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Chapter 50 Cardiopulmonary Rehabilitation Chapter 50 Cardiopulmonary Rehabilitation.

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Presentation on theme: "Chapter 50 Cardiopulmonary Rehabilitation Chapter 50 Cardiopulmonary Rehabilitation."— Presentation transcript:

1 Chapter 50 Cardiopulmonary Rehabilitation Chapter 50 Cardiopulmonary Rehabilitation

2 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Objectives  State the definition and general goals of pulmonary rehabilitation programs.  Describe the rationale for exercise conditioning and psychosocial support of patients with chronic pulmonary disease.  Describe how to evaluate and select patients for pulmonary rehabilitation.  Describe pulmonary rehabilitation program design including format and content.

3 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Objectives (cont.)  List the educational content to be addressed in a pulmonary rehabilitation program.  Describe the implementation of a pulmonary rehabilitation program including staffing, facilities, scheduling, class size, equipment, and costs.  Describe the outcome measures that can be used to evaluate pulmonary rehabilitation programs.  Identify the potential hazards associated with pulmonary rehabilitation.

4 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Definition and Goals  Defined as the restoration of the individual to the fullest medical, mental, emotional, social, and vocational potential  The overall goal is to maximize functional ability and minimize the impact of the disability.  Other goals are to control symptoms and improve the overall quality of life.

5 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Historical Perspective  In 1951, Alvan Barach recommended reconditioning programs for chronic lung disease patients.  In 1962, Pierce and associates published data that confirmed the value of reconditioning.  Gradually the medical community came to appreciate the value of pulmonary rehab for patients with COPD and other disorders.

6 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Scientific Basis Physical reconditioning  Physical activity increases energy demands.  Poor conditioning of muscles leads to inefficient use of oxygen and excess acid production.  Pulmonary rehab aims to recondition the muscles and increase exercise tolerance.

7 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Scientific Basis (cont.) Psychosocial support  COPD can negatively affect the patient’s overall outlook and reduce motivation.  Patients with COPD often have anxiety and stress.  Psychosocial support in combination with physical reconditioning is needed to cause the best possible outcome.

8 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Structure of a Pulmonary Rehab Program Program goals and objectives

9 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Structure of a Pulmonary Rehab Program (cont.) Patient evaluation  Patient evaluation begins with a complete patient history.  Next, a complete physical examination is done.  A chest radiograph, CBC, and ECG may be needed.  Pulmonary function testing and exercise evaluation are often needed.

10 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Structure of a Pulmonary Rehab Program (cont.) Patient evaluation (cont.)  Contraindications include  Patients who cannot perform the test  Those with severe pulmonary hypertension  Those with hypertension  Those with neuromuscular disease  Those with untreated or unstable asthma  Those with angina with exercise

11 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Structure of a Pulmonary Rehab Program (cont.) Patient selection

12 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Structure of a Pulmonary Rehab Program (cont.) Program design  Open-ended designs allow the patient to enter the program and progress through it until he or she achieves certain goals.  Closed designs use a set time period to cover the program content.  Classes meet 1 to 3 times per week for 6 to 16 weeks.

13 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Structure of a Pulmonary Rehab Program (cont.) Format  Long-term improvements are most likely to occur if planned follow-up is completed.  Follow-up must be ongoing and available to all patients who complete the program.

14 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Structure of a Pulmonary Rehab Program (cont.) Content

15 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Structure of a Pulmonary Rehab Program (cont.) Physical reconditioning  Consists of an exercise prescription with target heart rate based on the initial evaluation  For most patients, an initial target heart rate is 20 beats/min above resting rate.

16 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Structure of a Pulmonary Rehab Program (cont.) Physical reconditioning (cont.)  The exercise prescription includes the following:  Lower extremity aerobic exercises  Timed walking (6- or 12-minute walk)  Upper extremity aerobic exercises  Ventilatory muscle training using progressive resistance

17 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Structure of a Pulmonary Rehab Program (cont.)

18 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Structure of a Pulmonary Rehab Program (cont.) Educational component 1. Respiratory structure, function, and pathology 2. Breathing control methods 3. Methods of relaxation and stress management 4. Exercise techniques and personal routines

19 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Structure of a Pulmonary Rehab Program (cont.) Educational component (cont.)  Bronchial hygiene techniques  Home O 2 and aerosol therapy  Medications  Dietary guidelines  Recreation and vocational counseling

20 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Structure of a Pulmonary Rehab Program (cont.) Psychosocial and behavioral component  Emotional stress is a common problem for a patient with chronic lung disease.  Experts can be brought in to help patients cope with their anxieties and sources of stress.

21 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Structure of a Pulmonary Rehab Program (cont.) Staffing  Pulmonary rehabilitation is a multidisciplinary endeavor.  Staff conducting the program should be certified in basic and advanced life support.

22 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Structure of a Pulmonary Rehab Program (cont.)

23 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Structure of a Pulmonary Rehab Program (cont.) Facilities  The facility must be easy to reach, be accessible to public transportation, and have available parking.  Rooms should be spacious and comfortable with adequate lighting and ventilation.  A room for counseling is helpful.

24 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Structure of a Pulmonary Rehab Program (cont.) Scheduling  Class times need to be scheduled at a time most convenient for the patients.  Traffic patterns, bus schedules, and availability of rides are important factors to consider. Class size  The ideal class size is 3 to 15 patients.

25 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Structure of a Pulmonary Rehab Program (cont.) Equipment  Class room equipment to facilitate teaching is needed.  Blackboard or flipchart  35-mm projector or PowerPoint projector  Formal learning packages

26 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Structure of a Pulmonary Rehab Program (cont.) Equipment (cont.)  Physical reconditioning equipment is needed.  Stationary bicycles, treadmills, rowing machines  Pulse oximeters  Inspiratory resistance devices  Emergency O 2 should be in the room.

27 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Structure of a Pulmonary Rehab Program (cont.)

28 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Structure of a Pulmonary Rehab Program (cont.) Program results

29 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Structure of a Pulmonary Rehab Program (cont.) Potential hazards  Cardiovascular abnormalities  Blood gas abnormalities  Muscular abnormalities  Miscellaneous  Exercise-induced asthma  Hypoglycemia  Dehydration

30 Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Structure of a Pulmonary Rehab Program (cont.) Cardiac rehabilitation  A comprehensive exercise and educational program designed for patients with cardiovascular diseases  Goals are to improve heart health and work capacity, weight loss, and return to work.


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