Sara Folsom, MS, OTR/L

Sara Folsom received her MS in Occupational Therapy from the University of New Hampshire in 2006. She also has a BA in psychology with a minor in Rehabilitation Services from the University of Maine. Sara contributed a chapter to the AOTA publication, Living Life to Its Fullest; Stories of Occupational Therapy, Ashley M. Hofmann, Molly V. Strzelecki, eds., which was published in 2010. She is currently assigned to the therapy team at Oregon Heart and Vascular Institute and in the ICU at PeaceHealth Sacred Heart Medical Center at River Bend in Springfield, Oregon, and was instrumental in transitioning the inpatient therapies department to a new electronic health record system.

922 Pulmonary Disorders and the Rehab Therapist—Course Objectives 

At the completion of this course, the therapist will be able to:

• Recognize the prevalence of chronic pulmonary disease
• Identify terms associated with pulmonary disease
• Differentiate between obstructive and restrictive forms of pulmonary disease
• Identify risk factors for common types of pulmonary disease
• Identify common symptoms of pulmonary disease and of exacerbations
• Recognize the challenges in addressing hospital readmissions for pulmonary disease
• Identify the common classification systems for COPD
• Differentiate between management of stable vs acute exacerbation COPD
• Recall the staging system for idiopathic pulmonary fibrosis
• Recall the functional classification system for pulmonary hypertension
• Identify the different types of respiratory failure and recall which are potentially life threatening
• Recognize laboratory findings that could affect therapy treatments
• Identify medications that could affect therapy treatments
• Recall common tests of exercise capacity
• Identify common symptom management techniques for dyspnea, airway clearance and exercise intolerance
• Recognize oxygen saturation responses to activity and recall how and when to adjust supplemental oxygen rates
• Identify when to initiate mobilization for patients on ventilators
• Recall the importance of discharge education and follow up for pulmonary patients

 

922 Pulmonary Disorders and the Rehab Therapist—Contents

Page # 

HOUR 1

Course Instructions 2 

About the Authors 3

Course Description 4

Course Objectives 5

Table of Contents 6

Introduction 10

 

Unit I: Pulmonary Disease Overview 11

About Pulmonary Disease

Chapter 1: Chronic Obstructive Pulmonary Disease (COPD) 12

About COPD

Epidemiology

Economic Burden of COPD

Readmissions

Risk Factors 18

Signs and Symptoms

Classifications

Exacerbations

Symptom Severity

Prognosis

2017 GOLD Guidelines 21

Phenotypes

COPD Foundation Classification System

Comorbidities

Management of COPD 24

Medical Management

Pharmacology

Vaccinations

HOUR 2

Ventilatory Support 26

Oxygen Therapy

Noninvasive Ventilation (NIV)

Invasive Mechanical Ventilation 27

Exacerbations

Surgical Management

Chapter 2: Idiopathic Pulmonary Fibrosis 29

About IPF

Epidemiology and Economic Burden of IPF

Risk Factors

Signs and Symptoms

Classifications 33

Comorbidities

Management

Medical Management

Surgical Management

Chapter 3: Pulmonary Hypertension (PH) 37

About PH

Categories of Pulmonary Hypertension

Epidemiology and Economic Burden of Pulmonary Hypertension

Signs and Symptoms

Management 40

Surgical Management

Chapter 4: Respiratory Failure 42

About Respiratory Failure

Epidemiology and Economic Burden

Classifications

Risk Factors

HOUR 3

Signs and Symptoms 45

Acute Respiratory Distress Syndrome

Management

Medical Management

Surgical Management

Invasive Mechanical Ventilation

Chapter 5: Long-Term Management of Pulmonary Disease 51

Lifestyle Management

Lung Transplantation

Palliative and Hospice Care

 

Unit II: PT and OT Interventions 55

Introduction

Chapter 6: Chart Review 56

Laboratory Values

Other Lab Values of Interest

Medications

Imaging 61

X-ray

CT

ECG

TTE

Bronchoscopy

HOUR 4

Pulmonary Function Tests (PFT) 63

Lung volumes

Spirometry

Diffusing Capacity of the Lung for Carbon Monoxide (DLCO)

Exercise Testing

Chapter 7: Rehab Assessments 66

Vital Signs

Oxygen Saturation 

Factors Affecting Pulse Oximeter Readings

Perfusion

Motion Artifact

Other Factors

Oximetry Values

Types of Oximeters and Probes

Home Use

Observations 71

Thoracic Exam

Breathing Patterns

Breath Sounds

Auscultation

Normal Breath Sounds

Abnormal Breath Sounds

Adventitious Breath Sounds

Wheezes/Rhonchi

Crackles/Rales

Other

Functional Mobility Tests 77

SPPB

Exercise Capacity Tests

6MWT

Stair Climbing Test (SCT)

Shuttle Walk Test

Precautions for Exercise Capacity Testing

Cognitive Assessments 81

MMSE

MoCA

Quality of Life Questionnaires

HOUR 5

Chapter 8: Considerations when Planning Interventions 84

Introduction

Symptom Management for Breathing

Dyspnea

mMRC Dyspnea Scale

Baseline Dyspnea Scale

Modified Borg Scale of Dyspnea

Talk Test

Breathing Strategies 87

Pursed Lip Breathing

Diaphragmatic/Deep Breathing Exercises

Inspiratory Muscle Training

Airway Clearance Techniques 92

Forced Expiratory Technique

Active Cycle of Breathing Technique

Mechanical Devices

Chest PT

Incentive Spirometry

Inhalers/Bronchodilators

Exercise

Supplemental Oxygen 96

Long-Term Oxygen Therapy

Oxygen Delivery Devices

Positioning

HOUR 6

Exercise Intolerance 101

Fatigue

Rating of Perceived Exertion

Activities of Daily Living

Incontinence

Other Contributors to Exercise Intolerance

Chapter 9: Other Considerations for Mobilization 107

Post-Procedure Limitations

Mobilizing Patients in the Intensive Care Unit

Mobilizing Patients on Mechanical Ventilation

Noninvasive Ventilatory Support

Precautionary Notes

Prolonged Mechanical Ventilation

Weaning from Ventilator

Extracorporeal Membrane Oxygenation (ECMO)

Red Flags 112

Pulmonary Embolism

Work of Breathing

AECOPD

Acute Respiratory Failure

Pulmonary Rehabilitation and Exercise Training

Interval Training

Disease-Specific Considerations 115

COPD

IPF

Pulmonary Hypertension

Respiratory Failure

HOUR 7

Discharge Planning

Conclusion 120

Endnotes 121

Appendix 1: Glossary of Pulmonary Terms 122

Appendix 2: Resources for Therapists and Patients 124

References 128

Examination 145

Evaluation 150

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Educational Level: Intermediate

Target Audience: PT, PTA, OT, OTA

Course Completion Requirements: Passing an online exam with 70% or greater will be required to earn continuing education credit

This course is approved for 0.7 CEUS. 7 contact hours

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