Plumo Midterm PDF

## Role of Sexuality - Understanding the patient's fears, concerns, and previous patterns of sexual activity. - The reaction of the significant other to the disease and its effects on the mutual sexual function. ## The Training Program Covers Various Areas: 6 (SBAM RP) 1. **Self Assessment** 2. **B...

## Role of Sexuality - Understanding the patient's fears, concerns, and previous patterns of sexual activity. - The reaction of the significant other to the disease and its effects on the mutual sexual function. ## The Training Program Covers Various Areas: 6 (SBAM RP) 1. **Self Assessment** 2. **Bronchial Hygiene (BPCP)** - Breathing retraining, pursed lip, diaphragmatic breathing - PDT - Cough Technique - Positive expiratory pressure 3. **ADL (TLPTC)** - Time and energy conservation techniques - Leisure-time activities - Panic control and relaxation - Travel recommendations - Community resources 4. **Medications** 5. **Respiratory Modalities OOSVS** - Oxygen as a drug - Oxygen-conserving devices - Suctioning in home - Ventilator management - Sleep hygiene (apnea, oxygen desaturation) 6. **Psychosocial Interventions** ## Exercise Testing and Training ### Equipment and Personnel Requirements #### Minimal requirements: - A calibrated cycle ergometer or motorized treadmill (a measured walking distance may be used if no ergometer or treadmill is available). - A STEP TEST, which is very simple and practical, may also be used. - Cutaneous oximeter - Manual BP measurement equipment - Oxygen source - Access to laboratory for ABG analysis - Emergency plan and supplies - Test site personnel trained in BLS technique #### Additional requirements: - EKG monitoring during exercise - Defibrillator and crash cart - ACLS certification for test site personnel ## Indications for Exercise Testing (MAAE) 1. **Measure Exercise Tolerance** - Patients with chronic lung disease develop progressive dyspnea on exertion, which is the primary reason for their limited exercise tolerance. 2. **Assess Exercise Limitation** - If in some patients the cause of dyspnea on exertion may still unclear, it may be useful to perform incremental, maximal, symptom-limited exercise test to assess whether the patient has reduced exercise tolerance due to dyspnea and whether a cause of dyspnea can be determined. 3. **Assessing Blood Gas Changes** - Blood gas measurements during exercise may be significantly different from those obtained at rest. ​- Pa02 may change in an unpredictable manner during exercise. 4. **Exercise Induced Bronchospasm** - Patients with hyperactivity commonly develops worsening expiratory flow rates with an exercise challenge. ## Type of Exercise 1. Master's step test or the time walking distance (6 or 12-minute walk test) 2. Cycle ergometer or motorized treadmill ## Measurements (WCEAV) 1. Work Rate 2. Clinical signs and symptoms (Modified Borg Scale) 3. ECG 4. Ventilation 5. ABG ## The 4 Components to Set Up Exercise Program (DFRM) - Duration - Frequency - Intensity - Mode ## Emergency Procedure In the acutely dyspneic patient, the following may be recommended: 1. Have the patient stop the activity and assure a comfortable breathing position. 2. Encourage the patient to use pursed lip breathing and relaxation technique. 3. Use bronchodilator medication, if indicated. 4. Monitor oxygen saturation, if equipment is available. ## Typical Educational Topic Schedule for a 12 Week Pulmonary Rehab Program 1. Introduction and welcome, program orientation 2. Respiratory Structure, function, and pathology 3. Breathing control methods 4. Relaxation and stress management 5. Proper exercise techniques 6. Methods to aid secretion clearance (bronchial hygiene) 7. Home oxygen and aerosol therapy 8. Medications: their use and abuse - Medications: use of MDI and spacers 9. Dietary guidelines and good nutrition 10. Recreation and vocational counseling 11. Activities of daily living 12. Follow-up planning and program evaluation 13. Graduation ## Program Implementation (SFSCE) - **Staffing** - **Facilities:** (Rooms must be spacious and comfortable with adequate lighting ventilation and temperature control. FACILITIES need to be readily accessible) - **Scheduling:** - Class size (Ideal class size should range from 3 to 10 participants) - **Equipment** ## Limitations of Pulmonary Rehabilitation: - No proof of life extension. - Possibility of return to smoking. - Lack of capability to deliver services outside of the hospital. - Recidivsim - those who could benefit are prone to drop-out - Those entering have disease too advance to participate. ## Body Mechanics (The Art of Moving and Positioning Patients) ### Definition: As the efficient use of one's body as a machine and a locomotive entity. Positioning and moving dependent patients is an art, quite different than working with a patient who can move independently and assume any given position with it. ### The First Consideration in body mechanics is the need for maintenance of proper posture and balance (body stability). Consideration should be paid to the relationship between gravity, posture, and body stability. - **Gravitational Force:** - Is always exerted in a vertical direction toward the center of the earth. - **Center of Gravity:** - That point in a patient or object at which all of its mass is centered (the point at which the patient's maximum weight is concentrated). - **The Standing Position:** - The human bodies center of gravity is approximately 55% of the body's total height in the pelvic cavity, slightly anterior to the upper part of the sacrum. - **The Lower The Center of Gravity:** - The greater the body stability. Consequently, when the human body is used as a machine to lift an object, muscular effort great enough to maintain stability as well as to lift against the force of gravity is necessary, especially when the patient's center of gravity is further removed from your own. - **Therefore,** one way to conserve energy and maintain stability is to carry the weight of the patients (or objects) as close to one's own center of gravity as possible. - **The Bed:** - Should be adjusted so the therapist/nurse can reach the patient comfortably. Usually adjusting the bed to one's hip level is adequate. This makes the patient close to the therapist's center of gravity. - **All Lifting:** - Should be done with the therapist's legs (knees) and not by straining to lift with the arms and back. - **Line of Gravity:** - It is an imaginary line passing through the center of gravity of an object and perpendicular to the surface on which the object (body) rests. - The closer the line of gravity passes to the center of the base of support, the greater is the body's (object) stability. ### General Tips for Lifting: - Lift with your legs. Keep legs in a position that permits them to supply most of the force for shifting your trunk. - Do not attempt to lift with your arms and back. When lifting, avoid rotation of the spine. Shift feet into position for weight shift when moving or lifting patients. - Stabilize your body against stationary objects whenever possible. - For best efficiency, coordinate the move by a verbal expression understood by therapist and patients, such as 1,2,3 lift to synchronize the effort. - **Friction:** - A force that opposes the movement of one object over the surface of another. - Friction is reduced as the amount of surface area contact between two objects is reduced. ## Moving Dependent Patients ### 1. Moving the Patient Up or Down - **Using a turning sheet (fig 10-4 to 10-6):** - Sheet should cover from shoulders to hips. - Gather material as close to the patient's body as possible. - Hold at shoulders and hips, with a flexion pattern. (fig 10-5) - Cross patient's arms over chest, flex knees and hips. - Ask patient to raise head if possible. - Synchronize action by counting 1,2,3, lift. - Shift weight from one leg to the other rather than lifting up and pulling on back. - **Without a turning sheet (up or down), two people:** - Cross arms, lift head, flex knees and hips. - The therapist places his hands and forearms under the patient's shoulders and hips. - If the patient is extremely heavy or tall, another person can bend knees and assist. ### 2. Moving the patient to the side of the bed: - **With turning sheet:** - Cross arms, etc., toward the side to which the patient is to be removed. - One therapist's hand at patient's hips and shoulder on material close to the patient's body. - One therapist pushes, the other pulls. ## Incentive Spirometry, IPPB, CPAP & Lung Flute ### Incentive Spirometry: It is used to guide the patient to take a sustained maximal inspiratory effort resulting in a decrease in Ppl and maintain the patency of airways at risk for closure. ### Goals of Incentive Spirometry (PTPIM): 1. Prevent atelectasis 2. Treat preexisting atelectasis 3. Improve cough mechanism 4. Provide early detection of atelectasis or pneumonia 5. Maintain airway during the preoperative period - Strengthens lung muscles before surgery - Improves mobilization of secretions ### Indications of Incentive Spirometry: 1. Presence of conditions lead to the development of pulmonary atelectasis. - (Upper abdominal surgery, thoracic surgery, surgery in patient with COPD) 2. Presence of pulmonary atelectasis 3. Presence of restrictive lung defect. - Associated with quadriplegia or dysfunctional diaphragm ### Contraindications of Incentive Spirometry: 1. Patients cannot be instructed to ensure appropriate use of device. 2. Patients' cooperation is absent, or the patient is unable to ensure appropriate use of the device. 3. Patient is unable to deep breathe effectively. 4. Presence of an open tracheal stoma is not a contraindication but requires adaptation of the spirometer. ### Hazard and Complications of Incentive Spirometry: 1. Hyperventilations and respiratory alkalosis 2. Barotrauma (emphysematous lungs) 3. Exacerbation of bronchospasm 4. Fatigue ### Potential Outcomes of Incentive Spirometry: 1. Absence of or improved in signs of atelectasis 2. Decreased respiratory rate 3. Normal pulse rate 4. Resolution of abnormal breath sounds 5. Normal or improved chest radiograph 6. Improved Pa02 and decreased PaCO2 7. Increased SpO2 8. Increased VC and peak expiratory flows 9. Restoration of preoperative FRC or VC 10. Improved respiratory muscle performance and cough 11. Attainment of preoperative flow and volume levels 12. Increased VFVC ### Incentive Spirometry Devices: - Used to mimic natural sighing by encouraging patients to take slow, deep breaths. - Typically simple, portable and inexpensive. - Categorized into: Volume-oriented or Flow-oriented. - **Volume_oriented:** - Measures and visually indicate the volume achieved during an SMI. - **Flow-oriented:** - Measure and visually indicate the degree of inspiratory flow.