Saturday, April 13, 2013 Sharon L. Balkenhol, RN, MSN, CNS, APN Manager, Pulmonary Rehabilitation...
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Transcript of Saturday, April 13, 2013 Sharon L. Balkenhol, RN, MSN, CNS, APN Manager, Pulmonary Rehabilitation...
Saturday, April 13, 2013
Sharon L. Balkenhol, RN, MSN, CNS, APN
Manager, Pulmonary Rehabilitation
Jewish Hospital, Cincinnati, Ohio
What is Pulmonary What is Pulmonary
Rehabilitation – a Rehabilitation – a Patient’s Perspective?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 Rehabilitation
Program at Mt. Diablo Medical Center, Concord, CA
ATS Definition of ATS Definition of Pulmonary RehabilitationPulmonary Rehabilitation
“…“…a multidisciplinary program of care a multidisciplinary program of care for patients with chronic respiratory for patients with chronic respiratory
impairment that is individually impairment that is individually tailored and designed to optimise tailored and designed to optimise each patient’s physical and social each patient’s physical and social
performance and autonomy.”performance and autonomy.”
What is Pulmonary What is Pulmonary Rehabilitation?Rehabilitation?
A comprehensive service designed for those who experience lung problems
Monitored, supervised exercise
Education about your lung disease/condition
Psychosocial support, stress management, and coping strategies
What Does Pulmonary What Does Pulmonary Rehabilitation Do??? Rehabilitation Do???
Helps patients break Helps patients break
out of theirout of their
““emotional emotional straightjacketstraightjacket””
Why Do I NeedWhy Do I Need Pulmonary Rehabilitation?? 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!
Why Pulmonary Why Pulmonary Rehabilitation???Rehabilitation???
Fear of breathlessness
Reduced exercise tolerance
Inactivity/Immobility
Muscle weaknessFatigue, anxiety, isolation
CHRONIC LUNG DISEASE
↓CO2
↓Lactate
Pulmonary Pulmonary RehabilitationRehabilitation
ACTIVIT
Y
Breathlessness
PulmonaryRehabilitatio
n
Muscle Reconditionin
g
Decreased Leg
Fatigue&
Weakness
Do Do II Need Need Pulmonary Pulmonary
Rehabilitation?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?
Pulmonary Pulmonary RehabilitationRehabilitation
Are you or someone you know missing the benefits of Pulmonary Rehab?
EXTENT OF THE EXTENT OF THE PROBLEM PROBLEM “ “COPD”COPD”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 by 2020 -
2007 there were 124,477 deaths in U.S.
Significant Significant StatisticsStatistics
COPD ranks second as a cause of disability
COPD cost US TOTAL$49.9 billion $29.5 B indirect cost $ 8.0 B indirect morbidity cost $12.4 B indirect mortality cost
How Does LAM Affect Your How Does LAM Affect Your Lungs??Lungs??
CYSTS = oxygen uptake
Traps air
risk of pneumothorax
PNEUMOTHORAX
Effusions
Airway Narrowing
How Will Pulmonary How Will Pulmonary Rehabilitation Help You?Rehabilitation Help You?
Lessen your shortness of breath
Increase your awareness of your capabilities
Improve your strength and endurance
Manage your stress, anxiety and depression
Encourage your sense of well-being and improve your self-confidence
Teach you how to use your medications and oxygen appropriately
Reduce hospitalizations
What are the ComponentsWhat are the Componentsof Pulmonary Rehab?of Pulmonary Rehab?
Initial Assessment
Supervised Progressive Exercise/Activity
Functional and ADL Training
Energy Conservation
Breathing Retraining
Stress Management
Medication Education
INITIAL ASSESSMENTINITIAL ASSESSMENTInterview
Medical History
Symptom Assessment
Nutritional Assessment
Educational Assessment
INITIAL ASSESSMENTINITIAL ASSESSMENT
ADL Assessment
Psychosocial Assessment
Diagnostic Testing
Exercise Assessment
Physical Assessment
Oxygen & ExerciseOxygen & Exercise
Some patients may need oxygen with exercise, even though they do not need it at rest
Patients already on oxygen may need increased flow rates with exercise
Ideally, oxygen saturation (SpO2) should be
= or > 88-90%
Oxygen needs may vary day to day
What Can You Do For Your What Can You Do For Your LAM????LAM????
Healthy Lifestyle
Pulmonary Rehabilitation
Flu Vaccination
Pneumonia Vaccination
NO SMOKING
Physical Activity = “Lifestyle Physical Activity = “Lifestyle Exercise”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
Is Exercise Risky For You?
?????Risk??????????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 2003
Safer than base jumping or pregnancy
Risk 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
What About What About Pneumothorax and Pneumothorax and
Exercise?Exercise?In CF population
Pneumothorax 0.15% per 1000 patient years.
Injury 0.39% per 1000 patient years
Asthma attack 0.84% per 1000 patient years
Hemoptysis 0.12% per 1000 patient years
Pneumothorax seemed to be associated with coughing.
So What Exercise Should So What Exercise Should You Do???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
Should be part of warm-up and cool-down
May be done sitting or standing
Helps prevent muscle soreness, joint stiffness, improves balance and posture
Stretching & Stretching & FlexibilityFlexibility
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
Upper Extremity Upper Extremity Training?Training?
Upper Extremity Upper Extremity TrainingTraining
MODALITIES
Arm Ergometer
Rower
Dumbells
Fitness bands
AirDyne Bicycle
Upper Extremity Upper Extremity TrainingTraining
Benefits
Increased strength of arm & shoulder muscles
Increased exercise tolerance
Decreased shortness of breath during ADLs
These muscles provide support to the ribcage - strengthening them can make breathing easier
Lower Extremity Lower Extremity TrainingTraining
MODALITIES
Treadmill
Chair Aerobics
Water Walking/ Aerobics
Walking
Stationary bicycles
NuStep
Elliptical Trainer
Lower Extremity Lower Extremity TrainingTraining
BENEFITS
Strengthens Leg Muscles
Improves Muscle Tone
Increases Flexibility
Patient Education & Training
Patient Education & Training
Normal lung A & P
Pathophysiology of lung disease
Breathing retraining
Airway Clearance
Preventing infection
Medications & oxygen
Exercise principles
Patient Education & Patient Education & TrainingTraining
Activities of daily living & energy conservation
Smoking cessation
Self-assessment & symptom management
Emotional and social well-being
Travel
Nutrition
Control Your Control Your BreathingBreathing
Stop or slow down!
Assume rescue breathing position –sitting –propping your arms on pillows, or leaning against a wall
Use pursed-lip breathing
Relax your shoulders
Use your rescue inhaler
Emotional & Social Emotional & Social Well-BeingWell-Being
Breaking the dyspnea cycle
Coping with depression and anxiety
Learn relaxation techniques
Who Is Eligible for Who Is Eligible for Pulmonary Rehab?Pulmonary Rehab?
Medicare covers pulmonary rehab for those who have had any of the following: COPD Asthma Restrictive pulmonary disease Other chronic lung conditions
Private insurances vary and reviewed and cleared by staff prior to starting a program
What is the cost of pulmonary
rehab?
What is the cost of pulmonary
rehab?
Most charges for outpatient pulmonary rehab are covered by insurance
Staff 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.
The Pulmonary Rehab The Pulmonary Rehab TeamTeam
Referring Provider (Physician,
Nurse practitioner)Respiratory therapist Registered nurse Physical therapistOccupational therapist Medical DirectorExercise physiologist Supporting staff:
Dieticians/Nutritionists, Social Workers, Psychologists, Pharmacists
Again, Why is Pulmonary Again, Why is Pulmonary Rehabilitation Rehabilitation Important???Important???
Pulmonary Rehab will give you the tools, knowledge, and motivation you need to fight the progression with your “Daily Breath”!
How Do I Find a Quality How Do I Find a Quality Pulmonary Rehabilitation Pulmonary Rehabilitation
Program?Program?
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)- “Find a Program”
American Lung Association
Recommendations of physicians, friends
Be Active and Stay Active
Be Active and Stay Active
Go for a walk
Take stairs instead of an elevator
Follow a small child or toddler
Park the car further from the door
Be Active and Stay Be Active and Stay ActiveActive
Do yard work or gardening
Walk the dog
Clean a closet
Go shopping, play miniature golf, dance a little
Questions?????