + IRV + ERV -Decreases with age, supine pos. and with lung dz
Total Lung Capacity (TLC) -TV + IRV + ERV + RV
Graded Exercise Text (GXT) -Provide objective information about pt’s symptomatology, physical impairments, changes in oxygenation and pulmonary function during exercise -Variety of test which are symptom-limited
Pulmonary Rehab -Besides doing cardiovascular & strengthening activities, the patient will need to receive and learn how to do their own pulmonary care which includes techniques for clearing accumulated pulmonary secretions & relieving dyspnea
Lung tissue is ___ and ___ -Thin and spongy
_____ pressure helps keep the lungs inflated against the inner thoracic wall -Negative
Air moves in/out through pressure dynamics from movement of ___ & ____ -Ribcage and Diaphragm
Lung divided into lobes: R and L -R: lower, middle, & upper -L: Upper & lower only
Lobes divided into segments -RUL: Apical, Anterior Posterior -RML -RLL: Apical (Superior), Anterior, Posterior, Lateral, Medial -LUL: Apical, Anterior, Posterior, Lingular -LLL: Apical, Anterior, Posterior, Lateral
Parts of upper airway -Nose, -Pharynx -Larynx
Parts of lower airway -Trachea -L & R MSB -Lobe bronchi -Segmental bronchi -Continue for 23 more generations until alveolar sacs
Chest PT -Done mostly by RT now 1) Positional (Postural) Draining 2) Percussion & Vibration 3) Airway Clearance
Positional Drainage -Positioning the pt. to get bronchus of involved lung segment perpendicular to the ground
Airway Clearance -Coughing -Huffing -Spitting -Inspection of sputum -Documentation
Breathing techniques to prevent Dyspnea: Pursed lip breathing and Coordinated breathing -PLB: inhale thru nose/blow out non-forceably thru pursed mouth -Decrease RR & increase TV -Increase internal pressure, keeps more alveoli open for gas exchange -Facilitates accessory muscle activity -Should begin PLB when pt starts feeling SOB
Breathing techniques to improve respiration: Diaphragmatic (Deep) breathing -Balloon -Staircase -Paced breathing -Incentive Spirometer
Chest Expansion Exercises -Any activity that improves rib motion
Chest mobilization/Segmental breathing -Combine active movement of trunk or extremities with deep breathing
Breathing techniques to clear secretions -MLH -ACBT -AD -Devices- Chest compression devices
MLH= Manual Lung Hyperinflation -Slow, deep inspiration -Inspiratory pause -Fast, unobstructed expiration
ACBT= Active Cycle of Breathing Technique -Breathing control -Deep breathing -Breathing control -Deep breathing -Breathing control -Forced expiration
AD= Autogenic Drainage -Levels: unstickin, collecting, and evacuating -Position: neck slightly extended and clear nose/throat -Basic steps: breathe in thru nose / hold it / breathe out thru mouth
Bronchodilators -Can be used prior to exercise
Other components of pulmonary rehab -A&P of dz -Early detection and rx -Use & misuse of O2 -Diet -Activity levels -Coping strategies -Stress reduction -Behavior strategy for lifestyle changes
Inpatient Pulmonary Rehab -RT does chest PT and educates on respiratory devices -PT does AROM with coordinated breathing, walking using PLB, general deep breathing ex, education for pacing tasks/energy expenditure. -HR & RR are monitored as well as O2 saturation
Outpatient Pulmonary Rehab -Do circuit-interval training with emphasis on endurance more than strength and time spent on each activity is shorter -Pt and family education is stressed -General lack of motivation due to minimal or no insurance payment
Outpatient Pulmonary Rehab cont... -Usually seen 2-3 x wk for 6-8 wks -Monitor HR, RR, BP, weight -May use Dyspnea Scale or the Borg Scale of Perceived SOB -Will use symptoms of SOB and fatigue rather than HR to know how much to do
Created by: alovedaytn