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Cardiopulm Final > cardiopulm week 14: pulm disease exercise prescription > Flashcards

cardiopulm week 14: pulm disease exercise prescription Flashcards

(62 cards)

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1
Q

What are the FEV1 and FEV1/FVC values for a patient with mild lung disease?

A

FEV1: greater or equal than 80
FEV1/FVC: less than 70

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2
Q

What should be present in sufficient amounts for more maximal efforts in a patient with mild lung disease?

A

Vent reserve

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3
Q

What type of hypoxemia can moderate lung disease patients experience at rest?

A

Mild to moderate hypoxemia

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4
Q

What is the value for hypoxemia?

A

Below 75 mmHg

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5
Q

What is the goal of a patient with moderate lung disease regarding physiological responses to exercise?

A

To improve physiological responses including decreasing minute ventilation and decreasing heart rate

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6
Q

What is the value of FEV1 for a patient with moderate lung disease? How about severe?

A

Moderate: less than 80
Severe: less than 50

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7
Q

What may patients with severe lung disease experience during exercise?

A

Right ventricular dysfunction due to pulmonary hypertension

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8
Q

What are some other signs of poor oxygenation besides shortness of breath and decreased SaO2?

A

Retained secretions and cyanosis

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9
Q

What are some clinical examples of poor oxygenation?

A
  • Pneumonia
  • Chronic bronchitis
  • Cystic fibrosis
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10
Q

What occurs as a result of respiratory muscle weakness or diaphragm weakness?

A

Ventilatory pump dysfunction

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11
Q

What is ventilatory pump dysfunction a precursor of?

A

Pump failure

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12
Q

What may a patient present with during exercise with ventilatory pump dysfunction?

A
  • Shortness of breath
  • Costal retraction
  • Further decrease in O2 saturation
  • Concomitant cyanosis
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13
Q

What is the goal of supplemental oxygen?

A

To maintain saturation at 88-92% without suppression of respiratory drive from CNS

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14
Q

Which position places the least amount of stress on the diaphragm?

A

Leaning forward

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15
Q

Which type of ventilatory pump failure involves increased effort and accessory muscle recruitment?

A

Mechanical

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16
Q

Which type of ventilatory pump failure has increased effort and dyspnea?

A

Muscle

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17
Q

What type of ventilatory pump failure has decreased or normal effort?

A

Control (CNS problem)

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18
Q

What techniques would help a patient with mechanical ventilatory pump failure?

A
  • Pursed lips
  • Diaphragm & lower rib cage expansion
  • Positioning
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19
Q

What techniques would help a patient with muscle ventilatory pump failure?

A
  • Diaphragmatic breathing
  • Scooping
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20
Q

Describe paradoxical breathing seen with ventilatory pump failure.

A

During inspiration, abdomen and ribcage go in opposite directions

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21
Q

What positions may help a patient with ventilatory pump failure?

A
  • Leaning forward in chair
  • Abdominal binder to help get diaphragm up
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22
Q

What is the term for 3-4 broken ribs that can puncture lungs?

A

Flail segment

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23
Q

What is pulmonary hypertension (PH) defined as?

A

Mean pulmonary arterial pressure greater than 20 mmHg at rest and greater than 30 mmHg at exercise

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24
Q

What is the hallmark sign of pulmonary hypertension?

A

Chronically elevated pulmonary artery pressure

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25
What are some clinical examples of pulmonary hypertension?
- Advanced COPD - Cor pulmonale - Pulmonary fibrosis
26
What happens when pulmonary hypertension increases to around 40-50?
Leads to sudden decrease in exercise capacity including increased hypoxia and decreased cardiac output
27
List the 5 different groups of pulmonary hypertension.
- 1: Pulmonary arterial hypertension - 2: Left heart disease - 3: Lung disease - 4: Chronic thromboembolic pulmonary hypertension - 5: Unclear mechanisms
28
What are these treatment options for? Supplemental oxygen, bronchodilators, effective airway clearance techniques, mechanical ventilation.
Poor oxygenation
29
What are these treatment options for? Supplemental oxygen, facilitative breathing techniques, exercise training.
Ventilatory pump dysfunction
30
What are these treatment options for? Forward leaning/abdominal binder, facilitative/inhibitory breathing techniques, ventilatory muscle training, pursed-lip breathing.
Ventilatory pump failure
31
What are these treatment options for? Supplemental oxygen, vasodilators, calcium channel blockers, sitting with arms supported & semi-fowlers.
Pulmonary hypertension
32
Which type of muscle fibers atrophy first, especially in the lower limb?
Type 1
33
What are the parameters for PT intervention with restrictive disease?
- RR: < 40 - HR: 60-120 - Pulse ox: > 90 - Supplemental O2: Keep SpO2 above 90 (definitely don't let it get below 85)
34
What decrease in HR and SBP should stop PT intervention for restrictive disease?
Decrease in HR of > 10 beats/min and SBP decrease > 10 mmHg
35
Which obstructive lung disease is characterized by hypersecretion of mucus, CO2 retention, and hypoxemia?
Chronic bronchitis
36
Which obstructive lung disease involves dilation and destruction of terminal bronchioles and/or alveolar walls?
Emphysema
37
What type of training should be done with COPD patients?
Resistance training
38
Why is heart rate not an appropriate measure for exercise with COPD patients?
HRrest may be elevated; use Borg RPE (3-6) or dyspnea rating instead
39
COPD patients typically have greater dyspnea when performing ADLs with which extremities?
Upper extremities
40
What is the IMT prescription?
≥ 30% max inspiratory pressure, 30 min/day or 15 BID, 4-5 days/week
41
IMT is indicated for patients with Pinsp < 60 cmH2O or < what percent predicted?
50%
42
Which obstructive lung disease is characterized by inflammation of airway walls and increased mucus production?
Asthma
43
Bronchodilators should achieve what percentage improvement in FEV1?
12-15%
44
What is the aerobic exercise recommendation for obstructive lung disease?
2-3 days/week at 80% walking speed from 6MWT
45
Restrictive lung disease has preservation of tidal volume initially but as what decreases, tidal volume also decreases?
Compliance
46
What is created if respiratory rate becomes too high in restrictive lung disease?
Anatomical dead space
47
What pressure is increased in restrictive lung disease to achieve tidal volume breathing?
Transpulmonary pressure
48
What are some pulmonary causes of restrictive lung disease?
- Atelectasis - Pneumonia - Bronchiogenic carcinoma
49
Restrictive spinal cord injury ventilator dependence occurs at what injury level or higher?
C5
50
Restrictive spinal cord injury autonomic dysreflexia occurs at lesions of what level or above?
T6
51
Which restrictive lung disease with connective tissue cause may lead to interstitial pulmonary fibrosis?
Acute lupus pneumonitis
52
What may SLE have due to pericarditis?
Pleurisy
53
Which restrictive lung disease with connective tissue cause may have pleural thickening and pulmonary hypertension?
Rheumatoid arthritis
54
Which restrictive lung disease with connective tissue cause involves antigen-antibody reactions affecting multiple systems?
Systemic lupus erythematosus (SLE)
55
Which restrictive lung disease with connective tissue cause is characterized by progressive fibrosis of multiple organs?
Scleroderma
56
What restrictive lung disease leads to hypoventilation syndrome?
Obesity
57
What are the two best positions for an obese restrictive patient?
- Semi-fowlers - Sidelying
58
How are breath sounds affected in a patient with chronic airflow obstruction and emphysema?
- Decreased - Crackles
59
True or False: Obstructive lung disease can cause restrictive lung disease and vice versa.
False (only the first part is true, not vice versa)
60
If VEmax/MVV is 70% or greater, what does this indicate?
Respiratory limiting
61
What is MVV in a cardiopulmonary exercise test?
Max volitional volume (in/out in 1 min)
62
What should the cycling program be set at as a percentage of max workload in CPET?
60%

Cardiopulm Final (8 decks)

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