Respiratory Care Chapter 27 Quiz

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Questions and Answers

What does the Karvonen equation calculate?

Resting heart rate

Intensity percentage

Maximum heart rate

Target heart rate (correct)

Which of the following is NOT an absolute contraindication for exercise?

Performing the 6 minute walk test (correct)

Maximum heart rate exceeding 220 - age

Recent MI

Unstable angina

What is the recommended duration for the 6 minute walk test?

10 minutes

6 minutes (correct)

3 minutes

5 minutes

What is the recommended resting time prior to a 6 minute walk test?

10 minutes (C) Signup and view all the answers

During the 6 minute walk test, what should be assessed at the 3-minute mark?

All of the above (D) Signup and view all the answers

What is the recommended I:E ratio for pursed lip breathing?

1:2 (C) Signup and view all the answers

What is the primary benefit of pursed lip breathing?

Reduces dyspnea (B) Signup and view all the answers

Which of the following is NOT a component of the Borg scale?

Target heart rate (A) Signup and view all the answers

What is the primary goal of patient interviewing in a pulmonary rehabilitation program?

Determining the patient's chief complaint related to their diagnosis. (D) Signup and view all the answers

Which of the following is NOT a component of a baseline survey for a pulmonary rehabilitation program?

6 Minute Walk Test (A) Signup and view all the answers

What does the GOLD stage 3 COPD designation typically indicate about a patient?

The patient has moderate to severe COPD requiring regular medical management. (D) Signup and view all the answers

What is the primary purpose of monitoring a patient's SpO2 (oxygen saturation) at rest in a pulmonary rehabilitation program?

To identify potential hypoxemia (low blood oxygen levels) at rest. (D) Signup and view all the answers

Which of the following is a breathing technique commonly taught in pulmonary rehabilitation programs?

Autogenic drainage (B) Signup and view all the answers

How is the Borg scale used in pulmonary rehabilitation?

To measure the intensity of exercise based on perceived exertion. (C) Signup and view all the answers

What is the primary objective of reconditioning in a pulmonary rehabilitation program?

Improving muscle strength and endurance. (B) Signup and view all the answers

Why is it important for pulmonary rehabilitation patients to be aware of and manage their comorbidities?

All of the above. (D) Signup and view all the answers

During which phase of activity should diaphragmatic breathing be implemented?

During the most strenuous phase (A) Signup and view all the answers

What is the primary goal of diaphragmatic breathing during exercise?

To reduce shortness of breath (B) Signup and view all the answers

How is the effectiveness of diaphragmatic breathing assessed during exercise?

By observing chest movement (B) Signup and view all the answers

Which respiratory technique aims to improve lung strength and function?

Negative inspiratory pressure breathing (A) Signup and view all the answers

What is the recommended frequency for NIF breathing sessions?

Once a day, 5 days a week (D) Signup and view all the answers

What is the primary function of a forced expiratory technique (FET)?

To clear airway secretions (A) Signup and view all the answers

What does the term 'autogenic' refer to in autogenic drainage?

Self-induced (C) Signup and view all the answers

Which of these is NOT a phase of autogenic drainage?

Breathing at high lung volumes (C) Signup and view all the answers

Study Notes

Respiratory Care Clinical Competency Lab Manual - Pulmonary Rehabilitation

Chapter: 27, Pulmonary Rehabilitation
Key Terms: Active cycle breathing technique, Autogenic drainage, Borg scale, Comorbidities, Diaphragmatic breathing, Forced expiratory technique, Inspirations muscle trainer, Pursed lip breathing, Reconditioning, 6-minute walk test, Target heart rate.
Patient Interviewing: Determine chief complaint, Duration of symptoms, Orthopedic concerns, comorbidities, hospitalizations, smoking history, occupational exposure to hazards, Baseline surveys for program outcomes tracking.
Patient Interviewing: Diagnostic and Laboratory Tests: PFT, ECG, ABG, GOLD guidelines, Global Initiative for Chronic Obstructive Lung Disease, Medication regimen, SpO2 at rest, Nutrition, Fluid status, Activities of daily living.
Patient Interviewing: Activities of daily living: Assesses functional status, Vaccinations (flu, RSV, pneumococcal (pneumonia)/COVID), Respiratory support groups (Pulmonary group).

The 6-Minute Walk Test

Purpose: Provides a baseline for exercise prescription, indicator for hypoxic levels, dyspnea, perceived level of exertion, and pain.
Assessment: Uses Borg scale for assessing dyspnea, perceived level of exertion and pain and also Target heart rate (THR). Karvonen equation: Target HR = (Max HR - Resting HR) x Intensity Percentage + Resting HR (Exercising @ the desired level), Absolute contraindications including recent MI and unstable angina.
Preparation: Patient should wear comfortable clothes and shoes, use walking aids as appropriate, have not exercised in the past 2 hours, and be resting in a chair for 10 minutes before testing.

Performing the 6-Minute Walk Test (RT Procedures)

RT Responsibilities: Apply pulse oximeter, Assess 0-minute stats (O2 (L/min), FIO2, SpO2, HR, BORG (1-10), Pain, RR, Blood pressure, Breath sounds, Shortness of breath), Timer for 6 minutes, Explain the process, Allow for rest and slowing when needed (sit down and rest, if required), 3- and 6-minute stats assessment following the walk, post-test assessment while sitting.

Pursed Lip Breathing

Purpose: Reduces dyspnea during exercise, removes trapped air (auto-PEEP or intrinsic PEEP).
Technique: Inhale slowly and deeply through the nose, exhale through pursed lips (similar to whistling), exhale longer than inhale by targeting an I:E ratio of ≥ 1:2, instruct patients to perform this during strenuous parts of activity.

Diaphragmatic Breathing

Purpose: Decreases dyspnea and strengthens the diaphragm.
Technique: Place one hand on the abdomen and the other on the chest, promote 'belly breathing' (abdomen rises during inhalation while keeping the chest and accessory muscles low), limit chest and accessory muscle usage.

Using an Inspiratory Muscle Trainer

Comparable to: Weight training for the diaphragm
NIF Meter: Obtain 3 strong efforts to find the optimal amount of resistance, quick, deep inhalations
Calculation: Calculate and set 1/3 of best NIF effort on the trainer(resistance) level.
Sessions: Goal is 1 session of 30 minutes a day, 5 days a week, two 15-minute sessions as an alternative if needed.

Active Cycle Breathing Technique

Start: Begin with 6-8 diaphragmatic breaths (deep inhalation, passive exhalation).
Forced Expiratory Technique (FET): Perform 1-2 FET, "huff cough," and light coughs with active exhalation.
Diaphragmatic Breaths: Perform 3-4 diaphragmatic breaths following the FET exercises.

Autogenic Drainage

Goal: Loosen, centralize, and remove secretions.
Steps: Perform diaphragmatic breathing (three phases: 1st: Full inspiratory capacity, followed by low lung volume breathing; 2nd: Breathing at middle lung volumes; 3rd: Breathing at large lung volumes), Perform 1-2 FETs, Repeat steps 1 and 2 until secretions are removed.

Self-Assessment Questions (Various Topics)

Target Heart Rate: Methods for calculating target heart rate (THR) (Borg, Karvonen, Dyspnea, Exertion).
Patient Evaluation: Pulmonary function tests (PFTs), medications, sexual orientation, vaccines (except these).
Functional Status: Methods for obtaining functional status (chief complaint, nutrition, 6-minute walk test, smoking history).
6MWT Equipment: necessary equipment for the 6-minute walk test (arterial blood gas syringe, stethoscope, oximeter, and blood pressure cuff).
Methods for Releasing Trapped Air: Methods to release trapped air such as diaphragmatic breathing and pursed-lip breathing
Patient Goals: Determining reasonable goals for patients regarding exercise (Go jogging, Reverse disease, Return to golfing, Climb mountains)
Diaphragm Strengthening: Therapy to strengthen the diaphragm using a threshold resistor (IMT).
Pulmonary Rehabilitation: Upper and lower extremities and respiratory muscles as potential areas of focus.
Common Rehab Topics: Common educational topics in pulmonary rehabilitation programs, including Anatomy and physiology of the lung, Pathophysiology of lung disease, Airway management, Breathing retraining strategies, Energy conservation techniques, Medications, Self-management, Exercise, Environmental irritant avoidance, Oxygen therapy
ICU Readmission: Risk factors for increased ICU readmissions, including advanced age, chronic health conditions, dialysis, ICU admission from a step-down unit, after emergency surgery, with non-surgical diagnosis, or a higher acute physiology score at time of discharge.

Case Study 27-1 - Patient Interviewing

Questions: Example/potential interview questions for the 60-year-old COPD patient.
Education Topics: Example/potential educational topics for the patient.
Breathing Retraining: Whether breathing retraining would benefit him and, if so, what techniques.

Pulmonary Rehabilitation as an Integral Therapy

Focus: Keeping a discharged patient stronger and healthier, successful return to functional capabilities and activities of daily living (ADL).
Goal Setting: Patient goals set by patients and respiratory therapists (RTs) in conjunction with the patient.
Education: Common educational topics for pulmonary rehabilitation (e.g., Anatomy and physiology of the lung, Pathophysiology of lung disease, Airway management, Energy conservation).

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Description

Test your knowledge on Pulmonary Rehabilitation from Chapter 27 of the Respiratory Care Clinical Competency Lab Manual. This quiz covers key techniques, patient interviewing strategies, diagnostic tests, and relevant guidelines for managing respiratory patients. Evaluate your understanding of essential terms and practices in pulmonary rehabilitation.