Presentation on theme: "Pulmonary Rehabilitation – “Inspiration for Life”"— Presentation transcript:
1 Pulmonary Rehabilitation – “Inspiration for Life” Saturday, April 13, 2013 Sharon L. Balkenhol, RN, MSN, CNS, APN Manager, Pulmonary Rehabilitation Jewish Hospital, Cincinnati, Ohio
2 What is Pulmonary Rehabilitation – a Patient’s Perspective? “Pulmonary rehabilitation has been a life- saving pathway between inactivity and activity, isolation and socialization, depression and hope, and from being an observer of life to an active participant.”1994 Graduation class of The Pulmonary RehabilitationProgram at Mt. Diablo Medical Center, Concord, CA
3 ATS Definition of Pulmonary Rehabilitation “…a multidisciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimise each patient’s physical and social performance and autonomy.”
4 What is Pulmonary Rehabilitation? A comprehensive service designed for those who experience lung problemsMonitored, supervised exerciseEducation about your lung disease/conditionPsychosocial support, stress management, and coping strategies
5 What Does Pulmonary Rehabilitation Do??? Helps patients breakout of their“emotional straightjacket”
6 Why Do I Need Pulmonary Rehabilitation?? For many people, shortness of breath affects every aspect of daily living.As a result, you may become fearful of physical activity and become less active with increased shortness of breath!
7 Why Pulmonary Rehabilitation??? Fear of breathlessnessReduced exercisetoleranceInactivity/ImmobilityMuscle weaknessFatigue, anxiety, isolation
9 Do I Need Pulmonary Rehabilitation? Do you have a chronic lung disease such as asthma, emphysema, chronic bronchitis (COPD), LAM? Because of shortness of breath, is it hard for you to do the things you used to do easily, such as showering, climbing stairs, walking? Because of your condition, do you find yourself avoiding people and activities you used to enjoy? Do you have questions or concerns about your symptoms, medications, oxygen, or exercise?
10 Pulmonary Rehabilitation Are you or someone you know missing the benefits of Pulmonary Rehab?
11 “COPD” EXTENT OF THE PROBLEM COPD is the 4th leading cause of death worldwide, yet 75% of those affected remain untreated.World Health Organization estimates 600 million worldwide have COPD.Third leading cause of death by2007 there were 124,477 deaths in U.S.Pulmonary Disease effects every aspect of daily living.Dyspnea – Shortness of Breath (SOB) is the # 1 disability of persons over the age of 60.Reference American Lung AssociationLung Disease Data 2003
12 Significant Statistics COPD ranks second as a cause of disabilityCOPD cost US TOTAL$49.9 billion$29.5 B indirect cost$ 8.0 B indirectmorbidity cost$12.4 B indirectmortality costReference American Lung AssociationLung Disease Data 2003
13 How Does LAM Affect Your Lungs?? CYSTS = oxygen uptakeTraps airrisk of pneumothoraxPNEUMOTHORAXEffusionsAirway Narrowing
14 How Will Pulmonary Rehabilitation Help You? Lessen your shortness of breathIncrease your awareness of your capabilitiesImprove your strength and enduranceManage your stress, anxiety and depressionEncourage your sense of well-being and improve your self-confidenceTeach you how to use your medications and oxygen appropriatelyReduce hospitalizations
15 What are the Components of Pulmonary Rehab? Initial AssessmentSupervised Progressive Exercise/ActivityFunctional and ADL TrainingEnergy ConservationBreathing RetrainingStress ManagementMedication EducationKey Points:Emphasize to the audience that living With pulmonary disease means much more than just exercising regularly.Pulmonary Rehab provides the educational information, the support from staff and other patients with similar problems and needs, and serves as the eyes and ears of the MD to assess patient’s adherence to lifestyle changes.PHYSICAL INACTIVITYPhysical activity has been shown to have a positive effect on physical decline and improve the feeling of SOB. The intensity/duration does not need to rival that of an athlete in training for the Olympics. The pulmonary rehab staff will develop an individualized exercise/activity program that progresses according to patient stated goals, clinical stability, signs and symptoms, co-morbidities.
16 INITIAL ASSESSMENT Interview Medical History Symptom Assessment Nutritional AssessmentEducational Assessment
18 Oxygen & ExerciseSome patients may need oxygen with exercise, even though they do not need it at restPatients already on oxygen may need increased flow rates with exerciseIdeally, oxygen saturation (SpO2) should be= or > 88-90%Oxygen needs may vary day to day
19 What Can You Do For Your LAM???? Healthy LifestylePulmonary RehabilitationFlu VaccinationPneumonia VaccinationNO SMOKING
20 Physical Activity = “Lifestyle Exercise” Any activity that requires bodily movement Some activity is better than none, more is better than some The surgeon general’s report recommends that we accumulate a minimum of 30 minutes of moderate intensity activity on most days if not all days of the week
22 ?????Risk?????Maximal symptom-limited exercise testing is relatively safe.Death rate between 2-5/100,000 (1 in 20-50,000) ATS/ACCP Statement on CPET Am J Resp Crit Care Med 2003Safer than base jumping or pregnancyRisk of sudden cardiac death during moderate to vigorous exercise in women is 1:35,000,000 hours (4000 yrs)Relative risk vs no exercise is 2.38Long term cardiac risk is reducedWhang et al JAMA 2006
23 What About Pneumothorax and Exercise? In CF populationPneumothorax 0.15% per 1000 patient years.Injury 0.39% per 1000 patient yearsAsthma attack 0.84% per 1000 patient yearsHemoptysis 0.12% per 1000 patient yearsPneumothorax seemed to be associated with coughing.
24 So What Exercise Should You Do??? Warm–up: HR, lubricates joints, warms muscles Cool-down: Prevents muscle soreness & stiffness, lessens chance of lightheadedness & irregular heart rate and reduces risk of bronchospasm
25 Stretching & Flexibility Should be part of warm-up and cool- downMay be done sitting or standingHelps prevent muscle soreness, joint stiffness, improves balance and posture
26 Upper Extremity Training? Strength and endurance training improves work capacity (O2 consumption) and reduces metabolic (CO2 production) ventilatory requirements.Inspiratory Muscle Training -NO - unlikely to be safe in LAM
27 Upper Extremity Training MODALITIESArm ErgometerRowerDumbellsFitness bandsAirDyne Bicycle
28 Upper Extremity Training BenefitsIncreased strength of arm & shoulder musclesIncreased exercise toleranceDecreased shortness of breath during ADLsThese muscles provide support to the ribcage - strengthening them can make breathing easier
29 Lower Extremity Training MODALITIESTreadmillChair AerobicsWater Walking/ AerobicsWalkingStationary bicyclesNuStepElliptical Trainer
30 Lower Extremity Training BENEFITSStrengthens Leg MusclesImproves Muscle ToneIncreases Flexibility
31 Patient Education & Training Normal lung A & PPathophysiology of lung diseaseBreathing retrainingAirway ClearancePreventing infectionMedications & oxygenExercise principles
32 Patient Education & Training Activities of daily living & energy conservationSmoking cessationSelf-assessment & symptom managementEmotional and social well- beingTravelNutrition
33 Control Your Breathing Stop or slow down!Assume rescue breathing position –sitting – propping your arms on pillows, or leaning against a wallUse pursed-lip breathingRelax your shouldersUse your rescue inhaler
34 Emotional & Social Well-Being Breaking the dyspnea cycleCoping with depression and anxietyLearn relaxation techniques
35 Who Is Eligible for Pulmonary Rehab? Medicare covers pulmonary rehab for those who have had any of the following:COPDAsthmaRestrictive pulmonary diseaseOther chronic lung conditionsPrivate insurances vary and reviewed and cleared by staff prior to starting a programKey Points:Mention/explain the medical names for each conditionBe sure to mention Maintenance (Phase III) programs that your facility hosts.Remember that many older patients are very concerned about out-of-pocket expenses. Emphasize that staff will individually evaluate patient’s insurance coverage (when needed) prior to the patient incurring any expenses.
36 What is the cost of pulmonary rehab? Most charges for outpatient pulmonary rehab are covered by insuranceStaff assist in evaluating coverage and calculating out of pocket costs (if any) prior to starting“Maintenance” programs are designed to help patients continue their commitment to exercise. These programs are not covered by insurance.Key Points:Make sure that the presenter understands the concept of APC’s in regards to Medicare coverage and can explain co-pays if the patient has only primary Medicare coverage.Be prepared to “sell” your maintenance programs – compare what you get for the $$ in Maintenance (Phase III) programs vs. what you get for a similar amount of money at a health club or other fitness facility.
37 The Pulmonary Rehab Team Referring Provider (Physician, Nurse practitioner) Respiratory therapist Registered nurse Physical therapist Occupational therapist Medical Director Exercise physiologist Supporting staff: Dieticians/Nutritionists, Social Workers, Psychologists, PharmacistsAll work together as a team with primary physicians to assure the best outcome possible
38 Again, Why is Pulmonary Rehabilitation Important??? Pulmonary Rehab will give you the tools, knowledge, and motivation you need to fight the progression with your “Daily Breath”!We know that pulmonary disease is a progressive disease…it will worsen over time if aggressive steps aren’t taken to prevent and manage it!Pulmonary Rehab will give you the tools, knowledge, and motivation you need to fight that progression with your “Daily Breath”!
39 How Do I Find a Quality Pulmonary Rehabilitation Program? American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)- “Find a Program”American Lung AssociationRecommendations of physicians, friends
40 Be Active and Stay Active Go for a walkTake stairs instead of an elevatorFollow a small child or toddlerPark the car further from the door
41 Be Active and Stay Active Do yard work or gardeningWalk the dogClean a closetGo shopping, play miniature golf, dance a little