|_________ is the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential of which he or she is capable.||rehabilitation|
|what is the overall goal of rehabilitation?||maximize the functional ability & minimize the impact the disability has|
|________ __________ is the art of medical practice wherein an individually tailored, multidisciplinary program is formulated; attempts to return pt to highest possible functional capacity.||pulmonary rehabilitation|
|what are the general goals of pulmonary rehabilitation?||control symptoms, restore functional capabilities, IMPROVE QUALITY OF LIFE|
|application of ______ ______ is helpful in determining the psychologic, social, and vocational impact of the disability on the pt and family and in estabilishing ways to improve the pt’s quality of life.||social sciences|
|how does an individual maintain homeostasis at rest?||balancing external, internal, and cellular respiration|
|what increases in linear fashion as exercise intensity increases?||O2 consumption and CO2 production|
|what is the point called in exercise physiology that says: if the body cannot deliver sufficient O2 to meet the demands of energy metabolism, blood lactate levels increase above normal?||onset of blood lactate accumulation (OBLA)|
|the ________ ________ refers to the result of an abrupt upswing in both CO2 and VE.||ventilatory threshold|
|what does exercise in COPD pts result in?||resp acidosis, SOB|
|as ventilation increases in a COPD pt, what else increases significantly?||O2 consumption|
|what does reconditioning involve?||strengthening essential muscle groups, improving overall O2 utilization, enhancing the body’s cardiovascular response to physical activity|
|what do pts with COPD often have a tendency of developing?||severe anxiety, hostility, stress|
|what are key ingredients in a good rehabilitation program?||occupational retraining and job placement|
|who should be involved with the rehabilitation team and in the rehabilitation program?||occupational therapist|
|what are 3 examples of program objectives?||development of diaphragmatic breathing skills, development of stress management, focus on group support|
|what does patient evaluation begin with?||complete pt history|
|what should the pt’s complete history be followed by?||complete physical examination|
|to determine the pt’s cardiopulmonary status and exercise capacity, both pft and a _____________ ______ ________ may be performed.||cardiopulmonary exercise evaluation|
|what are the 2 key purposes that the cardiopulmonary exercise evaluation serves in pulmonary rehabilitation?||1. quantifies the pt’s initial exercise capacity 2. determine the degree of hypoxemia or desaturation w/ exercise|
|what does the second evaluation allow?||basis for titrating O2 during exercise|
|the actual exercise evaluation involves continuous measurements of parameters during graded levels of exercise on either an ________ or _______.||ergometer; treadmill|
|to allow for steady state equilibration, these graded levels are usually spaced as __-minute intervals.||3|
|work levels are increased progressively until either…?||1. pt cannot tolerate higher level 2. abnormal/hazardous response occurs|
|when are blood gas and arterial saturation obtained?||rest and peak exercise|
|what is the pulse ox used as?||a monitor to warn clinicians of gross desaturation and response to O2|
|what are 3 examples of relative contraindications to exercise testing?||1. pts who won’t/can’t perform test 2. severe pulmonary HTN/cor pulmonale 3. SaO2/SpO2 <80%|
|what can exercise evaluation help differentiate betweens?||primary respiratory or cardiac limitations to increased work capacity|
|what are the 5 safety measures during exercise evaluation?||1. physical examination (ECG) 2. qualified physician 3. emergency resuscitation device 4. basic/advanced life support techniques (clinicians) 5. terminated when indicated|
|how many hours before the procedure should the pt fast?||8 hrs|
|regardless of underlying conditions, pts also should be ________.||ex-smokers|
|when are pts excluded from pulmonary rehabilitation activities?||1. problems limit/preclude participation 2. condition complicated by malignant neoplasms (lung cancer)|
|groups or classes for pulmonary rehabilitation should be kept ___________.||homogeneous|
|how is it best to group pts together?||severity and overall ability|
|what are the two kinds of program designs?||open-ended or closed design|
|what is involved in the open-ended design?||pts enter program & progress through it until they achieve certain objectives|
|what is the major drawback with the open-ended design?||lack of group support and involvement|
|what does the closed design use?||a set time period to cover program content|
|when do these programs run?||6-16 weeks, 1-3 times a wk|
|what is a major drawback with the closed design?||the schedule determines program completion, rather than the objectives|
|regardless of the format used, long-term improvements cannot be expected without ______ _________.||planned follow-up|
|rehabilitation program content usually combines ________ __________ with education activities.||physical reconditioning|
|the ideal rehabilitation session should run for about __ hours.||2|
|for most pts, an initial target heart rate is set using _________ _______, or estimated 20 beats/min above resting rate.||Karvonen’s formula|
|what are the 4 related components in the exercise prescription?||1. lower extremity aerobic exercise 2. timed walking (6-12 mins) 3. upper extremity aerobic exercise 4. ventilatory muscle training|
|what is the duration set on for lower extremity exercises?||30 mins|
|what is the objective for walking exercises?||walk as far as possible during the allotted time|
|how long should arm exercises be?||up to 20 mins|
|ventilatory muscle training is based on the concept of _________ _________.||progressive resistance|
|what does the RT intially do during ventilatory muscle training?||measures pt’s maximum inspiratory pressure using calibrated pressure manometer (compares w/ norms)|
|what is the rate at which a pt should breath in the manometer?||10-12 breaths/min|
|as the level of resistance becomes more tolerable over time, the pt should progressively increase session duration up to ___ mins.||30|
|what are the 9 actual content of the educational sessions?||1. resp structure, functin, pathology 2. breathing control 3. relaxation/stress methods 4. exercise techniques 5. secretion clearance 6. home O2 7. meds 8. dietary 9. recreation/vocational counseling|
|what is the cornerstone for the physical reconditioning effort?||breathing control methods|
|what are common categories of meds?||B-adrenergics, anticholinergics, steroids, diuretics, methylxanthines|
|what is a common problem for pts with moderate to severe chronic lung disease?||psychological and emotional stress|
|pulmonary rehabilitation is a ____________ endeavor.||multidisciplinary|
|location and quality of facilities can directly affect patient _________.||attendance|
|what are the 2 rooms that the facility should provide?||1. educational activites 2. physical reconditioning|
|what is the length of the program often dependent on?||insurance coverage and expected reimbursement|
|what is a normal class size?||3-10|
|what does program viability realistically depend on?||number of participants|
|what is the equipment required to meet the educational needs of the program?||blackboard/flipchart, PP projector, screen, overhead, tape player; videotape/DVD player|
|what are the equipment guidelines for a class of 6-10?||5 stationary bikes, 2 treadmills/rowing machines/ergometers, 5 pulse ox, 1 emergency O2 cylinder, bronchodilator meds|
|what are 5 things needed for a program?||1. pt manuals 2. light refreshments 3. communication network 4. DME providers 5. payment plan|
|how do rehabilitation programs usually project their fees?||based on avg cost per participant|
|what is the goal of payment for rehabilitation programs?||obtain as much insurance reimbursement as possible|
|what are the common outcome measures in the program results?||exercise tolerance, levels of dyspnea at rest/exertion, quality of life surveys|
|what is one of the major predictors for improvement in a COPD patient’s health-related quality of life?||frequent attendance in a maintenance program|
|what are the major reasons for unsatisfactory outcomes?||insufficient training, lack of uniformity, inadequate program length, lack of follow-up|
|pulmonary rehabilitation has become recognized as a prerequisite for certain _________ pts who are able to undergo lung volume reduction surgery.||emphysema|
|what are the potential hazards?||1. cardiovascular abnormalities 2. blood gas abnormalities 3. muscular abnormalities|
|what are key factors in reducing possible hazards?||pt selection, education, supervision, monitoring|
|_______ _________ is defined as a comprehensive exercise and educational program designed for pts with cardiovascular diseases.||cardiac rehabilitation|
|what are the goals of cardiac rehabilitation?||pt education, physicial reconditioning to improve work capacity, weight loss, return to work|
|what is the goal of a structured cardiac rehabilitation program?||assist pts in developing a regular pattern of safe exercise to achieve greater performance|
|what is the age of cardiac pts compared to pulmonary pts?||30 to 60-70; pulmonary – 50 and up|
Egan’s Chapter 50 Practice Questions:
1. Absolute contraindications for conducting a cardiopulmonary exercise evaluation include all of the following except:: diastolic blood pressure greater than 110 mm Hg.
2. Attrition in pulmonary rehabilitation programs is most associated with which of the following?: Degree to which patients’ psychosocial needs are met.
3. Below what level of the predicted FEV1/FVC are patients with irreversible airway obstruction considered good candidates for pulmonary rehabilitation?: 60%
4. By following the reimbursement guidelines for a comprehensive outpatient rehabilitative facility (CORF), Medicare will reimburse up to what percentage of the allowable charge for a rehabilitation program?: 80%
5. A cardiopulmonary exercise evaluation is conducted on a patient before participation in pulmonary rehabilitation for what purposes?: I. To quantify the patient’s baseline exercise capacity,II. To develop an exercise prescription (including target heart rate),III. To determine how much desaturation occurs with exercise.
6. During exercise, the point at which increased levels of lactic acid production result in an increased VCO2 and VE is referred to as what?: Ventilatory threshold
7. During inspiratory resistive exercises, the desired load should be about what percentage of the maximum inspiratory pressure?: 30%
8. For which of the following patients would you recommend an open-ended format for a pulmonary rehabilitation program?: I. Those with scheduling difficulties. II. Those who require individual attention. III. Those who are self-directed.
9. In preparing an outpatient for a cardiopulmonary stress test to be conducted the next day, which of the following instructions would you provide?: I. The patient should fast for at least 8 hours before testing. II. The patient should wear loose-fitting clothing and sneakers.IV. The patient should review the drugs with the physician.
10. Knowledge from the clinical sciences is used in pulmonary rehabilitation programming for mainly what purpose?: I. Quantify the extent of physiological impairment. III. Set expectations for reasonable outcomes
11. Knowledge from the social sciences is used in pulmonary rehabilitation programming for mainly what purpose?: I. Determine the impact of the disability on the patient or family, III. Establish ways to improve the patient’s quality of life.
12. Minimum equipment requirements for the physical reconditioning component of a pulmonary rehabilitation program include which of the following?: I. Inspiratory resistive breathing devices, II. Rowing machines or upper extremity ergometers, III. Pulse oximeters (for pulse rate/SaO2),IV.
13. A patient in your pulmonary rehabilitation program has an orthopedic disability that precludes her from walking or using a stationary bicycle. Which of the following activities would you recommend to help recondition the lower extremities?: Aquatic exercises
14. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following pulmonary function tests would you recommend be performed as a component of the preliminary evaluation?: I. Lung volumes, including functional residual capacity (FRC) ,II. Diffusing capacity (DLCO) ,III. Pre- and post-bronchodilator flows
15. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following test regimens would you recommend in order to ascertain the patient’s cardiopulmonary status?: I. Cardiopulmonary exercise evaluation II. Pulmonary function testing
16. Patients with chronic cardiopulmonary disorders all share an inability to do what?: Cope effectively with their disease process
17. The physical reconditioning component of a pulmonary rehabilitation program usually includes which of the following?: I. Aerobic exercises for the extremities, II. Timed walking exercise, III. Ventilatory muscle training
18. The principal objectives of pulmonary rehabilitation include which of the following?: I. Control and alleviate the symptoms. II. Restore functional capabilities as much as possible. III. Improve the quality of life.
19. Reconditioning the inspiratory muscles of patients undergoing pulmonary rehabilitation is accomplished through which of the following methods?: Performing inspiratory resistive breathing exercises.
20. A small-group discussion format for pulmonary rehabilitation educational sessions is recommended in order to foster which of the following?: I. Group interaction, II. Peer support, III. Group identity
21. A small pulmonary rehabilitation program class size has which of the following beneficial effects?: I. It facilitates group interaction, II. It allows for more individualized attention, III. It helps to sustain participant motivation, IV. It reduces the likelihood of attrition.
22. To deal with incidents of hypoxemia, dyspnea, or airway hyperreactivity during physical reconditioning activities, which of the following should be available in the rehabilitation area?: II. Bronchodilator agents III. Emergency oxygen
23. To increase the likelihood that positive patient results are lasting, what must pulmonary rehabilitation programs provide?: Periodic follow-up and reinforcement
24. To maximize patient safety during cardiopulmonary stress testing, which of the following precautions would you recommend?: I. Immediate availability of a crash cart. II. Staff training in emergency life support. III. Presence of a physician throughout testing. IV. Patient physical exam or ECG before testing.
25. To physically recondition a patient and increase exercise tolerance, which of the following must be accomplished?: I. The body’s overall O2 utilization must be improved. II. The patient’s essential muscle groups must be strengthened. III. The cardiovascular response to exercise must be enhanced.
26. The VO2max at termination of exercise (as a percentage of the predicted) for five patients appears below. Which of these patients is the best candidate for pulmonary rehabilitation?: VO2max (predicted) 65%
27. What are some relative contraindications for cardiopulmonary exercise testing?: I. Severe pulmonary hypertension or cor pulmonale, II. Known electrolyte disturbances (e.g., hypokalemia), III. SaO2 or SpO2 less than 85% breathing room air IV. Untreated or unstable asthma
28. What are the overall goals of rehabilitation?: II. Minimize the disability’s impact on the individual or family, III. Maximize the functional ability of the individual.
29. What government programs can serve as a source for reimbursement for pulmonary rehabilitation?: II. Comprehensive outpatient rehabilitative facility (CORF), III. Veterans Administration benefits, IV. Civilian Health and Medical Programs of the Uniformed Services (CHAMPUS)
30. What is the first step in evaluating patients for participation in a pulmonary rehabilitation program?: Complete patient history
31. What is the ideal class size for pulmonary rehabilitation programs?: 3 to 10
32. What is the level of involvement of the respiratory therapist in cardiac rehabilitation?: Significantly less than in pulmonary rehabilitation
33. What is the term used to describe the restoration of individuals to the fullest possible medical, mental, emotional, social, and vocational potential?: Rehabilitation
34. Which of the following are differences between cardiac and pulmonary rehabilitation?: I. Cardiac patients are typically younger., III. Reimbursement is easier to obtain with cardiac rehabilitation, IV. Breathing exercises are not essential to cardiac patients.
35. Which of the following clinicians are commonly involved in the cardiac rehabilitation programs?: I. Nurse specialist, II. Cardiologist
36. Which of the following elements should be considered in most pulmonary rehabilitation programs?: I. Individual needs, II. Patient’s education, III. Patient’s personality, IV. Patient’s attitudes
37. Which of the following exercises are useful for reconditioning the lower extremities of patients undergoing pulmonary rehabilitation?: I. Walking on a flat surface for a specified period of time. II. Walking on a treadmill for a specified distance or time. III. Pedaling a stationary bicycle for a specified distance.
38. Which of the following health professionals would be best for conducting a pulmonary rehabilitation session on methods of relaxation and stress management?: Clinical psychologist
39. Which of the following health professionals would be best for conducting a pulmonary rehabilitation session on recreation and vocational counseling?: Occupational therapist
40. Which of the following is NOT a factor affecting the cost of a pulmonary rehabilitation program?: Patient health insurance
41. Which of the following is NOT a reasonable expectation for a pulmonary rehabilitation program?: Reversal of the disease process
42. Which of the following measures during cardiopulmonary exercise evaluation are most useful in differentiating between exercise intolerance of cardiac versus ventilatory origin?: III. PaCO2, IV. PaO2
43. Which of the following occur when the ventilatory threshold is exceeded during exercise?: I. Metabolism becomes anaerobic III. Fatigue increases.
44. Which of the following outcome measures is considered a major predictor for improvement in a COPD patient’s health-related quality of life?: Frequent attendance in a maintenance program
45. Which of the following patients are NOT good candidates for pulmonary rehabilitation?: I. Unstable cardiovascular patients who require monitoring. III. Patients with malignant neoplasms involving the lungs.
46. Which of the following patients with irreversible airway obstruction are the best candidates for pulmonary rehabilitation?: II. B 1.6 L 67% ,III. C 2.3 L 53%
47. Which of the following patients would benefit least from pulmonary rehabilitation?: Patient with malignant lung cancer
48. Which of the following topics should be covered in a rehabilitation education session on respiratory home care?: I. Self-administration of therapy II. Care of home equipment (e.g., cleaning) III. Safe use of home care equipment
49. Which of the following would you not expect to observe after a chronic obstructive pulmonary disease (COPD) patient completes a sound pulmonary rehabilitation program?: Permanent increase in forced expiratory volume in 1 second (FEV1) and forced expiratory flow (FEF25%-75%).
50. While you are assisting in a treadmill cardiopulmonary stress test procedure, the patient complains to you of severe shortness of breath and some chest pain. Which of the following actions would you recommend at this time?: Terminate the procedure at once.