Cardiopulm: Restrictive Lung Dx

Front 1

Common features of all restrictive dx?

Back 1

Dec compliance of lungs and/or chest wall
Inc work of breathing
Decreased lung volume (TLC, VC, IC)

FEV1/FVC remains the same bc flow rate is not affected as much in restrictive dz

Front 2

PFTs for restrictive dx?

Back 2

Dec TLC and VC
Dec in FEV1 and FVC, but proportional, so no dec in ratio

Front 3

Examples of restrictive lung diseases?

Back 3

Fibrosis - idiopathic, interstitial, pulmonary
Pneumonia
Pneumocoliosis - permanent deposition of inorganic material in pulmonary system such as dust and asbestos seen in coal workers
Pleural effusion - excess fluid in pleural space can compress lung tissue and cause dec in alveolar ventilation & increased work of breathing
ARDS-- acute respiratory distress syndrome

Front 4

3 characterisitcs of ARDS?

Back 4

1. Pulmonary edema
2. Alveolar damage
3. Hypoxemia

Front 5

4 reasons why lungs may become restrictive?

Back 5

1. Lung diseases
2. Chest wall problems
3. Factors associated with surgery
4. Adverse effects of drugs on the lungs

Front 6

4 types of chest wall problems that may cause restrictive lung pathology

Back 6

1. BONY - hypomobility of ribs, chest trauma (pneumothorax), congenital thorax deformities (scoliosis, kyphosis)
2. SHAPE - obese, prego, ascites difficult to inc chest capacity
3. MUSCULAR - SCI, dec mm fxt
4. CT disorders - RA, SLE, scleroderma
5. Also aging

Front 7

Characteristics of aging that cause restrictive problems?

Back 7

Chest wall changes
Lung changes
Chemoreceptor changes

Front 8

Chemoreceptor changes with aging pt?

Back 8

Less sensitive to changes in CO2 and O2 = less likely to signal respiration

Front 9

Chest wall changes with aging pt?

Back 9

Dec resp mm strength due to diaphragm sitting lower
Old folks recruit accessory mm earlier and more often
Dec in chest wall compliance = inc stiffness

Front 10

Lung changes with aging pt?

Back 10

Dec elastic recoil of alveoli = inc dead space
Dec in pulm cap bed = dec diffusional capacity

Front 11

What factors associated with surgery may cause lung restriction?

Back 11

General anaesthesia = dec drive to breathe secondary to decrease mm tone
Thoracic/abdominal incision makes it painful/difficult to expand rib cage and chest wall

Front 12

What is the ultimate result of restrictive lung dx on pressures?

Back 12

Inc transpulmonary pressure to inflate the lung
Force must be inc to change pleural pressure
Metabolism increases so pt works harder to breathe
May be stuck with decreased chest wall expansion if mm aren't strong enought to overcome this pressure

Front 13

s/s restrictive disorders?

Back 13

DOE/dec ex tolerance
Dyspnea, inc RR (tachypnea)
Dec lung volume and dec diffusion capacity
Corpulmonale
Dec lung sounds (crackles caused by fluid) and dec effectiveness of cough
Dec pulse oximetry with exertion--hypoxemia
Emaciated-- mm wasting in extremities
Dec Chest excursion

Front 14

Tx of restrictive dx

Back 14

Positioning
Submax ex
Breathing/chest wall ex
Rib mobs
Stretching
PNF

Front 15

Definition and causes of Atelectasis?

Back 15

Collapsing of one or more lobes resulting in a lack of gas or air in all or part of the lung--air sac collapse
Due to compression of lung tissue, plueral effusion, pneumothorax, or obstruction of airway

Front 16

s/s of Atelectasis

Back 16

Dec chest movt
Dec breath sounds
Inc RR
Hypoxemia

Front 17

When does atelectasis commonly occur

Back 17

After surgery d/t anesthesia/narcotics decreasing the depth of breathing & increased secretions causing obstructions

Thus decreased breathing effectiveness occurs after sx commonly

Front 18

Conditions combining restriction and obstruction

Back 18

COPD + Pneumonia
Pulmonary Edema

Often there is an initial obstruction with long term restriction

Front 19

Components of eval

Back 19

RR and tolerance
Ausculatation
Cough
Activity/functional evaluation
Posture
Chest eval
Breathing Pattern
MS assessment
Nutrition/obesity

Front 20

3 categories of PT tx for rehab

Back 20

Pulmonary rehab
Functional training:
1. Positioning to relieve dsypnea--not always in these positions; need to sit in normal/correct posture sometimes too
2. Task modification/energy conservation--i.e. exhaling during hardest part of activity
Phys trng/ex

Front 21

6 recommendations for tx of pulmonary pt

Back 21

1. Ex trng of mm of ambulation with high intensity
2. Strength trng
3. Unsupported UE trng
4. Education (self-mngt, tx, and prevention)
-MEDS
-Nutritional assessment
-Help pt learn how much exercise they can do before they drop under 90% SaO2--how much exercise they can do before they get to this point--stop exercising
5. Supp O2 with severe ex-induced hypoxemia
6. Psychosocial interventions

Front 22

Benefits of pulmonary rehab

Back 22

Improves health-related QOL
Reduces # of hospital days and other health-care utilization
Cost-effective
Psychosocila benefits

Front 23

Who does pulmonary rehab benefit? Time length of programs?

Back 23

COPD has the evidence.. but but also beneficial for others like respiratory dz's
Benefits after 6-12 weeks of pulmonary rehab, most of which decline over 12-18 months
Greater than 12 weeks produce more sustained benefits

Front 24

Dyspnea subjective grading

Back 24

0 None
1 Mild/barely noticeable
2 Some difficults with use of accessory mm
3. Moderaltley severe (pt can cont ex tho)
4. Severe - can't speak or cont ex

Front 25

Dyspnea objective grading

Back 25

0 count to 15 without taking breat
1 = 1 breath
2 = 2 breath
3 = 3 breath
4 = can't count to 15

Front 26

%PFT for mild, moderate, and severe

Back 26

Mild = 70-85%
Moderate = 55-70%
Severe = <55%

Front 27

What type of ex will a pt with moderate PFT tolerate?

Back 27

3 or 4 mets = brisk walking, wt lifting, water aerobics, stairs
Only want them in mild dyspnea range with "fairly light" RPE

Front 28

What type of ex will a pt with severe PFT tolerate?

Back 28

2-3 METs = slow walking and may need supp O2 if < 88% SpO2

Front 29

What is a MET?

Back 29

3.5 mL/kg/min
Amt of energy body uses at rest
A metabolic equivalent of energy expenditure

Front 30

How much O2 can be delivered via nasal cannula?

Back 30

3-5 L O2/min

Front 31

What are some outcome measures you can use in pulm rehab?

Back 31

Submax ex
6 min walk test
Scales used to measure QOL
Change in dyspnea/fatigue
Amt of time without rest break

Front 32

What are two things commonly used to prescribe exercise

Back 32

1. METS range
2. Dyspnea range

Front 33

What is normal SaO2 level

Back 33

90%

Give supplemental O2 if less than 88%

Front 34

What 2 criteria does a pt have to have to be a good pulmonary rehab candidate

Back 34

1. Some pulmonary dz
2. Some functional limitation

Front 35

What population has demonstrated the most benefit with pulmonary dz

Back 35

COPD--bc it has been research by far the most

Front 36

What are 4 very common goals of pulmonary rehab

Back 36

1. Improve health related QOL
2. Slow down progression of the dz & clinical sx's
3. Improve fxn & daily activity tolerance
4. Improve psychosocial matters

Front 37

What are 3 common ways to document progression with pulmonary rehab

Back 37

1. Increase total exercise time
2. Decrease the # or length of rest breaks
3. Increase level of activity
-HR/BP recover more quickly