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why should you "survey" a patients home?
to make modifications, assure saftey and for infection control.
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What things should you check for in a patients home when surveying? (7)
-no smoking
-check vents, ducts, and appliances for molds
-clean AC/ furnance filters
-furry/feathered pets
-cockroaches/rodent droppings/ dust mites
-use of air filters
-temperature shifts
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How do you figure out the ideal body weight for a male and female?
female: 105 lbs + 5 lbs for every inch over 60 inches
male: 106 lbs + 6 lbs for every inch over 60 inches
(side note: 60 inches = 5'0
my hieght: 5'9 = 69 inches)
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What should a persons predicted calories be?
what if they are underweight?
predicted calories: 25-35 cal/Kg
under weight: 35-45 cal/Kg
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What are 7 symptoms of impared food intake?
- 1. Early satiety (being full very early)
- 2. Dyspnea
- 3. Anorexia
- 4. Fatigue
- 5. Bloating
- 6. Constipation
- 7. Dental problems
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Name 6 foods that are apart of the Carbohydrates food group
what do they do?
Fruits, grains, potatoes, cereals, pasta, & sugar
Breaks down into CO2
(in excess can cause S.O.B)
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Name 6 food that are proteins
Milk, eggs, poultry, fish, beans, and meats
(eat more protein if going in for surgery)
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Name 2 food products that are fats
oil and butter
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How much salt, and water should a pateint consume in a healthy diet? should they drink alcohol? what kind of vitamins should they take?
- salt: 2400 mg/day (1 tsp - 2300 mg)
- (can = retained fluid)
- water: 6-8 glasses/day
alcohol : NO!
Vitamins/ minerals: multiple B with C
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What are antibiotics recommended for?
not recommended except for treatment of infectious exacerbations
*never use antibiotics for prevention
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what are mucolytics recommended for?
not recommended unless patient has viscous sputum
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When is the use of steroids appropriate? (2)
Only if :
1. Pt. has improvement in symptoms or documented response to inhaled steroids on PFT
2. FEV1 of less than 50% with history of repeated exacerbations requiring tx with antibiotics or steroids
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Regular use of Antitussives in contraindicated in for what disease?
Contraindicated in stable COPD
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What is prescribed for all symptomatic patients with COPD?
Bronchodilators
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Name the 1st - 4th line of medications for patients with COPD
- 1st line : anticholinergics for maintenance
- *ipratropium bromide
- 2nd line : beta agonists
- *short acting is for rescue
- *long acting is for maintenance
- 3rd line : methylxanthine
- (ex : Theophyllin - can increase ventilator drive, and strengthen contraction of diaphragm)
- 4th line : steroids
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What are the benefits of smoking intervention? (4)
- 1. reduced respiratory symptoms
- 2. improved pulmonary function
- 3. stops acceleration of age-related decline in lung function
- 4. reduces COPD mortality rates
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Name 6 physiologic effects of smoking ?
- 1. stimulates the brain
- 2. relaxes muscle tension
- 3. immediate gratification
- 4. vasoconstriction
- *facial wrinkles
- *impotence
- *stroke
- 5. brittle bones
- 6. stained teeth/gum disease
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What are 8 things patients may experience while withdrawing from smoking ?
- 1. irritability
- 2. anxiety/insomnia
- 3. difficulty concentration
- 4. restlessness
- 5. headache
- 6. dizziness
- 7. GI distress
- 8. increased hunger
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What are 3 techniques to get a patient to stop smoking ?
1. Group counseling
2. Hypnosis
3. Nicotine replacement
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What are 4 different types of nicotine replacement?
1. Nicotine polacrilex
2. Transdermal patch
3. Nasal spray
4. Inhaler
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What are 7 benefits to excerising?
- 1. increased energy level
- 2. increased muscle strength
- 3. increased cardiopulmonary endurance
- 4. ability to fight infection
- 5. relaxation
- 6. restful sleep
- 7. increased bone density
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what are 6 things that exercise can decrease?
1. shortness of breath
2. risk factors of heart disease
3. blood pressure
4. side effects of medications ( steroids)
5. depression (due to release of endorphins)
6. blood sugar levels
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What are 5 activities that involve large-muscle groups that can be maintained continuously?
1. walking
2. treadmill
3. stationary cycling
4. swimming
5. rowing
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For patient exercise, what should be the the frequency? intensity? duration? warm-up? and cool-down?
Frequency: 3-5 days per week
Intensity: 50% of peak exercise capacity based on maximum heart rate
Duration: 20-30 minuets
Warm-up: 10-15 minuets preceding
Cool down: gentle stretching
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Patient exercise evaluation:
1. what should you establish?
2. how much should their PR increase by?
3. patient should be tired but exhibit minimal ____.
4. PR should return to baseline within _____ ____.
5. When PR does return to baseline you should do what 2 things?
1. base line vitals
2. Increase by 20-30%
3. tired but exhibit minimal discomfort
4. PR should return to baseline in 5 minuets
5. When it does return; increase work load and decrease supplemental O2 levels
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When should inspiratory muscle training be considered?
When persistant dyspnea persists despite bronchodilator therapy
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inspiratory muscle training:
what is a Nonlinear device?
what is a Threshold device?
what should you start at?
what is the frequency?
nonlinear device: unreliable training loads if the expiratory flow is not controlled.
Threshold device: provides reliable loads
Start at 1/3 of patients MIP to a max of 60% of MIP
Frequency: 2-5 times per day, 15-30 min, approx 12 breaths per minuet
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