Exercise Perscription Flashcards by Chavez Girls

Asthma, Emphysema, and Chronic Bronchitis are…..

Obstructive diseases

How well did you know this?

Not at all

Perfectly

For mild Obstructive lung disease, FEV1 is going to be less than ____ of predicted values

FEV1/FVC is going to be less than __________

80%

70%

How well did you know this?

Not at all

Perfectly

The vital capacity of obstructive lung patients is _______

Typically within normal range

How well did you know this?

Not at all

Perfectly

What is the only lung volume not included in vital capacity?

Residual volume

How well did you know this?

Not at all

Perfectly

Your lungs capacities are considered normal if you’re within _____________ of predicted

80% and 120% of what’s predicted

How well did you know this?

Not at all

Perfectly

Any patient under __________ of FVC has a restrictive lung disease

80%

How well did you know this?

Not at all

Perfectly

Patients with MILD lung diease will present how?

They will tolerate normal exercise perscription that healthy people can do

How well did you know this?

Not at all

Perfectly

Patient’s with moderate lung disease have _______ ventilatory responses

abnormal

Patient becomes short of breath with mild activity

ventilation cant increase w/ exercise that well (little ventilatory reserve)

May experience mild to moderate hypoxemia at rest

How well did you know this?

Not at all

Perfectly

T or F: Using heart rate is a good tool to measure exertion for moderate lung disease patients

False

Their HR will be very high w/ activity

How well did you know this?

Not at all

Perfectly

In severe lung disease, FEV1 is under ________ of predictive value

50%

Pt may need continuous or intermittent oxygen

Pt may have elevated CO2 levels

Pt may have right ventricular dysfunction during exercise

How well did you know this?

Not at all

Perfectly

What is typically the problem for patient’s with poor oxygenation and how can PTs help?

Ineffective clearance of secretions

Teach patient’s how to remove secretions

How well did you know this?

Not at all

Perfectly

What are techniques that PTs can use to assist ventilatory pump dysfunction (precursor to pump failure, increased reliance on accessory muscles, weakness of diaphram)?

Sniffing

Diaphramatic breathing

Positioning (sidelying)

How well did you know this?

Not at all

Perfectly

For patients with pump dysfunction, if O2sat goes below __ we stop exercise

The goal of supplemental oxygen is to maintain atleast 88-92% without giving TOO much oxygen which can supress the drive to breath from the CNS

How well did you know this?

Not at all

Perfectly

Phrenic nerve damage can lead to…

Ventilatory pump dysfunction

How well did you know this?

Not at all

Perfectly

How can PTs help ventilatory pump failure patients?

Make sure they can expand properly for breathes

try to reduce accessory muscle use (diaphramatic breathing)

How well did you know this?

Not at all

Perfectly

What signifies the end stage of respiratory failure

paradoxical brathing (hoovers sign)

Abdomen and ribcage no longer expand together, and now theyre moving in opposite directions (one goes in while the other goes out)

How well did you know this?

Not at all

Perfectly

For patient’s with end stage pump failure or patients experiencing dyspnia how should we position them?

Position of recovery: leaning foward

Helps move diaphram upward so diaphram can descend and draw in breath

How well did you know this?

Not at all

Perfectly

What is the problem w/ giving patient’s too much oxygen

The lack of CO2 decreases CNS drive to breath

How well did you know this?

Not at all

Perfectly

How else can we move the diaphgram upward for a patient experiencing pump failure?

Scooping technique

How well did you know this?

Not at all

Perfectly

Why would a spinal cord patient use an abdominal binder

It replaces the pressure that the abdominal muscles would be providing to keep the diaphram up

w/o the abdominal binder their diaphram might rest too low

How well did you know this?

Not at all

Perfectly

If someone has a flail segment of ribs (3 or more ribs) what is the danger?

ribs might puncture lungs

How well did you know this?

Not at all

Perfectly

Pulmonary Artery hypertension critera

greater than 20 at rest

greater than 30 with exercise

How well did you know this?

Not at all

Perfectly

How is pulmonary arterial pressue monitored

Swan Gantz cathered

How well did you know this?

Not at all

Perfectly

5 groups of pulmonary hypertension

-idiopathic

-caused by
L heart failure

-Caused by lung disorders

-pulmonary embolus

-other diseases

How well did you know this?

Not at all

Perfectly

At what pulmonary hypertension level do you stop exercise

40-50 watch and pay attention to symptoms and stop the intensity of the exercise

What happens if a patient gets a spike of pulmonary artery pressure

Dizzy/light headed/ loss of conciousness (happens very quick) Sharp drop of SpO2

Treatment for poor oxygenaiton

Supplemental O2 Bronchodilators Teaching airway clearance techniques

Treatment for Ventilatory pump dysfunction

Supplemental O2, Facilitated breathing techniques (teach diaphramagtic breathing) Exercise training

Ventilatory Pump Failure treatment

Foward lean Facilitatory/inhibitory breathing techniques Pursed Lip Breathing Techniques Ventilatory muscle training Abdominal Binder

T or F, patients w/ pulmonary artery hypertension cannot take bronchodilators

True, because it will further raise the blood pressure

What muscles is it the hardest to get oxygen to?

Lower limbs

Acceptable Parameters for PT intervention:

Under RR over 40 at rest (dont work with patients 40+ RR) HR 60-120 at rest, able to speak comfortably (120+ no go) Pulse oximetry over 90 Need for supplemental O2 to keep SPO2 over 0

Reasons to stop or modify PT intervention

**Unable to speak comfortably** **SPO2 under 85** **HR drops more than 10BPM** **SBP drops over 10mmHG** Guy's i promise you this is going to be the majority of the questions lmao (no promises!)

Giving a patient too much O2 can do what?

Reduce drive to breathe by CNS

What is the preferable method of training respiratory patients

Short bursts of activity with many rest breaks, activity becomes longer overtime (interval walking)

What preformance tests are good for establishing someone's muscular endurance?

6MWT 2MWT 30Second STS for LE muscular endurance

Overall Exercise Perscription for non-acute COPD patient

Strength training 2 times a week 60-70% 10-15 reps Aerobic 3-5x a week Emphasis on interval training using BORG scale

Why is it important to work on muscular strength with lung patients

Muscles become more efficient at using oxygen

What kind of exercises should we use to help a patient correct posture after a lot of sitting and hunching over

Upper back

an RPE of __________ is good for patients with COPD/lung problems

3-6 15-20 reps

Why cant you use heartrate as a gauge of exertion for COPD patients?

HR is already very high at rest

It is important to have a patient on _____________ for initial exercise training sessions

Pulse Ox

What is MVV

Maximum ventilatory volume Amount of air in and out in 1 minute

MMV should never be more then __% of predicted MMV for a patient

70% If you see an exercise test with more than 70% that means that respiratory system was the limiting factor

If a patient is less than __% of predicted inspiration muscle strength, this indicates clinical weakness of respiratory muscles

50%

what are signs of too much oxygen?

drowsey, fatigued, RR suppresses, CO2 increases

what is the mMRC?

dyspnea scale used as a reassesment tool 0-4

How might a pt with COPD demonstrate gait?

slow, wide BOS bc bad balance - theyre not getting enough oxygen to the brain

what should you look for on the skin during your pt eval?

signs of chronic low levels of O2 - clubbing, cynaosis edema - could be R HF

patients with COPD tend to lose type ___ muscle fibers first because they are oxygen-dependent. then what happens?

1 rely on type 2 which fatigue easily

what is the role of weightloss on emphysema pts? (cycle)

impaired nutrition = muscle loss = decreased ability to inhale/exhale = SOB, dyspnea = loss of appetite

What do you have to consider when doing a submaximal graded exercise test on a pt with COPD?

these tests usually relay on a % of HRmax, but common COPD medications (inhalers, SABAs. LABAs) inc HR

optimal duration for GXT for a MILD-MODERATE COPD pt Optimal durarion for severe COPD pt

8-12 5-9 too long of test begins to asses muscular endurance over cardio!!

what is a good, gradually increasing GXT to use

incremental shuttle test can use to find VO2 NAUGHTON

What MET level should a pt be able ot function at to be safe to go home?

3-4

what are two important components to address in your prescription that are not directly lung-related

LE strength and balance UE for ADLs

describe how you would stop and adjust treatment for the following scenarios poor oxygenation vent pump dysfxn vent pump failure

poor oxygenation - clear airways, bronchodilators vent pump dysfxn - teach breathing exercises vent pump failure - may need mechanical vent or abdominal binder, purse lip and foward lean

what happens if the oxygen in the blood drops below 60mmHg?

vasoconstriction and shunting to maintain V/Q, decreased blood oxygenation

PA HTN levels and definition

mean pulmonary arterial presssure > 20 at rest and > 30 during exercise swann cath

*What are signs of Pulmonary HTN?

dizzy, light headness, abrubt decrease in pulse wave (less oxygenated blood is getting pumped out which dec CO, decreasing BP)

If your pt has a swann cath, what is important to monitor when moving your pt?

make sure the transducer is level to heart or it will read false increase or decrease in pressure

Reasons to stop PT for obstructive and restrictive patients

- unable to speak comfortably - drop in SpO2 below 85, especially if titration is not working - HR > 10 bpm - SBP > 10mmHg

mild, vs moderate, vs severe lung disease exercise considerations

mild - normal prescription mod - goals to improve ex tolerance and decrease perceived exertion, decrease minute ventilation with exercise severe - may need continuous or intermittent oxygen, elevated CO2, right vent dysfxn

*Using the Borg scale, what levels should you exercise your COPD patient?

3-6

You patient experiences dyspnea during your PT session, but vitals are stable. What do you do?

STOP exercise

How can flexibility help your COPD pt?

extension based exercises to reduce limited thoracic mobility

how do you structure exercise to combat the loss of type 1 fibers in COPD patients

light-moderate resistance with high volume and short rest endurance based

supp O2 is indicated for patients with a PaO2 < ____ or SaO2 < ___% on room air

55mmHg 88% may need to titrate during exercise

What pt would inspiratory muscle training be good for? What pt would you NOT use it with?

good - low lvl pts who are unable to exercise not use - pts with faulty breathing patterns - must fix those first

endurance vs strength IMT perscription

endurance - 15-20% MIP, 30 min 2x/day strength - 50-60% MIP, increase weekly, 2x day until failure (25-35 breaths)

cardiovascular causes of restrictive lung disease

chronic PE - localized area becomes necrotic pleural edema pulmonary edema - if heart is failing and fluid packs up, decreases lung expansion

Neuromuscular considerations

SCI - above T6 is autonomic dysreflexia ALS - limits innervation to resp muscles guilian barre and myasthenia gravis cause resp muscle weakness, no strength to expand rib cage

Considerations for connective tissue diseases causing restrictive lung disease

most are autoimmune disorders - do not over fatigue or you can cause a flair up! RA, scleroderma, acute Lupus pneumonitis, SLE

what are the advantages of interval training?

you can exercise the patient at higher workloads, less symptoms elicited

acute pts in hospital, how do you measure intensity for pulmonary pts as they begin walking?

2-4 above resting dyspnea level not HR (cardiac pts can use an increase 20-30 bpm)