occupational therapy and pulmonary conditions

Pulmonary disorders and OT in acute care

Clients with pulmonary conditions present occupational therapists with unique challenges. Learn some of the evidence that can help guide intervention in acute care.

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Pulmonary Conditions: What should an occupational therapist know?

  • Pulmonary: relating to the lungs, airways, and vascular system
    • OT should be aware of the general symptoms of pulmonary disorders:
      • Dyspnea (shortness of breath) OTs can use the Modified Medical Research Council Dyspnea Scale to assess the impact of SOB on daily activities (0-5)
      • Rapid, forceful, or shallow breathing
      • Coughing is a protective mechanism but can also be a concern.
      • Mucous secretions another protective mechanism but can be a problem if it is difficult to clear.
      • Wheezing is a sign of airway narrowing/obstruction.
  • OTs should know the basic principles of ventilation and gas exchange
    • Ventilation (gas transport into/out of lungs- O2 & CO2)
    • Respiration (gas exchange at alveoli and capillaries)

OT Considerations- 3 categories of pulmonary conditions

OBSTRUCTIVE RESTRICTIVE EXTRAPLEURAL
COPD Atelectasis Pleural effusion
Asthma Pneumonia Pneumothorax
Bronchitis Pulmonary edema Hemothorax
Emphysema Adult respiratory distress syndrome Frail chest
Cystic Fibrosis Pulmonary embolism Emphysema
Bronchiectasis Interstitial lung disease
Lung confusions

What should OT do with clients who have pulmonary conditions?

Chart Review: Important pulmonary critical values for OT to note:

  • Hemoglobin (Reference values male 14-17 g/dL; female 12-16 g/dL)
    • Trending upward >20 g/dL) (polycythemia)
  • pH (Reference values 7.35-7.45)
  • PaO2 (Reference values 80-95 mmHg)
  • HCO3(Reference values 20-30 mmol/L)
    • Respiratory Alkalosis (pH>7.45, PaCO2 <35 mmHg)
    • Respiratory Acidosis (pH<7.35, PaCO2 >45 mmHg)
    • Metabolic Alkalosis (pH>7.45, HCO3>30mmol/L)
    • Metabolic Acidosis (pH<7.35, HCO3<24 mmol/L)

Before and during OT session- OT should gather the following info:

  • Level of alertness
  • Ease of speech production
  • Skin color
  • O2 therapy (orders and current O2 levels)
  • Current reports of dyspnea
  • Baseline activity level

General safety guidelines for OT and pulmonary conditions:

  • Monitor vital signs before, during, and after session.
  • Observe for cyanosis, pallor, clubbing fingers/toes, abnormal breathing.
  • Modify activity if O2 saturation drops before 90% or more than 4% from baseline.
  • Notify medical staff if the patient’s O2 is less than 88% w/ activity or more than 4% from baseline.
  • Avoid resistive activities w/ thoracotomy or sternotomy patients (follow sternal precautions).

Occupational therapy intervention: Pulmonary conditions

  • Remember that shortness of breath and other symptoms can greatly impact a patient’s participation in therapy and meaningful occupations, impacting quality of life:
    • Be sure that you understand the client’s occupational history – roles, routines, and habits so that you can plan intervention and make appropriate recommendations.
    • Address psychosocial concerns.  Many times clients will experience decreased social interactions, have anxiety about their condition.  Offer emotional support for anxiety
    • Prioritize occupations to address quality of life issues – what does the client want and need to do?
    • Provide education and demonstration on stress management and coping techniques.
  • Educate client on specific techniques to reduce symptoms
    • Breathing re-training techniques and controlled breathing
    • Positioning (sleeping/pillows and posture to improve airway and airway clearance
    • Secretion clearing techniques
    • Energy conservation and work simplification
  • Promote “learning through doing”
    • These patients may be commonly re-admitted for exacerbation of symptoms making them less likely to listen or adhere to verbal instructions, occupational therapists should promote practice of preferred activities and provide cues and guidance during such activities.
    • Improve aerobic capacity and muscular endurance as tolerated

Final considerations for acute care OT and pulmonary conditions:

  • Group intervention may help with carryover (sharing experiences and helping clients feel like they are not alone)
  • Instruct on problem-solving and coping
  • Educate on avoiding environmental toxins
  • Recommend equipment and home modifications

Check out other other blog posts exclusively for acute care therapists here.

Acknowledgement: This blog post would not be possible without the help of Andrea Matanovic, a student in the MOT program at CSU when this was written. She has a passion for acute care and hopes to be working in an acute care setting soon!

References

Academy of Acute Care Physical Therapy (2016).  Laboratory Values Interpretation Resource (updated January, 2017).  Retrieved from  http://c.ymcdn.com/sites/www.acutept.org/resource/resmgr/docs/2017-Lab-ValuesResource.pdf

Martinsen, U., Bentzen, H., Holter, M. K., Nilsen, T., Skullerud, H., Mowinckel, P., & Kjeken, I. (2017). The effect of occupational therapy in patients with chronic obstructive pulmonary disease: A randomized controlled trial. Scandinavian Journal Of Occupational Therapy, 24(2), 89–97.

Paz, J.C. & West, M.P. (2013).  Acute Care Handbook for Physical Therapists – E-Book (Kindle Locations 13265-13266). Elsevier Health Sciences. Kindle Edition.

Polastri, M., Pisani, L., Dell’Amore, A., & Nava, S. (2017). Revolving door respiratory patients: A rehabilitative perspective. Monaldi Archives For Chest Disease = Archivio Monaldi Per Le Malattie Del Torace, 87(3), 857. https://proxy.ulib.csuohio.edu:2096/10.4081/monaldi.2017.857

Smith-Gabai, H. (ed.) (2011). Occupational Therapy in Acute Care. Rockville, MD: American Occupational Therapy Association.

 

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