1
Q
Congestive Heart Failure
A
Hearth can’t pump blood out → blood backs up
2
Q
With CHF the patient is at risk of:
A
- Pulmonary edema (can be intersitital, perivascular or alveolar edema)
- Pleural effusion
- atelectasis
becasue fluid is backing up into the lungs
3
Q
CHF, auscultation in stages 1, 2 and 3:
A
- Early (stage 1): may not hear anything
- Moderate (stage 2): crackles (wet), decreased BS
- Severe (stage 3): pleural rub (effusion), crackles, decreased BS
4
Q
Congestive Heart Failure symptoms:
A
- Dyspnea due to poor gas transport due to R-L
shunting due to fluid in alveoli - Paroxysmal nocturnal dyspnea (wakes them up at night)/orthopnea (# of pillows)
- Rapid RR (quick shallow breaths)
- Cheyne-Stokes breathing
- *Jugular dystention
- *Peripheral edema
5
Q
Goal of treatment of CHF:
A
- keep pulmonary capillary pressures at lowest possible levels
- help them breathe
6
Q
Caused by inadequate insulin production OR ineffective insulin action
A
Diabetes
7
Q
In diabetes, decreased elastic recoil and diffusion capacity. See more of a _________________ pattern
A
restrictive
8
Q
In diabetes, higher incidence of __________ infections and
sleep-related breathing problems
A
pulmonary
9
Q
Higher resting metabolic rate demands higher cardiac output and minute ventilation to meet the body’s needs
A
Obesity
10
Q
>30 BMI (obesity) may result in a ________ resting diaphramg
A
higher
11
Q
Diabetes, metabolic response to exercise may be altered:
A
- Development of ketoacidosis
- Can affect breathing pattern
12
Q
Obesity may see:
A
- Obstructive Sleep apnea
- Pulmonary HTN
- Mean pulm arterial pressure > 25 mmHg at rest
- Obesity hypoventilation syndrome (OHS)
13
Q
Pulmonary HTN = Mean pulm arterial pressure >
A
25 mmHg at rest
14
Q
Obesity hypoventilation syndrome (OHS)
A
don’t take a deep enough breath
15
Q
who has the higher diaphragm?
A
Apple
16
Q
True or false. Obesity may cause restrictive pulmonary issues, but may see obstructive sleep apnea
A
true
17
Q
Signs of COPD:
A
- Hypoxemia
- Hypercapnia
- Increased production of mucous/impaired mucous clearance
- Pulmonary hypertension
- Polycythemia
- Cor pulmonale
- Often see productive cough
- Decreased expiratory flow rates (FEV1)
- Increased residual volume
18
Q
Symptoms of restrictive pulmonary diseases:
A
- Dyspnea
- Cough
- Emaciation
19
Q
Signs of restrictive pulmonary diseases:
A
- Tachypnea
- Hypoxemia
- Diminished BS
- Adventitious BS
- Decreased lung volumes
- Decreased diffusion capacity
- Cor Pulmonale (Right hearth failure): hearth overloads
20
Q
In renal failure may see:
A
- Diaphragmatic weakness
- Restrictive lung dysfunction
- PH disturbances
21
Q
Renal failure
A
Fluid overload: Pulmonary edema, HTN, ascites (fluid in abdomen)
22
Q
ascites
A
the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
23
Q
Side effects of DIALYSIS can include:
A
- Anemia
- Pericarditis
- Ascites
24
Q
in CHRONIC RENAL FAILURE (CRF) can see decreased …..
A
- exercise/functional capacity
- May be as low as 50% of healthy age/sex matched controls
25
Chest PT (breathing exercises/PD) performed at Brompton Hospital in ______ in 1934
England
26
“Pulmonary rehabilitation is an evidence-based, **multidisciplinary**, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased dailyactivities. Integrated into the **individual** treatment of the patient, pulmonary rehabilitation is designed to **reduce symptoms**, **optimize functional status,** **increase participation,** and **reduce** **health care costs** through stabilizing or reversing systemic manifestations of the disease”.
American Association of Cardiovascular and Pulmonary Rehabilitation
27
Primary Goal of **Pulmonary Rehab:**
* **Rehab: Restore patient to highest possible level of independent function**
* Do this by heling patient become more physically active, learn more about their disease, treatment options, and how to cope
28
Primary goal of pulmonary **in-patient (acute care):**
* Goals are to improve ventilation and gas exchange, secretion clearance and maintenance of functional capacity
* Not geared toward increasing exercise capacity due to limited length of stay in acute care setting → home program
29
True or false: in **acute care setting**, the goal for the pulmonary patient is toward increasing exercise capacity
FALSE
Goals are to improve ventilation and gas exchange, secretion clearance and maintenance of functional capacity
30
results from decreased length of stay at the hospital
* Decreased length of stay (decreased cost)
* Reduction in post-surgical complications (ex. pna)
* Quicker return to activity and work
31
In out-patient pulmonary rehab, use\_\_\_\_\_\_\_\_\_\_ as a means of evaluating efficacy in lieu of physiologic parameters
**functional outcomes**
32
Out-patient pulmonary rehab pragrams include
exercise, education and counseling
33
Most pts in pulm rehab have \_\_\_\_\_\_\_, but other diagnoses can benefit too
COPD
34
Four Domains of Outcomes Assessment (AACVPR)
1. Health outcomes
2. Clinical outcomes (dyspnea, exertional, depression, anxiety)
3. Behavioral outcomes (smoking cessation)
4. Service outcomes
35
**Health outcomes** has 4 aspects:
1. Physical functioning
2. Psychological functioning
3. Social-role functioning
4. Disease and treatment symptoms and side effects
36
“The gap between that which is desired in life and that which is achieved”
Heath Outcomes: **Quality of Life**
37
Health Related Quality of Life assessments:
(generic and respiratory specific)
* **Generic:**
* Medical Outcomes Study Short Form SF – 36
* **Respiratory Specific:**
* Chronic Respiratory Disease Questionnaire (COPD)
* St. George’s Health Questionnaire
* Living with Asthma Questionnaire
* Pulmonary Functional Status Scale
* Pulmonary Functional Status Scale (PFSS)
38
These are measures done to evaluate patient’s progress and guide development of long-term goals in d/c plan
Clinical Outcomes
39
when are the clinical outcomes done?
* At start of rehab
* Scheduled intervals during rehab
* End of rehab
* May be physical tests or questionnaires
40
true or false: clinical respiratory outcomes may be physical tests or questionnaires
true
41
Reflect patient’s ability to make recommended lifestyle changes
**Behavioral Outcomes**
42
**Behavioral outcomes**
* Knowledge of educational objectives
* Success with smoking cessation
* Adherence to diet
* Adherence to medications
* Adherence to exercise prescription
* Supplemental oxygen use
* Success with coping mechanism, energy conservation and pacing techniques
* Success with relaxation and stress management
43
Service/Satisfaction Outcomes:
* Pulmonary rehabilitation is a customer service program
* Patient satisfaction survey
* Utilization rates
* Costs of providing care
44
to qualify for pulmonary rehab patients must have...
* Diagnosis of chronic, stable respiratory disorder with disabling symptoms that impair the patient’s function
* PFTs need to show:
* FEV1 \< 65% predicted
* FVC \< 65% predicted
* DLCO \< 65% predicted
* Hypoxemia at rest and with exercise testing
45
Clinical outcomes for dyspnea and fatigue:
(during a specific task & during daily activity)
* **Exertional breathlessness during a specific task:**
* Borg, VAS.
* **Overall level of breathlessness during daily activity:**
* Dyspnea Index, UCSD SOB Questionnaire, MRC Questionnaire.
46
Clinical outcomes for exercise performance:
* Field tests (6MWT, shuttle walk test)
* Laboratory tests (max and submax exercise testing)
47
Clinical outcomes for a anxiety and depression:
* Beck depression inventory,
* Hospital anxiety and Depression questionnaire.
Decks in class (10)
# Cards
-
Pulmonary Anatomy And Physiology112
-
Examination Of The Pulmonary Patient41
-
Pulmonary A&P MUST KNOW13
-
Restrictive and Obstructive Lung Dysfucntion111
-
Diagnostic Testing64
-
Special Populations47
-
Medical / Surgical Management of Pulmonary Dysfunction66
-
Exercise Physiology27
-
LAB Stuff23
-
Exercise testing and prescription20
