Term
| What is COPD and its causes and how to diagnose |
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Definition
| main cause is tobacco smoke; encompasses asthma, emphysema, chronic bronchitis; diagnosis includes review of pt history, physical exam, diagnostic tests such as chest radiograph and PFT. chest physical findings include increased anterior to posterior diameter, barrel chest, cachexsia, decreased diaphragmatic excursion, use of accessory muscles with respiration, prolonged exhalation, pedal edema, cor pulmonale (possibly) |
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Term
| Name several ways to improve patient compliance in pulmonary rehabilitation programs |
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Definition
| Presenting A&P of respiratory system in simple terms; teach a basic understanding of pathophysiology of the disease, specific to the patient; expain medical tests and the results; teach proper breathing techniques - using pulse ox while performing pursed-lip breathing may increase use of breathing techniques; teach and demonstrate bronchial hygiene techniques; medication education; exercise teaching - develop an individualized home program; teach ADLs; correct training to use respiratory devices and modalities; smoking cessation; proper nutrition; dealing with psychosocial issues |
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Term
| What are the essential components of a pulmonary rehabilitation program |
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Definition
| Prevention and Outcomes; psychosocial intervention; promotion of long-term adherence; education/training, assessment, exercise |
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Term
| When do COPD symptoms become apparent |
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Definition
| When one or more test reaches the following levels: FEV1 less than or equal to 65% of predicted; FVC less than or equal to 65% of predicted; Diffusing capacity for carbon monoxide adjusted for hemoglobin less than or equal to 65% of predicted; Resting hypoxemia less than or equal to 90%; exercise testing demonstrating hypoxemia less than or equal to 90% or ventilatory limit (VE/MVV more than or equal to .8) ora rising Vd/Vt |
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Term
| The Joint-Evidence Guidelines note improvements in |
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Definition
| an increase in the duration of work, such as walking longer; arm exercises improve arm function in COPD patients; dyspnea and quality of life, utilization of health care resources declines and survival may improve |
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Term
| Average duration of a pulmonary rehab sessions and the overall program? |
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Definition
| 2-3 hours per day, 2-3 times per week for 6 - 12 weeks |
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Term
| Skill training should include what elements and how often |
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Definition
| patients learn what to do with regard to their recommended treatments and why the physician ordered it; learning objectives and topics from the ground up to encourage understanding, and building knowledge of the basics of how the lungs work and how the human body functions, teach patients what muscles they have and how to pursed-lip breathe. |
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Term
| Pulmonary rehab teams should include what members |
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Definition
| coordinator (possibly RT or RN), medical director, physical therapist, occupational therapists, social worker or psychologist, exercise physiologist, possibly nutritionist consult |
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Term
| Respiratory therapist can serve what role in pulmonary rehab program |
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Definition
| may serve as coordinator or staff |
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Term
| What are appropriate diagnoses for referral to a pulmonary rehab program |
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Definition
| Asthma, Emphysema (including alph 1 anti-trypsin deficiency), chronic bronchitis, bronchiectasis, Insterstitial Pulmonary Fibrosis- sarcoidosis-other occupational types, pre and post surgical candidates - lung transplantation, lung resection, etc, kyphoscoliosis, sleep apnea, neuromuscular disease |
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Term
| Patients may be excluded from a program for what reasons |
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Definition
| unstable cardiac disease, severe orthopedic problems that would hinder ability to exercise, serious unstable medical problems, lack of desire or interest; appropriate financial ability, in some cases active smokers, means of transport |
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Term
| What components are included in the evaluation process (is phone survey appropriate)? |
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Definition
| initial telephone screen after referral to the program, assessment for expectations, gain insight to pt perceptions, etc. face to face interview |
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Term
| Know the positive outcomes of lower extremity training |
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Definition
| increase in the duration of work, such as walking longer on the treadmill or further in a distance-walk test |
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Term
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Definition
| category of breathlessness - 0 none at all, 10 maximum - completely breathless |
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Term
| What in included in an exercise prescription |
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Definition
| duration frequency, mode and intensity should be included |
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Term
| Medical records would provide what information |
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Definition
| respiratory history, active medical problems or comorbidities, other medical and surgery history, family history of respiratory disease, use of medical resources, all current meds including otc and herbal, allergies and drug intolerance, smoking hx, occupational, environmental, and recreational exposures, alcohol and other substance abuse. |
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Term
| What is the estimated cost of care for COPD patients in the U.S. |
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Definition
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Term
| Know the American Thoracic Society Stages of disease |
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Definition
| Stage I Fev1<50% predicted; Stage II Fev1 35-49% predicted; Stage III Fev1 <35% predicted |
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Term
| What is Asthma and what are its causes |
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Definition
| cause unknown; symtpoms of coughing, wheezing, dyspnea, and sputum production- reversible bronchospasm and airway inflammation |
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Term
| What is the treatment geared towards for Chronic bronchitis. |
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Definition
| reversing airway obstruction, and controlling secretions, since pulmonary infection is common in COPD; lessen airflow limitation, prevent and treat secondary medical complications (hypoxemia and infection), decrease respiratory symptoms and improve quality of life |
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Term
| What are typical physical findings in emphysema patients? |
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Definition
| increased AP diameter, barrel chest, cachexsia, decreased diaphragmatic excursion, use of accessory muscles with respiration, prolonged exhalation, pedal edema, possibly cor pulmonale |
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Term
| Know the different members of the rehab program’s multidisciplinary team |
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Definition
| RT, RN - possibly, nutritionist - possibly, medical director, physical and occupational therapist, social worker or psychologist, exercise physiologist |
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Term
| What exercises are best for COPD patients |
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Definition
| incorporate both endurance and strength training, arm exercises are safe and improve arm function |
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Term
| Know members of rehab team, best group sizes, smoking, etc |
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Definition
| small groups with individualized sessions; medical director, program coordinator, rehab specialist, interdisciplinary team structure - one specialist for each 4 patients |
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Term
| Documentation of evaluations would include what information |
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Definition
| symptoms, previous hospitalizations, medications, smoking history, allergies, and the ability to perform daily activities |
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Term
| What is the distance walking test and IMET |
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Definition
| distance walking test is easier to perform, the results correlate well with functional status, ant they can identify the need for supplemental oxygen. IMET is incremental maximal exercise test; more complex but they stress the cardiopulmonary system maximally and better define the absolute limits on a patient |
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Term
| Patient selection criteria. (What about smokers?) |
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Definition
| conditions for exclusion - unstable cardiac disease, orthopedic problems, unstable medical problems, pulmonary hypertension, lack of desire/interest. some allow smokers, cessation is encouraged and smoking is discouraged. possibly included if a quit date is given, some include smoking interventions. |
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Term
| Patient assessment components |
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Definition
| medical history, physical assessment, diagnostic tests, symptom assessment, musculoskeletal and exercise assessment, pain assessment, adl, nutritional, educational, psychosocial, |
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Term
| Grade A evidence for lower extremity testing/training |
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Definition
| scientific evidence derived from randomized or non-randomized controlled trials, with well-executed methodology, and statistically significant findings. lower extremity training is indicated and beneficial. increase in duration of work such as walking longer or greater distance on the distance walk test |
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Term
| Expert opinion re: education & psychosocial support sessions |
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Definition
| grade c - less supported by evidence, but supported by expert opinion |
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Term
| Effective pulmonary rehabilitation requires |
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Definition
| early referral to learn how to manage the disease before it is severe, active participation is required, the evaluation |
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Term
| COPD is what rank with regard to death |
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Definition
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Term
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Definition
| Because patients with moderate to severe lung disease suffer tremendous loss of independence as pulmonary reserve declines |
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Term
| Restorative and preventive qualities of rehab |
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Definition
| art of medical practice wherein an individually tailored, multidisciplinary program is formulated which through accurate diagnosis, therapy, emotional support, and education, stabilizes or reverses both the physio- and psychopathology of pulmonary disease |
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Term
| Necessity of a home exercise program |
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Definition
| encourages patients to engage in a continuum of physical activities outside the formal program setting. it can be developed and begun |
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Term
| Benefits of providing pulmonary rehabilitation in small groups |
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Definition
| expert opinion encourages skills training in small groups with individualized sessions to improve learning and support changes in behavior. |
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Term
| Submaximal exercise and evaluating O2 needs |
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Definition
| submaximal, steady-state exercise testing can be performed to assess supplemental oxygen requirements for ADLs. conducted at a work rate that approximates those encountered during normal living conditions. a submaximal exercise test may also be conducted with patients with severe pulmonary hypertension or congestive heart failure, for whom maximal stess testing is containdicated |
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Term
| Benefits of Rehab for restrictive lung disease |
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Definition
| helps them manage symptoms, adhere to oxygen prescriptions, and improve physical endurance. the primary symptoms of obstructive/restrictive are dyspnea. |
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Term
| Common reasons for referral to Rehab programs |
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Definition
| dyspnea at rest or exertion, reduced exercise tolerance or a reduction in ability to perform ADLs, anxiety, fear and/or panic episodes attributable to dyspnea; pre-op intervention; post-op management to return and restore; oxygen eval |
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Term
| Common reasons for exclusion |
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Definition
| unstable cardiac disease, orthopedic problems, unstable medical problems, lack of desire or interest |
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Term
| Purposes of the Evaluation/assessment |
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Definition
| all known conditions are recorded, as well as any observable lack of assessed skills. problem section is summary of all teh areas of the evaluation. the compass that sets the rehabilitative efforts in motion |
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Term
| The exercise prescription and what 4 elements it should contain |
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Definition
| developed and begun early in the rehab program, patients are expected to exercise at home, it is monitored with an exercise diary, prescription can be modified for maintenance |
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