pulmonary disease exercise prescription

Question 1

in mild lung disease the spirometry testing is < ____ of predictive values of FEV1 but < ___ for FEV1/FVC

Answer 1

80%
70%

Question 2

if static lung volume is between 80% -120% this it is ___, if it < 80% then it is ___ if it is > 120% then it is ___

Answer 2

normal
restrictive
obstructive

Question 3

for moderate lung disease ___ is < 80% if predicated value

Answer 3

FEV1

Question 4

exercise tolerance limited due to:
 abnormal ventilatory responses
 patient becomes SOB with mild activity
 little ventilator reserve

in what lung disease

Answer 4

moderate

Question 5

pateints with moderate lung disease will have mid to moderate ___ at rest

Answer 5

hypoxemia

Question 6

which vital may not be the best to assess in patients with moderate lung disease bc meds can increase it

Answer 6

HR

Question 7

in patients with severe lung disease the fev1 is < ___ of predicted values

Answer 7

50%

Question 8

a patient with severe lung disease may have ___ ventricular dysfunction during exercise

Answer 8

right

Question 9

poor ___ limits exercise capacity

Answer 9

oxygenation

Question 10

what are some sings of poor oxygenation

Answer 10

SOB
decreases SaO2
retained secretions
cyanosis

Question 11

what are clinical examples of poor oxygenation patients

Answer 11

Pneumonia, chronic bronchitis, cystic fibrosis

Question 12

ventilatory pump dysfunction is due to ___ mm fatigue or weakness of ____

Answer 12

respiratory
diaphragm

Question 13

ventilatory pump dysfunction is a precursor of pump failure and characterized by increased reliance on ___ mm and ____ retraction during exercise

Answer 13

accessory
costal

Question 14

if O2 sat is < ___ stop exercise

Answer 14

88%

Question 15

goal of supplemental O2 is to maintain O2 saturation at lease ___ - ____ without suppression of respiratory drive from CNS

Answer 15

88-92

Question 16

ventilatory pump failure casues what nerve damage

Answer 16

phrenic

Question 17

what type of breathing is present with ventilatory pump failure

Answer 17

paradoxical breathing pattern

Question 18

the abdomen moves ___ and ribcage move ___ during inspiration for paradoxical breathing

Answer 18

inwards
outwards

Question 19

what position may help a patient with paradoxical breathing pattern

Answer 19

leaning forward in a chair over abdominal binder bc helps add pressure to push dia[hragm up

Question 20

what is defined as a mean pulmonary arterial pressure greater than 20 mmHg at rest and greater then 30 mmHg during exercise

Answer 20

pulmonary hypertension

Question 21

how is pulmonary hypertension measured

Answer 21

swan gaze catheter

Question 22

pulmonary hypertension is when MAP is ___ at rest and ____ during exercise

Answer 22

> 20
30

Question 23

what is the hallmark sign of pulmonary hypertension

Answer 23

chronically elevated pulmonary artery [pressure

Question 24

what are clinical examples of pulmonary hypertension

Answer 24

Advanced stage of COPD, Cor
Pulmonale, pulmonary fibrosis

Question 25

is pulmonary hypertension (MAP) is between 40-50 what should you do as a PT

Answer 25

water symptoms and sit them down and change intensity

Question 26

what is the cascade of events that can happen w someone with pulmonary hypertension if they experience sudden decrease in exercise capacity

Answer 26

increase hypoxia increase pulmonary vascular resistance decrease right SV decreased Oxygenated blood volume to the left heart decreased CO Bp drops and patient becomes dizzy and lightheaded

Question 27

what are some treatment options for poor oxygenation

Answer 27

Supplemental O2, bronchodilators, effective airway clearance technique, mechanical ventilators

Question 28

what are some treatment options for ventilatory pump dysfunction

Answer 28

Supplemental O2 , facilitated breathing technique, exercise training

Question 29

what are some treatment options for ventilatory pump failure

Answer 29

Forward leaning /abdominal binder; facilitatory/ inhibitory breathing technique, Ventilatory muscle training, purse-lip breathing

Question 30

what are some treatment options for Pulmonary Arterial Hypertension

Answer 30

Supplemental O2, vasodilators (Flolan, Ventavis, Viagra, Cialis, etc), Ca channel blockers, sitting with arms supported and semi-fowler’s position

Question 31

what are the acceptable parameters from initiation of PT for RR, HR , pulse ox , and supplemental O2

Answer 31

RR : < 40 HR : 60-120 PUlse ox: > 90% supplemental: Spo2 > 90%

Question 32

what are the reason to stop or modify pt intervention for RR , SpO2, HR and SBP

Answer 32

RR: unable to speak comfortably SpO2 : < 85% HR: decreased in 10 BPM SBP: drop in > 10 mmhg

Question 33

Obstructive lung disease: chronic bronchitis patients will have ___ of mucus , ___ endurance, ___ on light exertion , ___ of air way wall , ___ retention

Answer 33

hypersecretion low dyspnea thickening CO2

Question 34

obstructive lung disease: emphysema patients will have ___ and destruction fo the terminal bronchiole and/or alveolar wall , ___ of the lung due to enchanced tissue ___

Answer 34

dilation hyperinflation compliance

Question 35

both chronic bronchitis and emphysema patients will have reduced ___ and ____

Answer 35

FEV1 FEV1/ FVC *prob wont have a decreased in FVC*

Question 36

T/F: emphysema patients will have increased TLC

Answer 36

true

Question 37

___ traingin shoudl be an integral part of the exercise program for COPD patients

Answer 37

resistance

Question 38

what may be needed for both the emphysema and chronic bronchitis patients

Answer 38

extra nutritional support

Question 39

for patients with COPD , increased dyspnea may be found with agressive ___ aerobic exercises

Answer 39

UE

Question 40

what scale is a reliable measure during exercise for COPD patient

Answer 40

dyspnea

Question 41

what level of SAO2 may require supplemental O2 during exercise for COPD patients

Answer 41

< 88%

Question 42

T/F: you cane exercise a patient during acute pulmonary exacerbation

Answer 42

false

Question 43

what grade on the dyspnea scale is stops for breath after walking 100 yards

Answer 43

4

Question 44

what is the main limitation at peak exercise in patients with severe COPD

Answer 44

ventilatory limitations

Question 45

As an alternative to using peak work rate or ሶ VO2peak to determine exercise intensity, dyspnea ratings of between __ and __ on the Borg CR10 Scale may be used for COPD patients

Answer 45

3-6

Question 46

Maximizing pulmonary function using ____ before exercise training in those with airflow limitation can reduce dyspnea and improve exercise tolerance from COPD patients

Answer 46

bronchodilators

Question 47

Because individuals with COPD may experience greater dyspnea while performing ADL involving the upper extremities, include resistance exercises for the muscles of the ____

Answer 47

upper body

Question 48

Supplemental oxygen is indicated for patients with a PaO2 < __ mm Hg or an SaO2 < __% while breathing room air for COPD patients

Answer 48

55 88

Question 49

_____ muscle weakness is a contributor to exercise intolerance and dyspnea in those with COPD.

Answer 49

inspiratory

Question 50

what breath sound may you hear with an asthma patient

Answer 50

wheezing

Question 51

patients that have restrictive lung disease have a ___ in lung and cheat wall compliance

Answer 51

reduction

Question 52

in restrictive lung disease if the RR is to high that leads to ___ anatomical dead space

Answer 52

increased

Question 53

what is the positioning in bed for an obesity patient with restrictive lung diease

Answer 53

semifowlers or sidelying

Question 54

if you are preforming a cardiopulmonary exercise test and VE max is 70% or height then the predicted MVV that what does that mean

Answer 54

respiratory system is the limiting factor

Question 55

here are no clear guidelines for IMT although an intensity of the training load of > ___% of maximal inspiratory pressure has been recommended.

Answer 55

30

Question 56

IMT improves ____ muscle strength and endurance, functional capacity, dyspnea, and quality of life which may lead to improvements in exercise tolerance

Answer 56

inspiratory

Question 57

what are some symptoms with someone with asthma

Answer 57

wheezing chest tightness SOB decreased FEV1 greater than the reduction of FVC

Question 58

asthma is inflammation of the ___ ____

Answer 58

airway walls

Question 59

asthma ____ mucus production

Answer 59

increased

Question 60

asthma is ___ of the airway walls and ___ mm contraction

Answer 60

thickening smooth

Question 61

if your pateint has asthma and they are going to exercises ____ should be used before test and achieve at least a ___% improvement of FEV1

Answer 61

bronchodilators 12-15%

Question 62

for asthma patients the Use of heart rate to set exercise intensity may not be appropriate due to ventilatory limitations to exercise (T/F)

Answer 62

true

Question 63

exercise induced asthma should be assessed with ____ ex tests:

Answer 63

vigorous

Question 64

with people with obstructive lung diease you should considers using ____ based walking program with progressive increases in ___

Answer 64

interval duration

Question 65

in restrictive lung disease as the compliance ___ , TV ___ as well

Answer 65

decreased 2x

Question 66

in RLD , transoulmonary pressure is ___ which increased the work to achieve TV breathing

Answer 66

increased

Question 67

in RLD , as RR increased , TV decreased to maintain what

Answer 67

minute ventilation

Question 68

what are pulmonary causes of RLD

Answer 68

atelectasis pneumonia brhonchiogenic CA

Question 69

in RLD, what are the 3 things exercise / activity consideration are based on

Answer 69

ventilatory compromise hemodynamic stability immunologic responses

Question 70

if a patient has a C5 or higher SCI what will be weak and what kind of breathing pattern will they have

Answer 70

diaphragm will be weak Paradoxical breathing pattern

Question 71

what training do we do for inspiratory mm weakness with RLD

Answer 71

Inspiratory mm training

Question 72

if your patient has ASL (RLD) you want to refrain from ___ physical exertion

Answer 72

excessive

Question 73

what do you want to teach your pateints with ALS (RLD)

Answer 73

breathing techniques

Question 74

what are the 3 exercises you should teach your pateint with kyphoscoliosis

Answer 74

breathing / chest wall expansion exercise (segmental breathing) extension based strengthening active breathing exercsies

Question 75

what are 4 thing you want to teach your pateint wiht anklyosing Spondylitis (RLD)

Answer 75

patient positioning in extension trunk extensor and scapula retractor strengthening activit breathing exercsies thoracic mob techniques

Question 76

pateint with RA (RLD ) have may ___ and ___ complication

Answer 76

cardiovascular and pulmonary

Question 77

pateint RA (RLD) will have ___ VC , lung compliance and diffusion gradient

Answer 77

decreased

Question 78

patients with RA (RLD) have pleural ____ , effusion and interstitial ___

Answer 78

thickening fibrosis

Question 79

patients with RA may have pulmonary ___ and pulmonary ___

Answer 79

HTN vasculitis

Question 80

pateints with connective tissue disease for RLD may have steroid induced weakness of what mm

Answer 80

diaphragm

Question 81

what are some symptoms of Lupes (RLD)

Answer 81

SOB, hypoxemia, cyanosis, tachypnea, tachycardia

Question 82

Lupes (RDL) may lead to what

Answer 82

interstitial pulmonary fibrosis

Question 83

what is Antigen-antibody reactions that affect the skin, joints, kidneys, lung, heart and nervous system

Answer 83

SLE

Question 84

50-90% of SLE involves the ___

Answer 84

lung

Question 85

Lupes , SLE , RA pateints typical have ____ weakness , elevated and ___ diaphragm , and weakness in other ___ MM

Answer 85

diaphragmatic shortened inspiratory

Question 86

what is a RLD that is Progressive fibrosis of lung, heart, skin, kidney, GI tract, vascular system

Answer 86

scleroderma

Question 87

what is the pateint RX for scleroderma

Answer 87

 IMT  Active cycle breathing  Segmental breathing  Positioning education  Thoracic mobilization  ROM and strengthening of trunk extensors , UEs and LEs

Question 88

what metabolic disease Leads to hypoventilation syndrome and is also a RLD

Answer 88

obesity

Question 89

patients wiht obesity have RLD and the diaphragm is forced ___ due to ___ abdominal pressure

Answer 89

upwards increased

Question 90

patients with obesity have RLD and have ___ compliance of the chest wall

Answer 90

decreased

Question 91

pateint with obesity have RLD and this promotes early airway ___ and ___ lung expansion

Answer 91

closure decreased

Question 92

what is the PT RX for patients with obesity and RLD

Answer 92

 Positioning in bed:  Semifowlers  Sidelying  Referral to dentist and physician for sleep appliance and / or CPAP machine