Hey guys,
The last week of my cardio placement has been really good in tying together all the pt’s seen so far on placement. This week a 67 y.o. female presented to the ED with increasing SOB, excess sputum production (green-yellow) and decreased exercise tolerance.
PMHx: End stage COPD with numerous exacerbations, last being Dec. ’07, hypertension, hypercholestermia.
SHx: retired, married, lives in a single story home on a large property. Has a 4WW for around the house and a scooter for outdoors. Smoker- 10 a day
Exercise tolerance: usually 60-80 meters before requiring a rest
After the subjective & objective examination the problem list in order of priority was:
Dyspnoea
Impaired airway clearance
Impaired gas exchange
¯ exercise tolerance
Airflow limitation
Initial Rx for this pt involved ACBT to help clear secretions and positioning to ¯WOB. The pt was too breathless to stand and ambulate. Over the next couple of days Rx was given 2 times a day with improvements in the pt evident after each intervention. Ambulation was the main intervention employed with excellent results. This increased Vt and FRC- increasing airflow and shearing secretions thus improving V/Q matching. Upper limb exercises were also prescribed increasing the efficiency of accessory muscles used for ventilation. Lower limb strengthening exercises incl. STS & ¼ squats were also employed to improve exercise tolerance and increase the requirements of the respiratory system.
The pt progressed quite quickly and just prior to D/C could ambulate ≈140-160 meters with 1 rest. A HEP was given with the exercises performed on the ward being prescribed. The pt was also r/f to pulmonary rehabilitation for further intervention and continuing education for self mx of her COPD. It was good to see a pt through from admission to almost D/C.
Thanks
Subscribe to:
Post Comments (Atom)
3 comments:
I totally agree that seeing a patient from the beginning through to discharge gives you a complete picture and really helps with your clinical reasoning and identification of prognosis.
That was one area I struggled with on our outpatient placement. Picking up patients from other people was challenging in the first week and then as you became familiar and ready to progress their treatment it was time to go. Estimations on how long it takes to regain ROM, or strengthen a muscle from grade 2-3 or 3-4 is an area of physiotherapy that I struggle with. Because I havin't had a patient from start to finish to know the time course for their progression I have no cases to refer to for the answers to these time frames. I think it's great and valuable that you got to experience the whole thing start to finish. Well done sounds like you did a really good job with her. :)
dani
I've also just done my cardio placement, and one thing i really enjoyed was being able to make such a difference to patients. COPD pts were one group that physio has a really good effect with, and in such a short time. It was really satisfying to see a pt on admission that could barely talk to you without feeling out of breath, and then 3 days later they're walking out of the hospital after being discharged. With these pt's tho i think maintenence is the key, which is where the referral to pulmonary rehab and HEP come into effect. Hopefully
During my cardiopulmonary placement I had an opportunity to supervised pulmonary rehab classes and I would like to share my experience. I found that many patients with COPD attending pulmonary rehab are highly motivated, compliant with exercises regime and they are well educated about their condition. Many patients after completing 8 weeks pulmonary rehab classes express the willingness to continue participating in program. During my placement, I had “new respiratory patient” referred to be assessed for pulmonary rehab. This patient, 76 years old female with COPD diagnosis during subjective assessment asked to be enrolled to pulmonary rehab program. Patient reported that she participated in pulmonary rehab before 3-4 years ago. Currently her exercises tolerance decreased significantly and these classes are her chance to regain/improve her ability to walk longer distance, be independent, and be able to come back to her voluntary work. I agree with you is great and very motivating to see that physio treatment makes real difference to patients’ quality of life.
Post a Comment