Respiratory Care Chapter 27 Quiz

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).