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Christina > Exercise > Flashcards

Exercise Flashcards

1
Q

chronic, obstructive disease resting heart rate is high/low due to?

A

increase resting HR due to increase work of breathing as well as chronic bronchodilator use

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2
Q

use breathlessness scales and talk test along with HR response to activity as needed EXAM

A
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3
Q

over oxygenation can lead to

A

decrease hypoxic drive

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4
Q

O2 titration with PT intervention with what orders

A

MD

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5
Q

Spo2 target with activity in acute setting

A

88-92%

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6
Q

SPo2 target for those who retain CO2 where goal is

A

mid 80s based on documented blood gas (consult with healthcare)

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7
Q

Acceptable parameters for initiation of PT intervention
RR
Pulse ox
HR

A

RR: <30 able to speak comfortable
restrictive <40
pulse ox:>90 at rest +/- supplemental o2
HR: 60-120 caution >120

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8
Q

Two central drivers of respiratory drive

A
  1. COPD. pt chronically hypercarbia and have limted O2 drive (hypoemia)
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9
Q

what should you do after exercise patient

A

titrate supp o2 to meet SPo2 order of MD and then turn to pre-intervention levels after PT

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10
Q

what if patient cant tolerate preinterventional o2 level

A

CALL MD

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11
Q

dyspnea goal for COPD after exercise

A

borg 3-5 (brewer said 5 you need to stop, rest, decrease intensity)
goal 11-13 on RPE 6-10 scale

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12
Q

S&S of overoxygenation

A

RR is suppressed in relation to increase exercise –> decrease ventilation

CO2 increases production
-fatigue
-drowsy

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13
Q

too much o2 can do what to lungs

A

injure

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14
Q

what is the primary pt reported issue to STOP exercise

A

dyspnea

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15
Q

chest evaluation inc

A
  • auscultation of lung and heart
    -cough assessment
    -inspection of breathing pattern part. accessory mm use
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16
Q

overinflation (RESTRICTIVE patients )or over FORCED exhalation can lead to

A

increase dyspnea

AVOID FORCEFUL EXHALATION

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17
Q

wheezles and crackles can be do to what other than pulmonary system

A

heart

B crackles in lungs –> can be heart problem –> tailor exercise to heart

VICE VERSA

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18
Q

thoracic extension is critical for

A

breathing and coughing

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19
Q

what if cant produce strength for scapula and thoracic spine

A

limits inhalation

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20
Q

Signs of decrease O2

A

pitting edema
cyanotic at lips
clubbing

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21
Q

COPD patients can develop pulmonary hypertension because ? can lead to

A

of decrease O2 and can leas to R systolic failure –> edema in legs

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22
Q

what muscles tend to get weak with patients and can affect breathing

A

trunk extensors
hip extensors
scapular/ shoulder muscles (more rounded, forwrad posture)

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23
Q

what pt can experience wt gain vs wt loss

A

gain: COPD and restrictive
loss: emphysema, COPD

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24
Q

weight loss is lost in

A

muscles

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25
what is PT goals in regards to muscles and muscle fibers
increase muscles increase slow twitch type 1 because this is for endurance oftentime pt starts to lose both types --> type 1 is now used faster rate than type II --> pt rely more on type II but these are for power and fatigue quicker --> instead of aerobic its glycolytic = fatigue faster
26
what exercise test can access functional exercise capacity
6MWT and shuttle walking test
27
often physicians use exercise test with flow volume curve to determine an effective bronchodilator which improves expiratory flow by
FEV1 ~12-15% improve in expiratory flow see improve in volume/airflow
28
submax exercise testing may be used but prediction of VO2 peak based on age predicted HRmax may not be appropriate for terminating sub max GTX because??
inhalers mimic SNS (bronchodialators are SABA/LABA) that tend to already increase HR --> so using 85% HR and HR as guide is error --> SUBMAX AS HR DONT USE
29
what can you use instead of submax GTX
-incremenetal exercise test (GTX) -VO2 -VO2 peak (highest VO2 during exercise)
30
test duration for mild to mod COPD test for servere
min: 8-12 min severe: 5-9 mins NOTE: longer test can b/c of fatigue in mms instead of pulm status as limited factor
31
is incremental shuttle test good to use?
yes cause each pace = certain O2 consumption -gradual increase -can be used as max test
32
ideal to measure pt w/ VO2 not HR because
of bronchodilator meds can increase HR so submax exercise erroneous
33
MET goal for pt discharge
3/4
34
exercise limitation elements
-ventilatory impairments -lower limb muscle dysfunction -psychiological impact -cardiac abnormalities -restpiratory muscle problem -gas exchange abnormalities
35
exercise program intensity higher or lower reps higher or lower
intensity: lower reps: higher
36
purpose of ab binder
pushes diaphrgram upwards to improve FRC, exhale which allows for more air into lung cause can exhale more air out
37
pulmonary arterial hypertension
when O2 levels. <60 promotes VC to reduce perfusion to areas lungs to maintain V/Q ratio little vent to purfusion --> shunt too little perfuse to vent ---> dead space
38
pulm arterial hypertension
can happen in COPD/LHF, or chronic O2
39
how is pulmonary arterial hypertension measured
swan gath cathether inserted in Jugular vein
40
mean pulmonary arterial pressure greater than 20 mmhg at rest and <30 mmHg during exercise
pulmonary hypertension
41
hallmark sign of PAH
chronically elevated pulmonary artery pressure -advanced COPD, cor pulmonale, pulmonary fibrosis pt
42
PTN cascade of events
increase hypoxia --> increase pulm vascular resistance because low levels of O2 tries to increase V/Q so cause VC --.> decrease R SV --> decrease oxygenated blood volume to left heart --> decrease CO --> BP drop and pt dizzy light headed --> LOC
43
measures concise, continous bp arterial pressure through radial or brachial artery
arterial line
44
pulmonary arterial pressure
swan gath catheter
45
if transducer (the device that measure pressure )not in line w/ heart
get artificial inflated or deflated number
46
level TRANSDUCER WITH HEART!!!!!!!
If it's too high, the reading will be falsely low. If it's too low, the reading will be falsely high.
47
signs push patient too much PAP: SPO2: RR:
PAP: increase SPO2: decrease RR: increase
48
reasons to stop or modify PT
unable to comfortable speak SPO2 <85% esp if titration of O2 ineffective decrease HR >10 decrease SBP >10
49
mild lung disease ventilatory ABGs spirometry testing sufficent ventilator reserve is present for more maximal efforts
ventilatory: n ABGs: n spirometry testing : > or equal to 80% of FEV1 but <70% FEV1/FVC sufficent ventilator reserve is present for more maximal efforts
50
in COPD HR rest is
often elevated and ventilatory limitations as well as effects of meds prohibit HR max to use in intensity calc
51
flexbility exercises can help with
postural impairments that limit thoracic mobility and therefore lung function. focus on extension based exercises, anterior to thoracic spine, hip flexors
52
what supercedes objective measures of Ex Rx
DYSPNEA
53
type 1 do they need O2
yes
54
does type 2 muscles need O2
no
55
peripheral muscle dysfunction contributes to exercise intolerance and is signficiant and independelty related to
poorer prognosis and mortaility
56
how do you strengthen type 1
light - mod resistance high volume short rest periods note: also strengthen type II so become less use so type I can become more use so less fatigue
57
what develops because type II more work
lactic acid produced
58
COPD may have greater dyspnea with UE so include resistance exercise for UE why?
because mm group smaller
59
what to include in exercise
flexibility: to increase rib cage and thoracic, hip girdle resistance: balance: b/c get lightheaded and dizzy
60
Supplemental oxygen is indicated for patients with a PaO2 ______or an SaO2 _____% while breathing room air.
PaO2 < 55 mm Hg SaO2 < 88%
61
In patients using ambulatory supplemental oxygen, flow rates will likely need to be increased during exercise to maintain SaO2 ____
SaO2 > 88%.
62
Inconclusive evidence suggest supplemental O2 to those who do not experience exercise-induced hypoxemia may lead to greater gains in exercise endurance
63
T/F Individuals suffering from acute exacerbations of their pulmonary disease should limit exercise until symptoms have subsided.
T
64
In patients receiving optimal medical therapy who still present with inspiratory muscle weakness and breathlessness,______ may prove useful in those unable to participate in exercise
inspiratory muscle training IMT
65
IMT improves _________ and endurance, functional capacity, dyspnea, and quality of life which may lead to improvements in exercise tolerance
inspiratory muscle strength note: ind sucks in air at a resistance; really benefiical for muscle strength
66
do you teach IMT to pt with faulty breathing patterns
no
67
when is IMT indicated
Indicated if Pinsp<60 cmH2O or <50% pred
68
IMT indicated if able to perform what 2 things
diaphragmatic breathing with minimal accessory mm use strategies to facilitate expiration with minimal airway closure
69
IMT perscription: Start at ___%maximal inspiratory pressure 30 minutes / day or 15 minutes BID Done 4-5 days per week
30%
70
restrictive lung disease -lung and chest wall compliance is increase or decrease
decrease lungs are more stiff and smaller reduce chest wall expansion; non compliant
71
all lung volumes in restrictive lung disease
are decreased. static: TV, TLC, ERV,IRV decreased body tries to reserve TV initially, but as compliance decrease ,TV decrease
72
in restrictive disease work of breathing is: inititally RR: transpulmonary pressure
work of breathing increases initially RR increase shallow to maintain min vent, TV decreaes to maintain min vent if RR too high --> increase physiological dead space --> reduce gas exchange transpulmonary pressure is increased: increased work to achieve TV breathing
73
how does PE cause restrictive lung disease
decrease blood supply, nectrotic to lung decrease expand decrease gas exchange
74
how does pulmonary edema lead to restrictive lung disease
limit lung expands and gas exchange if heart doesnt work fluid back into lungs and affect lung sac and bronchiles to expand --> restrictive - intrapleural edema
75
obesity
-promote wt loss -supine not ideal -activity with pressure support b/c early airway closure or sleep apnea -exercise with pressure support and well ventilated cool environment -goal: expand lungs because load on abs reduce FRC

Christina (89 decks)

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