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Special Topics
Pulmonary Rehab
| Question | Answer |
|---|---|
| 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
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