CARDIORESPIRATORY CASE PRESENTATION: CHRONIC

OBTRUCTIVE AIRWAY DISEASES

NAME: ELDAWATI BINTI HESAPIL

DIP: IN PHYSIOTHERAPY

ID NO:03-200901-00375

INTRODUCTION

DEFINITION:- Chronic Obstructive Airway Disease is a

combination of chronic bronchitis and emphysema. Both of these conditions are airway constricting and worsen over time.

ETIOLOGY- long-term smoking- secondhand smoke- air pollution - extended exposure to occupational chemical fumes.

-

PERMANEN DILATATION

CLINICAL FEATURE

1. Chronic cough

2. Expectoration of mucus

3. Wheezing

4. Dyspnea on exertion

5. Decrease in expiratory flow rate

6. Increase in residual volume (RV)

PATHOLOGY CHANGES• Increase mucus production or impairment of

mucus clearance• Inflammation of the mucosal lining of the

bronchi and bronchioles• Mucosal thickening• Spasm of the bronchial smooth muscle

SYMPTOM- shortness of breath- wheezing - chest tightness- chronic coughing - Dyspnea on exertion- Decrease in expiratory flow rates- Increase in residual volume

TREATMENT- Although no cure has been discovered for this

condition, symptoms can be treated using:- bronchodilators,- inhaled steroids and antibiotics. - In some cases, oxygen therapy or surgery may

be required.

CARDIORESPIRATORY ASSESSMENT

SUBJECTIVE

Name: MR. N

Age: 70 years old

Sex: Male

Race: Bidayuh

Marital status: Married

Date of assessment: 11/07/2011

Date of admission: 07/07/2011

Doctor diagnosis: Chronic obstructive airway diseases

Doctor management: On Medication

PROBLEM

- Difficulty in breathing

HISTORY

Present illness:- Patient given a nebulizer- Patient currently cough with whitish sputum associated with

shortness of breath

Past history:- Multiple admission before with same problem

Past medical history:- Chest X-Ray: Done on: - 2/01/2011, 27/05/2011,

23/06/2011, and 06/07/2011 for chest- finding: -the trachea is become lateral shift

Past surgical history:- NIL

Drug/steroid:- Neb A:V:N 2:2:2

- salbutamol

- atovent

- nacl 0.9%

Social / occupational history:- (warga emas) / farming, always use tools like the mattock

Smoking/Alcohol consumption:- No

Investigation:- Chest x-ray: Done on: - 2/01/2011, 27/05/2011,

23/06/2011, and 06/07/2011 for chest.- finding: -the trachea is become lateral shift

-Seen HAZZINESS on the chest x-ray

OBJECTIVE ASSESSMENT

OBSERVATION

Vital signs: temperature: 36.7’c

: Respiratory Rate:22/min

: Pulse Rate:112/min

: Blood pressure:

~Interpretation:- taken from nursing chart

General observation

i. General health: hypertension

ii. Built: mesomorphic (moderate)

iii. Walking aids: no walking aids

iv. External appliances: no external appliances

v. Internal fixation: no internal fixation

vi. Posture: normal

vii.Gait: normal

Local observation

Breathing: pattern:

: Level: apical / diaphragmatic/basal

Chest deformity: Y / N

Coughing: productive/non-productive

effective/ineffective

Sputum: -colour = whitish

-amount = minimal

-consistency = loose

O2 treatment: Yes

Type: nasal cannulae/nasal pronge

= 1 liter / minute

PALPATION

Chest expansion: good/ moderate/ poor

Chest measurement:

MEASUREMENT INHALE EXHALE DIFFERENT

AXILLA 81 80 1

NIPPLE 80 79.5 0.5

XIPHI STERNUM 78 77.5 0.5

NO ABNORMAL MEASUREMENT FINDING

Percussion note: can’t do to more. Because it maybe increased sob to the patient

- normal/ hyper resonance/ hypo resonance/ dull

Auscultation: ronchi sound (left lower lobe)

Crepitation: mild / moderate/ coarse/ ronchi/ wheezing/ clear

SPECIAL TEST

Exercise tolerance test:

6 minutes walking test…

3 minutes step test……..

Pulse ratio: 1 min + 2 min

rest

= unable to test to the patient because the patient can’t walking for long time due to short of breath (SOB). Always feeling tired.

PHYSIOTHERAPY IMPRESSION- Short of breath- Secretion retention- Decreased chest mobility retentions

SHORT TERM GOALS

1. To facilitate removal of secretion

2. To prevent further bronchi spasm

3. To improve pattern of breathing control

4. To teach local relaxation and improve posture

5. To mobilize treatment to shoulder girdle

6. to improve exercise tolerance

7. To give advice

LONG TERM GOAL

1. To regain optimal functional activity

2. To prevent cardio respiratory activity

3. To achieve independent functional with out SOB

PLAN OF TREATMENT

4. Chest physio

5. ACBT

6. Posture correction

7. Exercise tolerance

8. Patient education

11/07/2011

S

O

A

P

SAME AS INITIAL ASSESSMENT

INTERVENTION

1. Chest physio

* Percussion

- patient in lying position

- doing percussion on the apical chest of patient, cover with towel (1 layer)

- doing for 1-2 minute

* Vibration

- patient in lying position

- doing vibration on the apical chest of patient

- doing for 3 times

2. ACBT

* Breathing control

- patient in sitting position

- ask patient to breath in and out (inspiration + expiration)

- do 5 times 3 session daily

* thoracic expansion exercise

- Patient in half lying position

- Shoulder flex through expiration with inspiration

- Shoulder lowering expiration

- Do 5 times, 3 session daily

* Effective huffing

- Do 2 to 3 times , 3 session daily

* Effective coughing

- Do 2 to 3 times , 3 session daily

* Relaxation position

- Relax sitting position on bed

- Relax high side lying

- Forward lean sitting

- Relaxed standing

- Forward lean standing

PATIE NT DOING FOR A FEW MINUTES

3. Posture correction

* using mirror feedback

- patient in sitting position

- ask patient to stabilize their shoulder level. Do retraction and lateral rotation of the arms

4. Improve Exercise tolerance

- ask the patient to walking slowly around the bed area 6 time daily

5. Patient education

- ask the patient to continue the exercise 3 session daily.

EVALUATIONPatient cooperative and able to perform all

exercise.

REASSESSMENTReview next visit

FOLLOW UP12/07/2011 – Tuesday

S – patient fell slightly weak for today

- fell pain when breath

- give medication for cough and asthma (-3x/day)

O - look puffiness of the face

- palpation: -chest expansion

= axilla 80-81

= nipple79.5-80

= xiphi sternum 77.5-78

- percussion note: dull sound

- Auscultation: ronchi and wheezing

- Functionally: independent

- Breath: have sound present

- Shoulder level: asymmetrical

- Walking aids: NIL

A-still in physiotherapy treatment

P - blowing tissue: but can’t blow for long time

- thoracic expansion exercises

- breathing exercises

- ACBT-deep breathing exercises, huffing ( to clearing secretion)

- Patient education

13/07/2011 - Wednesday

S- patient fell fever and using nebulizer

- medication: BUSE/ Creatinine

Vital sign =

Temperature: 36.5’c

Blood pressure: 170/90 mhg

Pulse rate: 117

Respiratory rate:23/min

Spo2: 96%

O – No shortness of breath at rest

= taken from nursing chart

Auscultation: still ronchi sound

A – continue physiotherapy treatment

P – breathing control

- thoracic expansion exercises

- blowing tissue exercises

- free active exercises

- hold= 1 until 5 only and stop to inhale

- patient education.

15/07/2011-Friday

S- patient felling better today. Face seen cheerful and cooperative.

- still use nebulizer (on and off )

O- Auscultations:-wheezing

- ronchi

- Vital sign: temperature-36.6’c

blood pressure- 150/90mmhg

pulse rate- 92/min

respiratory- 22/min

spo2- 93%

= from nursing observation chart.

A- still continue physiotherapy treatment

P- walking around the bed area(exercises tolerance)

- hold = 1 until 6 and stop to inhale

- breathing control

- thoracic expansion exercises

- Patient Education

-END-