Phase 2 Pulmonary Rehab

Question 1

essential components of a comprehensive program (1)

Answer 1

assessment by appropriate pulmonary rehab team

pt training

Question 2

essential components of a comprehensive program (2)

Answer 2

exercise

psychological intervention

follow up

Question 3

outcomes of improvement (1)

Answer 3

symptom-limited exercise capacity

fxnal levels of ADLs

resp symptoms

Question 4

outcomes of improvement (2)

Answer 4

resp mm fxn

psychological status

frequency of hospitalization

Question 5

outcomes w/o accepted improvements

Answer 5

lung fxn (once damaged, lost re oil)

heart fxn

maximal aerobic capacity

mortality rate

Question 6

goals of pulmonary rehab

Answer 6

improvements in…

-health status
-resp symptoms
-daily activity tolerance
-nutritional status
-self reliance

Question 7

candidates for rehab

Answer 7

dx resp dz

documented fxnal limitations

Question 8

what does phase 1 of pulmn rehab include

Answer 8

general care

Question 9

general care

Answer 9

prior to exercise phase
-evals, therapeutic interventions, preventative care

Question 10

pulmonologist evals

Answer 10

pulmonary fxn tests

lab work - chem, CBC

arterial blood gases (ABGs)

Question 11

cardiologist evals

Answer 11

12 lead ECG

stress test/nuclear stress test

echo cardiogram

Question 12

PT evals

Answer 12

physical assessment –> chest wall assessment

6 minute walk test

titration - exercise tolerance test

Question 13

titration test for exercise tolerance

Answer 13

6 MWT measuring FiO2, SpO2, HR and BP

Question 14

what is SpO2

Answer 14

O2 saturation through pulse oximeter

Question 15

stages of titration test

Answer 15

stages 1-4

Question 16

stage 1–> stages of titration test

Answer 16

0.8 mph for 2 min

Question 17

stage 2 -> stages of titration test

Answer 17

1.0 mph for 2 min

Question 18

stage 3 -> stages of titration test

Answer 18

1.2 mph for 4 min

Question 19

stage 4 -> stages of titration test

Answer 19

1.4 mph for 4 min

Question 20

how do we report predicted HR for titration test

Answer 20

@ 70%, 85% and 100% and METs

Question 21

what does phase 2 of pulmonary rehab include

Answer 21

pulmonary care

Question 22

pulmonary hygiene

Answer 22

removal of excessive secretions that obstruct airways, cause ventilator defects, symptoms of cough, possible lead to an increase incidence of resp infections and deterioration of lung fxn

Question 23

short term effects of pulmonary hygiene

Answer 23

improved
-breath sounds
-volume of pulmonary secretions produced
-subjective improvements in breathing ability

Question 24

long term effects of pulmonary hygiene

Answer 24

maintenance of baseline pulmonary fxn

reduced frequency of resp exacerbations

decreased number and length of hospitalizations

Question 25

fxnal training for phase II

Answer 25

environmental modifications task mods relief of dyspnea

Question 26

tx goals of fxnal training

Answer 26

adapting the environment to improve the ease of performing ADLs

Question 27

how do pts advance --> fxnal training (1)

Answer 27

increase the pts independence in performing tasks

Question 28

how do pts advance --> fxnal training (2)

Answer 28

decrease -time to complete task -time or frequency of rest periods -dependence on adaptive equipment -need for supplemental O2

Question 29

document improvements by --> fxnal training

Answer 29

quantity of work performed HR RR RPE

Question 30

environmental mods

Answer 30

ID of the ADs that are most problematic

Question 31

examples of environmental mods (1)

Answer 31

Work areas with appropriate seating Placing most used equipment in locations to minimize bending and lifting

Question 32

examples of environmental mods (2)

Answer 32

Placement of chairs for rest periods Use of adaptive equipment to simplify tasks Improving ventilation for the bathroom and kitchen

Question 33

task mods

Answer 33

Each activity can be broken down into smaller tasks and modified to include energy conservation techniques

Question 34

examples of task mods (1)

Answer 34

Slowing down the pace Minimizing large body movements such as moving body weight up and down

Question 35

examples of task mods (2)

Answer 35

Setting priorities and organizing activities to minimize wasted movement Planning appropriate amounts of time to complete tasks, including breaks for rest

Question 36

relief of dyspnea techniques (1)

Answer 36

Simple procedure to minimize and relieve shortness of breath during ADL's Controlling the breathing pattern, altering posture to improve respiratory muscle function, and using relaxation techniques

Question 37

relief of dyspnea techniques (2)

Answer 37

Maintaining uninterrupted breathing patterns by avoiding holding breath during tasks Pursed-lip breathing patterns Leaning forward Relaxation of nonrespiratory muscles Desaturation of 5% or more should be noted

Question 38

phase II exercise training

Answer 38

Aerobic exercises Ventilators muscle training Diaphragmatic breathing exercises Diaphragmatic strengthening

Question 39

how must pts exercise during phase II training

Answer 39

sit 90/90 no supine

Question 40

goals of physical conditioning

Answer 40

include -CV endurance -maximal work capacity -strength -flexibility -resp mm fxn

Question 41

mild lung dz

Answer 41

pts do not require pulmonary rehab SOB w/ relatively heavy exercise (stair climbing, hills)

Question 42

FEV1 and ABG for mild lung dz

Answer 42

> or = to 80% FEV1 normal O2 sat dec

Question 43

exercise prescription for mild lung dz

Answer 43

80-85% predicted max

Question 44

moderate lung dz

Answer 44

acute exacerbation or worsening symptoms of SOB with ADLs and workload of 3-4 METs

Question 45

FEV1 and ABGs for moderate lung dz

Answer 45

<80% FEV1 impaired, O2 sat dec

Question 46

exercise prescription for moderate lung dz (1)

Answer 46

50-80% of predicted max 3-5 days/week; interval training 20-30 min of exercise maintaining

Question 47

exercise prescription for moderate lung dz (2)

Answer 47

O2 sat above 88% while monitoring HR, BP, ECG Aerobic and strength training Respiratory muscle retraining Pt education

Question 48

pts with severe lung dz

Answer 48

restricted by symptoms of SOB during most daily activity pt required continuous O2

Question 49

FEV1 and ABGs for severe lung dz

Answer 49

<50% FEV1 ABGs - acid base imbalance, O2 sat decrease

Question 50

exercise prescriptions for severe lung dz

Answer 50

40-50% of predicted max 3-5 days/week; interval training 20 min of exercise maintaining O2 sat above 88% monitoring HR, BP and ECG Aerobic and strength training Pt education

Question 51

what strengthening exercises are involved in phase II PR

Answer 51

aerobic training for LE light wt training for UE

Question 52

what flexibility exercises are involved in phase II PR

Answer 52

postural training breathing exercises

Question 53

respiratory muscle exercises consist of what approaches

Answer 53

CPAP at night (helps give accessory mm a break) aerobic fitness