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: 36.7c : 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 AXILLA NIPPLE XIPHI STERNUM INHALE 81 80 78 EXHALE 80 79.5 77.5 DIFFERENT 1 0.5 0.5

NO ABNORMAL MEASUREMENT FINDING

Percussion note: cant 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 cant 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 1. Chest physio 2. ACBT 3. Posture correction 4. Exercise tolerance 5. 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.

EVALUATION Patient cooperative and able to perform all exercise. REASSESSMENT Review next visit

FOLLOW UP
12/07/2011 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 cant 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: 36.5c 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-36.6c 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-