2nd semester "pulmonary rehabilitation"
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. What would you like to do?
why should you "survey" a patients home?
to make modifications, assure saftey and for infection control.
What things should you check for in a patients home when surveying? (7)
-check vents, ducts, and appliances for molds
-clean AC/ furnance filters
-cockroaches/rodent droppings/ dust mites
-use of air filters
How do you figure out the ideal body weight for a male and female?
female: 105 lbs + 5 lbs for every inch over 60 inches
male: 106 lbs + 6 lbs for every inch over 60 inches
(side note: 60 inches = 5'0
my hieght: 5'9 = 69 inches)
What should a persons predicted calories be?
what if they are underweight?
predicted calories: 25-35 cal/Kg
under weight: 35-45 cal/Kg
What are 7 symptoms of impared food intake?
- 1. Early satiety (being full very early)
- 2. Dyspnea
- 3. Anorexia
- 4. Fatigue
- 5. Bloating
- 6. Constipation
- 7. Dental problems
Name 6 foods that are apart of the Carbohydrates food group
what do they do?
Fruits, grains, potatoes, cereals, pasta, & sugar
Breaks down into CO2
(in excess can cause S.O.B)
Name 6 food that are proteins
Milk, eggs, poultry, fish, beans, and meats
(eat more protein if going in for surgery)
Name 2 food products that are fats
oil and butter
How much salt, and water should a pateint consume in a healthy diet? should they drink alcohol? what kind of vitamins should they take?
- salt: 2400 mg/day (1 tsp - 2300 mg)
- (can = retained fluid)
- water: 6-8 glasses/day
alcohol : NO!
Vitamins/ minerals: multiple B with C
What are antibiotics recommended for?
not recommended except for treatment of infectious exacerbations
*never use antibiotics for prevention
what are mucolytics recommended for?
not recommended unless patient has viscous sputum
When is the use of steroids appropriate? (2)
Only if :
1. Pt. has improvement in symptoms or documented response to inhaled steroids on PFT
2. FEV1 of less than 50% with history of repeated exacerbations requiring tx with antibiotics or steroids
Regular use of Antitussives in contraindicated in for what disease?
Contraindicated in stable COPD
What is prescribed for all symptomatic patients with COPD?
Name the 1st - 4th line of medications for patients with COPD
- 1st line : anticholinergics for maintenance
- *ipratropium bromide
- 2nd line : beta agonists
- *short acting is for rescue
- *long acting is for maintenance
- 3rd line : methylxanthine
- (ex : Theophyllin - can increase ventilator drive, and strengthen contraction of diaphragm)
- 4th line : steroids
What are the benefits of smoking intervention? (4)
- 1. reduced respiratory symptoms
- 2. improved pulmonary function
- 3. stops acceleration of age-related decline in lung function
- 4. reduces COPD mortality rates
Name 6 physiologic effects of smoking ?
- 1. stimulates the brain
- 2. relaxes muscle tension
- 3. immediate gratification
- 4. vasoconstriction
- *facial wrinkles
- 5. brittle bones
- 6. stained teeth/gum disease
What are 8 things patients may experience while withdrawing from smoking ?
- 1. irritability
- 2. anxiety/insomnia
- 3. difficulty concentration
- 4. restlessness
- 5. headache
- 6. dizziness
- 7. GI distress
- 8. increased hunger
What are 3 techniques to get a patient to stop smoking ?
1. Group counseling
3. Nicotine replacement
What are 4 different types of nicotine replacement?
1. Nicotine polacrilex
2. Transdermal patch
3. Nasal spray
What are 7 benefits to excerising?
- 1. increased energy level
- 2. increased muscle strength
- 3. increased cardiopulmonary endurance
- 4. ability to fight infection
- 5. relaxation
- 6. restful sleep
- 7. increased bone density
what are 6 things that exercise can decrease?
1. shortness of breath
2. risk factors of heart disease
3. blood pressure
4. side effects of medications ( steroids)
5. depression (due to release of endorphins)
6. blood sugar levels
What are 5 activities that involve large-muscle groups that can be maintained continuously?
3. stationary cycling
For patient exercise, what should be the the frequency? intensity? duration? warm-up? and cool-down?
Frequency: 3-5 days per week
Intensity: 50% of peak exercise capacity based on maximum heart rate
Duration: 20-30 minuets
Warm-up: 10-15 minuets preceding
Cool down: gentle stretching
Patient exercise evaluation:
1. what should you establish?
2. how much should their PR increase by?
3. patient should be tired but exhibit minimal ____.
4. PR should return to baseline within _____ ____.
5. When PR does return to baseline you should do what 2 things?
1. base line vitals
2. Increase by 20-30%
3. tired but exhibit minimal discomfort
4. PR should return to baseline in 5 minuets
5. When it does return; increase work load and decrease supplemental O2 levels
When should inspiratory muscle training be considered?
When persistant dyspnea persists despite bronchodilator therapy
inspiratory muscle training:
what is a Nonlinear device?
what is a Threshold device?
what should you start at?
what is the frequency?
nonlinear device: unreliable training loads if the expiratory flow is not controlled.
Threshold device: provides reliable loads
Start at 1/3 of patients MIP to a max of 60% of MIP
Frequency: 2-5 times per day, 15-30 min, approx 12 breaths per minuet
What would you like to do?
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