Case 3 - Pulmonary Rehabilitation Flashcards
(24 cards)
what is Pulmonary Rehabilitation - 2 bullet points
Pulmonary rehabilitation (PR) is a
treatment programme made up of:
* exercises classes designed for people with
long-term lung conditions
* information about looking after their body
and lungs
* advice on managing their lung condition
* techniques to manage breathlessness.
who is Pulmonary rehabilitation for
- Designed for people living with a lung condition that makes them breathless
- It can benefit people with long-term lung conditions, including:
- chronic obstructive pulmonary disease (COPD)
- bronchiectasis
- pulmonary fibrosis
- severe asthma
who is Pul rehab not suitable for
too breathless to leave the house
pain limits walking
uncontrolled cardiovascular conditions
had a recent Myocardial infarction
Neurological or orthopaedic conditions which
make exercise impossible
where is Pul rehab taken place
- Portable O2 – Can be done with Portable
0xygen, may help individuals stay active
for longer. - Usually held in: community halls, leisure
centres and health centres. - Some places may offer Digital Pulmonary
rehabilitation
who is Pul rehab delivered by
- Usually delivered by a pulmonary
rehabilitation team consisting of: - Specialist Nurses,
- Occupational therapists,
- Physiotherapists
how does Pulmonary rehab take place
A course of PR usually lasts six to eight
weeks, with two sessions of about two
hours each week, held as a group.
Theres an initial assessment then in
each class about half the time is
exercising
Patient education aspect of Pul rehab - 2 points
- why being active is so important for people with lung
conditions - ways to be more positive about being active
- how to use breathing techniques during physical activity
- how to use breathing techniques to manage anxiety
- how to manage low mood or low motivation to move
- how to use inhalers and other medicines
- how to eat when breathless
- how to stop smoking
- what to do when unwell with a chest infection or flare-up.
WHY DO Pul Rehab - 2 or 3 points
There is now good evidence that
pulmonary rehabilitation
* Improves Quality of life
* Improves Maximal and functional
exercise capacity
* Reduces decline in FEV1 over time
in COPD patients
* Demonstrates a clinically relevant
improvement in Anxiety and
Depression
* Patients who have undergone PR are
more conducive to having advanced
care planning
* Saves Money though smoking
cessation
asthma - the types of inhalers and regimen (when to take)
- Preventers – taken daily contain low dose steroid (ICS) +/- long acting bronchodilator (LABA)
- Relivers – taken only when needed (patients should NEVER only be on a reliver)
- Anti-inflammatory relivers – taken only when
needed; contain a steroid and a bronchodilator (for
mild asthma)
Preventor types - Pressurised metered dose inhalers (pMDIs) - how to use this
[asthmatics]
Pressurised metered dose inhalers (MDIs) release a spray of medicine when you press
the top of the canister.
Always used with a spacer
name the preventor types [asthmatics]
Dry powder inhalers (DPIs)
Breath actuated inhalers (BAIs)
Pressurised metered dose inhalers (MDIs)
Breath actuated inhalers (BAIs) - how to use this
Breath actuated inhalers (BAIs) release a
spray of medicine when you breathe in through the mouthpiece
Dry powder inhalers (DPIs) - how to use this
Dry powder inhalers (DPIs) give the
medicine in a dry powder when you
breathe in through the mouthpiece
how do Soft mist inhalers work
good for severe asthmatics
Soft mist inhalers use liquid medicine to
create a mist that is inhaled
asthma inhaled drugs - relievers are what
Relivers – Short-Acting Bronchodilator Medicines
(SABAs)
* Salbutamol or Terbutaline (often blue)
* NEVER USED ALONE IN A REGIME
asthma inhaled drugs - what about the preventors (name 2 or 3)
Steroids (ICS) :
* Beclometasone. Brands include Clenil Modulite®, and Qvar.
* Budesonide. Brands include Easyhaler
Budesonide®, Novolizer Budesonide® and
Pulmicort®.
* Ciclesonide. Brand name Alvesco®.
* Fluticasone. Brand name Flixotide®. This is a yellow-coloured or orange-coloured inhaler.
* Mometasone. Brand name Asmanex Twisthaler®.
Long-acting bronchodilator inhalers (LABAs)
salmeterol (brand name Serevent® and Neovent®) and formoterol
Combination inhalers (steroids and LABAs)
- Fostair® (formoterol and beclometasone).Seretide® (salmeterol and fluticasone), Symbicort®(formoterol
and budesonide)
regimes - asthmatics (name a few)
- As needed reliver – NOT recommended any more
- Anti-inflammatory reliever (AIR)
- Regular preventer and as-needed reliever
- MART therapy
what is MART therapy
- MART stands for maintenance and reliever therapy. MART involves using one single combination inhaler, instead of separate preventer and reliever inhalers.
[MART appears to work better than the regular preventer and as-needed reliever regime and is increasingly being used as
the regime of choice for people with moderate or severe asthma.]
how often should a MART inhaler be used
- A MART inhaler should be used regularly (twice a day) and should also be taken when asthma symptoms get worse, or if
you have an asthma attack.
PEFR - peak Expiratory flow rate is used in diagnosing what
diagnosing COPD and Asthma and in
monitoring asthma
Taking A PEFR OSCE
- Wash your hands and don PPE if appropriate.
- Introduce yourself to the patient including
your name and role. - Confirm the patient’s name and date of birth.
- Briefly explain what the procedure will involve using patient-friendly language: “Today we need to measure how well air flows in and out of your lungs, which is known as peak flow rate. To do this, we use a peak flow meter, which is this device here. By measuring peak flow we can check how well your asthma is controlled.”
- Gain consent to proceed with PEFR measurement.
- Position the patient so that they are sitting
comfortably. - Ask the patient if they have
any pain or shortness of breath before performing PEFR measurement.
Measuring PEFR
- Ensure you clearly explain and demonstrate each of the following steps to the patient:
- 1.Ensure the peak flow meter is set to zero.
- 2.Position yourself sitting up straight or standing.
- 3.Take the deepest breath you are capable of.
- 4.Hold the peak flow meter parallel to the floor and position your mouth around the mouthpiece of the peak flow meter, creating a tight seal with your lips.
- 5.Exhale as forcefully as you are able to.
- 6.Note the reading on the peak flow meter, which is measured in litres per minute.
- 7.Repeat steps 1-6 twice more.
- 8.The highest reading of the three attempts should be used as the final result.
- After you have explained and demonstrated PEFR measurement, observe the patient carrying out the procedure
