2nd semester "Pulmonary Rehabilitation"
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What is the definition of pulmonary rehabilitation?
" A multi-disciplinary program of care for patients with chronic pulmonary impairment that is individually tailored and designed to optimize physical and social performance and anatomy"
What do all of these stand for?
1. forced expired volume in one second
2. forced vital capacity
3. total lung volume
4. Activities of daily living
What are the predicted PFT results for a patient with an obstructive disease?
FEV1/FVC less than 70%
TLC greater than 80% of predicted
What does "etiology" mean?
The science and study of the causes or origins of disease.
What is the "etiology" & "result" of a patient with a obstructive lung disease?
- Etiology: Inflammation response
- *Bronchospasm (2/3 have reversibility)
- *Edema (airways < 2mm in diameter)
- * Mucus production and loss of elastin
Result: Over inflation of alveoli and air trapping
What is the 3rd leading cause of death in the United States? and what are the 2 main causes?
COPD (Emphysema and Chronic Bronchitis)
- 1.Cigarette smoking
- 2.Alpha-1-antitrypsin deficiency
What does Alpha-1-antitrypsin deficiency lead to?
Leads to destruction of the lung, since its lacking Alpha-1 antitrypsin
Name the 5 diseases that are considered to be "Obstructive"
1. Cystic Fibrosis
_____ _______'s impact on COPD mortality and morbidity far outweigh all other factors combined
What is the second most common cause that has a major impact on COPD's mortality and morbidity ? explain
Genetic AAT deficiency. It results in early onset emphysema.
What are two preventive measures that can help to avoid early onset COPD?
1. Stop smoking
2. Treatment with IV augmentation therapy may prevent neutrophil elastase damage to lung tissue
What are the predicted PFT results for a patient with a restrictive disease?
TLC and VC less than 70% of predicted
What is the "etiology" and "results" for a patient with a restrictive disease?
Etiology: Interference with bellows action of the lungs and chest wall
Results: Reduction in lung volumes
What are the 2 objectives with pulmonary rehab for a patient with a restrictive disease?
1. Alleviate/control as many medical symptoms of resp. impairment possible.
2. Teach/train patient how to maximize their ability to carry out ADL " activities of daily living"
Name 7 diseases that are considered to be "Restrictive"
- 1. Pulmonary fibrosis
- 2. Pneumoconioses
- 3. Sarcoidosis
- 4. Kyphoscoliosis
- 5. Myasthenia Gravis
- 6. Muscular Dystrophy
- 7. Spinal Cord Injury
What are the benefits for a patient with a restrictive lung disease for doing pulmonary rehab? (7)
- 1. Improved tolerance for dyspnea
- 2. Improved sputum clearance
- 3. Increased efficiency of skeletal muscles
- 4. Decreased frequency of hospitalizations
- 5. Reduced resting heart rate
- 6. Improved ability to perform activities of daily living
- 7. Improved appetite
What are the 3 types of pulmonary rehabilitation programs?
1. IN PATIENT PROGRAM
2. OUT-PATIENT PROGRAM
3. HOME BASED PROGRAMS
What saturation percentage qualifies a patient for home O2 use?
less than 88% saturation
What does not change with pulmonary rehabilitation?
It disease doesn't change.
"as lung reserves decline, dyspnea worsens and independent daily activity performance erodes, pulmonary rehab provides multidisciplinary training to improve patients ability to manage and cope with progressive dyspnea"
Does EZPAP have oscillation?
No, works only on expiration
1.) What does FET stand for?
2.) What is FET also known as?
1.) Forced expiratory technique
2.) aka Huff cough
How do you perform a "Huff cough" ?
1 or 2 huffs (forced expiration) from mid-to-low lung volumes with a OPEN GLOTTIS
followed by a period of relaxed, controlled diaphragmatic breathing
(can be reinforced by self-compression of the chest wall using a brisk adduction movement of the upper arms)
What is a manually assisted cough?
The external application of mechanical pressure to the epigastric region or thoracic cage coordinated with forced exhalation.
what are the steps to perform a manually assisted cough?
1. stand in front of patient
2. place one hand over the chest and one on the abdomen or both hands in the abdomen area
3. have patient take deep breath, then RT should compress manually
4. you must compress just a few seconds before the patient exhales, pushing harder against a closed glottis a split second before exhalation
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