Renal Rehab

Question 1

how long does renal rehab usually last

Answer 1

6-12 wks

Question 2

discuss renal rehab effects

Answer 2

improves VO2 max and edurance based on 6MW

Question 3

indications of renal rehab

Answer 3

nephritis

nephrosis

Question 4

discuss nephritis

Answer 4

aka glomerulonephritis

inflammation of kidneys

diff for kidney to filter waste products

Question 5

discuss nephrosis

Answer 5

aka nephrotic syndrome

caused by diff diseases - cardiac prob, MI, stroke, DM, HTN

attacks body leading to kidneys being unable to prevent proteins to leaking in urine

Question 6

stage 1 CKD

Answer 6

c normal or high GFR

> 90

Question 7

stage 2 mild CKD

Answer 7

60-89

Question 8

stage 3A moderate CKD

Answer 8

45-59

Question 9

stage 3B moderate CKD

Answer 9

30-44

Question 10

stage 4 severe CKD

Answer 10

15-29

Question 11

stage 5 end stage CKD

Answer 11

<15

complete kidney failure

Question 12

what is GFR

Answer 12

optimal way of measuring kidney function

Question 13

rehab implication for stage 1-4

Answer 13

indicated

Question 14

rehab implication for stage 5

Answer 14

requires medical clearance

Question 15

discuss dialysis

Answer 15

removes waste and excess fluid from blood

can lead to impaired function, mobility, disability, hospi, falls, morbidity and mortality

Question 16

effect of PT in dialysis

Answer 16

PT can help produce positive outcomes

Question 17

discuss kidney transplantation and effect of PT

Answer 17

pt may be inactive s/p kidney transplant

PT can help reduce risk of CV prob, obesity, weakeness and function limitations

Question 18

effects of hemodialysis

Answer 18

hypotension

fatigue

muscle cramps

anemia

sleep disturbances

weak bones

Question 19

impact of renal disease to physical function

Answer 19

CKD + dialysis = uremia, fluid imbalance and electorlyte disturbance = affects muscle function and function

manifests:
- fatigue and dec CV endurance
- weakness
- fucntional limits

Question 20

discuss implementation of GXT

Answer 20

standard testing: stage 1-4

clearance needed: stage 5

usually treadmill and ergo c warm up and cooldown

use METs as a guide

Question 21

guidelines for pt c maintenance hemodialysis

Answer 21

EXT on on-dialysis days

BP monitored on non fistula arm

use 75% of HRmax or lower

Question 22

guidelines for pt c cont ambulatory peritoneal dialysis

Answer 22

dapat wla dialysate fluid in abdoments

recsched p 2-3 hrs or ext day

Question 23

ex guidelines in general

Answer 23

HR not reliable - also use RPE

dynamic strength - 3RM or higher 10-12
- no 1 RM

muscular strength and endurance - isokientic dynamometry c angular velocities 60-180°/sec range

testing:
CV endurance - 6MWT
muscular stregth - STS
balance - fucntional reach test

Question 24

ACSM reccomendations for frequency

Answer 24

aerobic: 3-5x / wk ideally 5

resistance: 2-3

flexibikity and balance: 2-3

Question 25

ACSM reccomendations for intensity

Answer 25

40-60% of HRR RPE: 11-16 60-75% 1RM also use VO2 max

Question 26

ACSM reccomendations for time

Answer 26

aerobic 20-60 min or 10 min bouts until 20-60mins resistance - 10-15 reps for 1-3 sets malakas pa pt - 3 to 5 RM

Question 27

ACSM reccomendations for type

Answer 27

aerobic - cycling or walking resistance - PRE using elastic bands or free weights

Question 28

in patient RPE

Answer 28

11-13

Question 29

special considerations for nephritis/nephrosis

Answer 29

ex should be based on disease stage, needs and capcity lifestyle and diet mod oral steroids or risk for fx: PRE of any WB should be in caution and manual techniques

Question 30

special considerations for hemodialysis patients

Answer 30

should not be done immed aft mas maganda sa non dialysis days if during dialysis days better if before, during or first half to avoid hypotesion - after madali mag hypotension use RPE if HR is not reliable

Question 31

special considerations for kidney or renal transplant patients

Answer 31

if in period of rejection dec freq and intensity to give time to recover CV is still adjusting check for color changes, skin reactions, monitor esp p kidney transplant

Question 32

barriers to ex particiaption

Answer 32

fatigue and SOB lack of motivation lack of clearly defined programs loc of exercise training additonal cost

Question 33

what to do if may contra or red flag

Answer 33

refer back to MD team