Pulmonary Rehab exam 1 Questions and Answers

Pulmonary Rehab exam 1 Questions and Answers Pulmonary rehabilitation: evidence based, multidisciplinary & comprehensive intervention for pts w/ chronic resp diseases who are symptomatic & often have decreased daily life activities. COPD is ____ leading cause of death in U.S. 3rd COPD costs U.S. economy? 32.1 billion/year-18 direct & 14 indirect (*NHLBI) How many people have impaired lung function & are undiagnosed? 24 million What % of COPD is caused by cigarette smoking? 85% What % of COPD is caused by factors such as occupational & environmental exposures, previous lung infections, or genetic abnormalities? 15% What % of smokers develop COPD? 15-20% COPD can lay dormant for how many yrs before pt becomes symptomatic? 20 years Around what % do pts die within 10 yrs of a diagnosis of COPD? 50% Essential components of pulmonary rehab: -promotion of long-term adherence -education & training -assessment -psychosocial intervention -exercise PT goals & program goals =staff should be consistent in their understanding of goals -pt goals need to be established & reviewed w/ the pt/significant other at the beginning of program -goals should be realistic & readily achievable -goals may be altered as program progresses Patient goals: breathe better, more active, improve QOL, improve ADL, be able to travel w/ greater ease, increase strength & endurance Program goals: increase exercise tolerance & pt compliance, decrease psychological symptoms, education, infection control, tx plan, return pt to gainful employment (active retirement) Demonstrated outcomes of pulm rehab: -reduced resp symptoms -increased exercise tolerance & endurance -increased knowledge of pulm disease -enhanced ability to perform ADL -improved health-related QOL -improved psychosocial symptoms -reduced hospitalizations -return to work for some pts Traditional primary selection criterion is based on? physiologic impairment Physiologic impairment: -abnormal PFTs -FEV1/FVC 70% of predicted -FEV1 80% of predicted -DLco ≤ 65% of predicted -Resting hypoxemia: SpO2 90% -Oxygen desaturation w/ exercise: SpO2 90% Selection criterion may also be based on functional impairment Functional impairment: dyspnea, occupational performance, increased use of medical resources, reduction in ADL, reduction in physical activity The chronic lung conditions appropriate for pulmonary rehab: (OBSTRUCTIVE) -emphysema -persistent asthma -bronchiectasis -chronic bronchitis -CF -bronchiolitis obliterans The chronic lung conditions appropriate for pulmonary rehab: (RESTRICTIVE) -interstitial fibrosis -sarcoidosis -occupational lung disease: asbestosis;silicosis The chronic lung conditions appropriate for pulmonary rehab: (NEUROMUSCULAR) -ALS -diaphragmatic dysfunction -postpolio syndrome The chronic lung conditions appropriate for pulmonary rehab: (CHEST WALL DISEASES) -kyphoscoliosis -ankylosing spondylitis The chronic lung conditions appropriate for pulmonary rehab: (OTHER LUNG CONDITIONS) -lung cancer -pre/post lung transplantation -pre/post lung volume reduction surgery -primary pulmonary hypertension Exclusion criteria for pulmonary rehab: -unstable cardiac disease -severe pulm hypertension -metastatic cancer -severe cognitive defect -severe psychiatric disease -significant orthopedic impairment **asess comorbid conditions prior to initiating pulm rehabilitation Other considerations for exclusion from pulmonary rehabilitation: tobacco abuse, pt motivation, financial situation, transportation GOLD 1: (MILD) FEV1 /= 80% predicted GOLD 2: MODERATE 50% /= FEV1 80% predicted GOLD 3: SEVERE 30% FEV1 50% predicted GOLD 4: VERY SEVERE FEV1 30% predicted Medicare law requires what stages to be approved for pulmonary rehab? Stage II, Stage III, or Stage IV Components of an initial pt interview: 1. observation skills 2. listening skills 3. ability to ask the right questions Principles of adult learning: - rely on past experiences as rich resource for learning - adults are motivated to learn when they experience a need to learn to cope w/ real life tasks - performance or problem centered - adults want knowledge gained to apply immediately as opposed to postponed application Developmental stage: physical cognitive, and psychosocial elements. Motivation: capacity to learn, readiness to learn, presence of moderate anxiety, previous successful experiences, a positive teacher-learner relationship, and a social support system. Compliance: ability to adapt to & follow through w/ a health-promoting regimen Elements consistent w/ pt's adherence to behaviors requested of them include: pt must value the healthy state that pulm rehab promotes, believe that actions occurring in rehab will help them attain a healthy state, sees how others cope w/ chronic lung diseases & better understand & accept the rehab process Health literacy: The degree to which individuals have the capacity to obtain,process and understand basic health information as well as basic health information and services needed to make appropriate health decisions Examples of health literacy: ability to read & comprehend -medication bottles -appt slips -health-related materials needed to successfully function as a pt. Research shows the strongest predictor of an individual's health status is health literacy Other factors that may predict an individuals health status are: age, income, employment status, education level, racial or ethnic group