Interstitial Pulmonary Fibrosis & PVD

Initial Evaluation

Plan of Care

Discharge

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Vital Signs- Looking at SaO2, respiratory rate, blood pressure and heart rate

Pain scale- Pain from claudication, would want to get baseline

Functional Mobility- Decreased endurance

MMT- Possible weakness from lack of O2 reaching muscles, no endurance in muscles

Sensation- Possible lower extremity sensation loss or paresthesias resulting from claudication

6 MWT- Expecting longer times, must get a baseline to know how endurance improves. For the pulmonary disease population, we are looking for a result of 54 meters as an MCID (Rasekaba et al, 2009)

Breathing exercises

Teaching in correct physiological breathing and training in diaphragmatic breathing

Breathing in the lower, middle and upper portions of the lungs focusing on breathing through nose and mouth at rest and during exercise

Slow breathing with emphasis on exhalation in different specific respiratory postures sitting in chair

Forced exhalation exercises including coughing exercises and encouragement of exhale by pronouncing syllables

( Dimitrova,, Izov, Maznev, Vasileva, Nikolova, 2017)

Endurance Training

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**Monitor SaO2 stats the whole time and BP. It is important to be aware of SaO2 dropping. If this is an issue, refer to general physician for supplemental oxygen

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Patient walks on a treadmill at an exercise intensity sufficient to bring on claudication pain (Hiatt, Wolfel, Meier,. Regensteiner,1994).

Walking exercise is interrupted by rest periods to relieve claudication pain

In addition to treadmill walking exercise, other activites have been incorporated into the training sessions of some programs. These activities have included isotonic exercise of specific muscle groups, bicycle exercise,, and stair climbing. (Dimitrova,, Izov, Maznev, Vasileva, Nikolova, 2017)

Walking exercises then resume for a total rest and exercise time of 1 hour

Supervised treadmill walking exercise is very effective in improving treadmill exercise performance and community based walking ability

Community Walking program, while monitoring O2 Saturation level . Recommend pulse oximeter

Outpatient PT (possible cardiopulmonary rehab) in order to maintain function and increase cardiovascular endurance and community participation

Recommend protective gear for harvest. Also, recommend supplemental O2 for exertion and farming

ICF

participation: farmer, involved in children' activities

body function: severe chest tightness, shortness of breath, history of respiratory allergies, claudication of R calf

environment: father with 5 children and wife living on family farm, some family smoke around him

personal factors: male, 55 years old

Try to stay away from second hand smoke that will cause exacerbation of pulmonary issues.

Supplemental ambulatory oxygen may be beneficial for someone with fibrotic lung diseases. A current study is looking at if there are any overall benefits of this use. We will continue oxygen until results tell us differently. (Visca et al 2017)

SF-36-- Supervised treadmill and lower extremity resistance training shown to improve quality of life over the control group. (Moneta, 2009)

activities: grain harvesting