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Which of the following should be monitored during a cardiopulmonary exercise evaluation?

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Which of the following should be monitored during a cardiopulmonary exercise evaluation?

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The top common causes of death in the United States Heart disease, cancer, cerebrovascular disease, COLD
An accepted phrase for writing an educational objective At the end of the lesson, the patient will be able to list, describe or demonstrate (not just understand)
What is a learning domain Learning occurs in three domains: cognitive, psychomotor, and affective
Teaching physical skills is what domain psychomotor
Teaching facts is what domain Cognitive
Information associated with teaching in the affective domain Motivation and attitude
“Verbalize” falls in which domain Affective
What concept is emphasized in teaching new skills Repitition
What may be necessary with children before learning can take place Reward system
Which is used to evaluate cognitive objectives Written exam
What is used to evaluate the affective and psychomotor domains Performance checklist
What is the primary goal of health education Change the behavior
What is the primary goal of health promotion Change the lifestyle
Factors linked to one of the major causes of death in the United States
What is the goal of tertiary prevention To prevent acceleration of the disease process once it has occured
Examples of health care representing tertiary prevention Pulmonary rehabilitation
Broad goals of Healthy People 2010 To eliminate health disparities, to increase quality and years of healthy life.
Percentage of smokers wanting to stop 70%
Work site wellness activities performed by respiratory therapists Performing pulmonary function and/or blood pressure screenings, developing and implementing stress management or nicotine intervention programs, consulting on policies related to smoking and occupational or environmental exposure to foreign dusts such as
Term describing the restoration of individuals to the fullest medical, mental, emotional, and, social potential Rehabilitation
Goals of rehabilitation Minimize the disability’s impact on the individual or family, maximize the functional ability of the individual
Principal objectives of pulmonary rehabilitation Control and alleviate the symptoms, restore functional capabilities as much as possible, and improve quality of life.
Expectation for COPD patient who completes a pulmonary rehabilitation program Reduced pulse rate during exercise, decreased breathing rates during exercise, reduction in CO2 production during exercise, lower minute volumes during exercise
Role of clinical sciences knowledge in pulmonary rehabilitation programming Quality the extent of physiological impairment and set expectations for reasonable outcomes
Role of social sciences knowledge in pulmonary rehabilitation programming Determine the impact of the disability on the patient of family, and establish ways to improve the patients quality of life.
The point at which increased levels of lactic acid production result in an increased VCO2 and VE ventilatory threshold
What occurs when the ventilatory threshold is exceeded during exercise Metabolism becomes anaerobic and fatigue increases
Steps to physically recondition a patient and increase exercise tolerance The body’s overall O2 utilization must be improved, the patients essential muscle groups must be strengthened, the cardiovascular response to exercise must be enhanced.
Causes of attrition in pulmonary rehabilitation programs Degree to which patients psychosocial needs are met
Common goals shared by most pulmonary rehabilitation programs Improvement in physical activity levels, control of respiratory infections, reduction in medical costs and hospitalizations, family education, counseling and support
Reasonable expectations for a pulmonary rehabilitation program Reduction in hospitalizations, improvement in ambulation, and control of respiratory infections
First step in evaluating patients for a pulmonary rehabilitation program Complete patient history
Purpose of a cardiopulmonary exercise evaluation before participation in pulmonary rehabilitation To quantify the patients baseline exercise capacity, to develop an exercise prescription, to determine how much desaturation occurs with exercise
Contraindications for conducting a cardiopulmonary exercise evaluation Severe pulmonary hypertension or cor pulmonale, known electrolyte disturbances, SaO2 or SpO2 less than 85% breathing room air, untreated or unstable asthma
Actions if a patient complains to you of severe shortness of breath and some chest pain Terminate the procedure at once.
Items monitored during a cardiopulmonary exercise evaluation RR, HbO2 sat., ECG and BP
Contraindications for cardiopulmonary exercise testing Serious cardiac arrhythmias, unstable angina, and recent myocardial infarction
Measures that differentiate between exercise intolerance of cardiac versus ventilatory origin PaCO2 and PaO2
Precautions for patient safety during cardiopulmonary stress testing Immediately availability of a crash cart, staff training in emergency life support, presence of a physician throughout testing, and patient physical exam or ECG before testing
Good candidates for pulmonary rehabilitation Those with exercise limitations due to severe dyspnea and those with moderate to severe obstructive lung disease
Patients who would benefit least from pulmonary rehabilitation Patient with malignant lung cancer
The VO2max at termination of exercise indicating a patients is a good candidate for pulmonary rehabilitation VO2 max predicted 65%
Level of the predicted FEV1/FVC showing patients are good candidates for pulmonary rehabilitation 60%
Patients who would benefit from an open-ended format for a pulmonary rehabilitation program Those with scheduling difficulties, those who require individual attention, and those who are self-directed
Exercises for reconditioning the lower extremities of patients Walking on a flat surface for a specific period of time, walking on a treadmill for a specified distance or time, pedaling a stationary bicycle for a specified distance
Activities to help recondition lower extremities in a patient who has an orthopedic disability Aquatic exercises
Exercises for reconditioning the upper extremities Using a rowing machine, using an arm ergometer, and using free and weights
Exercises for reconditioning the inspiratory muscles Performing inspiratory resistive breathing exercises
Which health professionals are best for conducting methods of relaxation and stress management Clinical psychologist
Health professionals best for conducting recreation and vocational counseling occupational therapist
Topics covered in a rehabilitation education session on respiratory home care Self-administration of therapy, care of home care equipment, and safe use of home care equipment.
Areas covered on nutrition Elements of a good diet, proper eating habits, foods to avoid, and daily menu planning
What is fostered in a small-group discussion format for pulmonary rehabilitation educational sessions Group interaction, peer support, and group identity
Class size for pulmonary rehabilitation programs 3-10
Minimum equipment requirements for the physical reconditioning in a pulmonary rehabilitation program Inspiratory resistive breathing devices, rowing machines or upper extremity ergometers, pulse oximeters, and stationary bicycles
Medicare reimburses what percentage of the allowable charge for the rehabilitation program of a CORF 80%
Government programs serving as a source for reimbursement for pulmonary rehabilitation CORF, veterans administration benefits, and CHAMPUS
Outcome measures considered predictors for improvement in a COPD patient’s health-related quality of life Frequent attendance in a maintenance program
Pulmonary rehabilitation is a prerequisite for what procedures Lung volume reduction surgery
Location of most cardiac rehabilitation programs Hospital facilities
Differences between cardiac and pulmonary rehabilitation Cardiac patients are typically younger, reimbursement is easier to obtain with cardiac rehabilitation, and breathing exercises are not essential to cardiac patients
The level of involvement of the respiratory therapist in cardiac rehabilitation Significantly less than in pulmonary rehabilitation
Clinicians commonly involved in the cardiac rehabilitation programs Nurse specialist and cardiologist
Elements of the physical reconditioning component of a pulmonary rehabilitation program Aerobic exercises for the extremies, timed walking exercise, ventilatory muscle training
Pulmonary function tests performed for the preliminary evaluation Lung volumes, including FRC, Diffusing capacity (DLCO), Pre-and post-bronchdilator flows
Where postacute respiratory care is provided The home
Desired outcomes of the discharge plan Prevent hospital readmission due to poor planning, satisfactory performance of all treatments by caregivers, caregivers’ ability to assess the patient and solve problems, and patient’s and family’s satisfaction
Respiratory home care team member who establishes therapeutic objectives for home care Attending physician
Member of the respiratory home care team providing regular in-home visits and assessing the patient’s progress Respiratory care practitioner
Factors in advising a patient on the selection of durable medical equipment (DME) Accreditation, cost, availability
What to assess to determine if a home setting can support a mechanically ventilated patient Available space for equipment, amperage of power supply, number and location of grounded outlets, presence of hazardous appliances
Environmental factors assessed in considering discharge of a patient to the home care setting
Heating and ventilation, humidity, and lighting
Interval to follow up ABG to determine the need for long-term home O2 therapy after initial justification 1 to 3 months after initiation
Rationale for repeat ABG or pulse ox once the need for long-term home O2 therapy has been documented To follow the course of the disease, to assess changes in clinical status, and to facilitate changes in the prescription
Basis of HCFA regulations for home O2 therapy Documented hypoxemia
Specifications a physician must include in a home O2 prescription Appropriate medical diagnosis, lab evidence of hypoxemia, frequency of O2 use, and duration of O2 use.
Home O2 systems Liquid O2 systems or O2 concentrators
Advantages and disadvantages of using compressed O2 cylinders in the home Dis. High pressure hazards, limited volume of O2, and need for frequent deliveries
Primary use of compressed O2 cylinders in alternative settings Ambulation and back up supply
Solution used to fill a bubble humidifier for home O2 therapy Distilled water
Convert volume of liquid O2 to gaseous O2 1cu/ft of liquid O2 is 860 cu/ft of gaseous O2Elements of postacute care settings
Pressure range in a home liquid O2 system 20-25 psi
Purpose of refillable liquid O2 tank that comes with home liquid O2 reservoirs Provide O2 to ambulatory patients outside the home
Recommendations to overcome portable liquid home O2 flow/time limitations Use an O2-conserving device
How does a concentrator work Separates O2 in room air from N2, thereby providing an enriched flow of O2 for therapeutic use
Advantages of O2 concentrators for home O2 therapy Operate at safe low pressures, are cost-effective for continuous use, and do not waste or lose any O2
What are some disadvantages of O2 concentrators for home O2 therapy FIO2 values decrease with increased flow, backup O2 is required in case of electrical failure, they cannot operate high-pressure devices, loss of electricity disrupts delivery
How often should the patient or caregiver check all O2 delivery equipment Once a day
Additional equipment needed to set up continuous low-flow O2 therapy through an O2 concentrator Backup gas cylinder
Explain measuring the FIO2 of a concentrator as 0.63 when flow is 2L/min The sieve pellets are exhausted
Recommended home care gas sources to drive intermittent positive-pressure breathing (IPPB) treatments Compressed gas cylinder
O2 delivery system for an active home care patient with low FIO2 needs who desires increased mobility Conserving device used in conjunction with a portable liquid O2 system
Actions appropriate for marked erythema and swelling at a transtracheal stoma site Promptly report your observations to the prescribing physician
Patient conditions requiring daytime or nocturnal home mechanical ventilation support Kyphoscoliosis, amyotrophic lateral sclerosis, myasthenia gravis
Indicate a patient isn’t stable enough for home mechanical ventilation Severe dyspnea while breathing on the ventilator, frequent premature ventricular contractions, and use of a cuffed oral endotracheal tube
AARC standards to be met when considering ventilatory support outside the hospital Services must be based on the attending physician’s prescription, those providing the support should be appropriately trained, appropriate recording and reporting mechanisms should exist, and safe, effective, and appropriate equipment must be provided
Step in discharging a patient who will require home-based mechanical ventilation The family is consulted about the feasibility
Indication for noninvasive positive-pressure ventilation (NPPV) The patient requires low concentrations of supplemental O2
Contraindications for using noninvasive positive-pressure ventilation (NPPV) Severe upper airway dysfunction, copious secretions that require suctioning, FIO2 requirements exceeding 40%
Appropriate patients for long-term negative pressure ventilation in an alternative setting Patients who cannot or will not use NPPV, patients who need frequent airway access for suctioning, and patients with severe nasal congestion or obstruction
Strategies for a cooperative patient with an intact upper airway requiring home ventilatory support NPPV
Strategies for a hemodynamically unstable patient with an intact upper airway requiring home ventilatory support Negative-pressure ventilation
Actions to alleviate pressure sores over the nasal bridge caused by a mask Artificial skin, forehead spacer, reduce strap tension, try nasal pillows
Alarm systems needed for intermittent pressure-limited noninvasive positive-pressure ventilation Loss of power alarm
Negative-pressure ventilation systems requiring a separate negative pressure generator Body wrap and chest cuirass
Who can change a tracheostomy tube on a home care patient Respiratory care practitioner and visiting nurse
Components of a portable home suction unit Electric suction pump, suction tubing, and collection bottle
Components of adult home nasal CPAP apparatus CPAP pressure valve, flow-generating device, form fitting nasal mask
Method to eliminate the need for a separate sleep study to adjust a patient’s CPAP level Use an auto-adjusting CPAP system, use SpO2 values to titrate the CPAP level
Hospitalized infants frequently set up on apnea monitors Those at risk for SIDS
Steps in the cleaning of nondisposable respiratory care equipment Disassemble equipment, wash in cool water, soak in warm soapy water, scrub equipment, rinse and drain excess water.

What should be monitored during a cardiopulmonary exercise evaluation?

The primary physiologic measurements during CPET include the following physiologic information: Cardiac monitoring: Continuous heart rate, rhythm, and ECG changes. Hemodynamic monitoring: Blood pressure at set intervals. Breath-by-breath analysis of inspired and expired gas: VO2, V.

What are some relative contraindications for cardiopulmonary exercise testing?

The relative contraindications that may preclude the use of CPET until the patient is more stable to complete the test include:.
Severe pulmonary hypertension..
Untreated left main coronary artery stenosis..
Moderate stenotic valvular disease..

Under which of the following conditions would you recommend ending a cardio pulmonary exercise evaluation?

Indications for ending a cardiopulmonary exercise evaluation include: (1) ECG abnormalities (e.g., dangerous dysrhythmias, ventricular tachycardia, ST-T wave changes); (2) severe desaturation (SaO2 < 80% or SpO2 < 83% and/or a 10% fall from baseline values; (3) angina; (4) hypotensive responses; (5) a fall of > 20 torr ...

What is the first step in evaluating patients for participation in a pulmonary rehabilitation program?

res231.

monitored cardiopulmonary exercise evaluation Pulmonary rehabilitation Quizlet

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