copd physiotherapy case study

There is also the presence of chronic cough occasionally associated with mucoid sputum which further suggests COPD. On inspection, the abdomen is flat and moves with respiration. Mr TLT then developed symptoms of upper respiratory tract infection such as rhinorrhea and sore throat one week prior to admission. Close monitoring of vital signs and SpO2 hourly until the patient’s breathlessness improves. There was no clubbing or cyanosis seen. By continuing you agree to the use of cookies. To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on UKEssays.com then please: Our academic writing and marking services can help you! He should be counseled on the various options of smoking cessation which will be discussed further below. The cardiovascular system examination was normal. He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. 1. We're here to answer any questions you have about our services. (A) Comparison of smoking cessation intervention with usual care. Nursing staff to inform if patient deteriorates such as increased respiratory rate or drop in oxygen saturation below 92%. View Physiotherapy Case Study PPTs online, safely and virus-free! Copyright © 2021 Elsevier B.V. or its licensors or contributors. He had been diagnosed with hypertension for the past one year and is currently on T Amlodipine 5 mg od. CHAPTER FIVE Case studies in respiratory physiotherapy Lead authorJanis Harvey, with contributions fromSarah Ridley, Jo Oag, Elaine Dhouieb, Billie Hurst Case study 1: Respiratory Medicine – Bronchiectasis Out-patient 34 Case study 2: Respiratory Medicine – Lung Cancer Patient 36 Case study 3: Respiratory Medicine – Cystic Fibrosis Patient 38 Case study 4: Respiratory Medicine –… Arterial blood gas should be done in order to ensure adequate oxygenation without carbon dioxide retention of acidosis. Published: 10th Jul 2017 in If you need assistance with writing your essay, our professional essay writing service is here to help! 3. Current Global initiative for chronic Lung Disease guidelines [4] recommend that antibiotics should be given in: i) patients with exacerbations of COPD and the three cardinal symptoms of increased. However new evidence have shown that COPD may be a systemic disease that involves pathology in several extra-pulmonary systems. Case study patient with copd 1. However, as many COPD airways are colonised with bacteria, secondary bacterial infection occurs in up to 60% of cases. During this admission Mr TLT had increasing severity of shortness of breath even at rest. On percussion, there is hyperresonance over both lungs with loss of liver and cardiac dullness. (B) Comparison according to smoking status. BY NAWAL GALET 2. A spirometry appointment may also be made. He drinks one to two bottles of beer each time. Mr TLT was also able to ambulate without feeling breathless. It may include asthma, emphysema and bronchitis. Counseling for smoking cessation should play a significant role in the holistic management of a patient with chronic obstructive airway disease. Mr TLT is the eldest of 5 siblings. This was not given in this patient with further discussion below. Mr TLT should be counseled on smoking cessation as it has been proven that smoking cessation would alter the course of progression in COPD and is associated with lower all-cause mortality. The chest moves equally with respiration and there is use of accessory mucles with intercostal, subcostal and suprasternal retraction. Education on the symptoms of an acute exacerbation and advise to return to the hospital if there is development of those symptoms. Results: ECG with sinus rhythm. There may also be secondary polycythemia if the patient has chronic pulmonary hypertension. Chronic obstructive pulmonary disease (COPD) causes breathing difficulty and leads to other systemic problems. Mr TLT then proceeded to have shortness of breath for the past one year. Oral antibiotics such as T. Cefuroxime may be given. Case Study One . He has also been having persistent breathlessness for the past 1 year especially on exertion. This is associated with early and continuing improvement during treatment with corticosteroids in lung function, breathlessness and blood gases and with a shorter hospital stay. He is a chronic smoker for the past 40 years and smokes about 20 sticks of cigarrettes a day. Physiotherapy is one such treatment. Justification: In order to look for any bacteria which may have been the cause of the exacerbation . He has not consulted any doctors for these symptoms prior to admission. Systemic inflammation is also seen in patients with COPD. This may be attributed to the increase in number of goblet cells and later on fibrosis of the bronchial walls causing airway obstruction seen in chronic obstructive airway disease. There is a strong family history of hypertension in that his mother as well as two other siblings are also hypertensive. No bounding pulse. Justification: In order to view the total white count as well as the differential count to see if there is an infection which has caused this episode of exacerbation. However the patient, Mr TLT was not given any systemic corticosteroids. There is low voltage seen. This could be because he merely had a mild exacerbation. He is currently considering it and would like to learn more about the various options of smoking cessation. His breathlessness improved after nebulization with ipratropium bromide, salbutamol and normal saline for one day. He is also a chronic smoker for the past 40 years who smokes about 20 sticks of cigarettes a day. There was also an increase in cough as well as production of sputum. He drinks alcohol with his friends on weekends. At Northeast Nursing and Rehabilitation, we cared for a 77-year-old white male who had been recently hospitalized for acute cholecystitis. There was no guarding or tenderness. The following case studies outline the different ways in which Mitchell Physiotherapy can assist you. This is evidenced by elevated levels of the proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-a), interleukin-6, interleukin-8, and TNF-a receptors. Systemic review: There was no loss of appetite or loss of weight. His PMH included CAD, a pacemaker, cardiac stents, HTN and COPD. Mr TLT then developed increasing shortness of breath 4 days prior to admission. In the event that Mr TLT is unable to coordinate well, he may be advised to purchase an aerochamber. He had fever of 38 degress celcius at that time which resolved with paracetamol. NAME: Breeana Wainscott Case Study: COPD SCENARIO D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). [3]. Nursing. If the patient is not yet willing to quit, there are 5 Rs which should be identified together by the patient and the doctor: • Risks of illness related to continued tobacco use, • Roadblocks for quitting, internal and external, • Repetition of the motivation intervention at each encounter, There are two means of intervention in smoking cessation namely pharmacological and behavioural. SpO2: 95% under nasal prong oxygen 3 litres per minute. He has had hypertension for the past one year and is taking T Amlodipine 5mg od. Chronic obstructive pulmonary disease (COPD) is recognized as a systemic illness with significant extra-pulmonary features, such as exercise intolerance and muscle weakness. Another proposed mechanism is increased cytokine production due to chronic hypoxia. Mr TLT is a 58 year old taxi driver who presented with shortness of breath for the past four days. Postural drainage and chest physiotherapy may be performed. Int Phys Med Rehab J. A bit more about Jim: Medical history: COPD, FEV1 six weeks ago was 38% of normal predicted, recent CXR shows flattened diaphragm with increased AP diameter, appendectomy age 34, broken nose and broken right arm as a child. 4. Mr TLT was discharged after 3 days of admission and educated on chronic obstructive airway disease. Citation: Teixeira PJZ, Lumi C. Pulmonary rehabilitation in COPD: a case study. This in turn has a positve impact on the economic cost of treating exacerbations, with fewer follow-up visits and hospital admissions. Furthermore patients who present with an acute exacerbation are at greater risk of having a bacterial infection. Info: 5376 words (22 pages) Essay The results show that there is a decrease in short-term mortality, treatment failure and sputum purulence with antibiotic therapy compared to placebo. Chest plain radiograph should be done in order to look for thickened bronchial walls or cystic shadows. I therefore looked up a Cochrane metaanalysis on the use of systemic corticosteroids for acute exacerbations of chronic obstructive airway disease [9]. With the right pharmacological and non-pharmacological strategies, people with COPD can lead active, independent and productive lives. Initially, he appeared to do well with the nifedipine with improved symptoms but presented back for evaluation 2 months later with worsening shortness of breath with minimal activity. A combination of prescribed and personalised resistance training and aerobic exercise 2. It is also not copious and foul smelling in nature. 6. STUDENT NAME: Tan Hai Liang ID NO : M0409146, NAME OF SUPERVISOR : Prof Khin ROTATION: Internal Medicine, SEX : Male DATE OF ADMISSION : 2 June 2009. Mr TLT has been having intermittent chronic cough for the past 3 years. A working diagnosis of acute exacerbation of chronic obstructive airway disease due to upper respiratory tract infection was made. Suspected in patients with a history of smoking, occupational and environmental risk factors, or a personal or family history of chronic lung disease. Pulmonary rehabilitation is a supervised programme consisting of: 1. [1]. Mr TLT presented with shortness of breath which progressively increased in severity for the past 4 days. Give nebulization of Ipratropium Bromide:Salbutamol:Normal Saline in ratio of 2:2:1 every four hours until breathlessness decreases. Investigations done include chest plain radiograph which showed a hyperinflated chest, tubular heart and absence of vascular markings at the peripheries. Counseling on proper inhaler technique. The role of physiotherapy in the management of COPD. Patients who had stopped smoking had lower rates of death due of coronary heart disease , cerebrovascular disease, lung cancer, and other respiratory disease as compared with those assigned to usual care who continue to smoke. Thank you for seeing this 58 year old gentleman who is hypertensive for the past 1 year currently on T. Amlodipine 5mg once daily. This is because studies have shown that smoking cessation changes the clinical course of COPD by preserving lung function. He has been a chronic smoker for the past 40 years. From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. As such he may require the use of ipratropium bromide in a metered dose inhaler upon discharge in order to feel less breathless due to the bronchodilator effect of the ipratropium bromide. Effect of smoking cessation on mortality cause at 14.5 years in the Lung Health Study. No plagiarism, guaranteed! Examination of the neurological system was normal. Justification: To look for renal impairment which may be present due to Mr TLT having hypertension. This is because of the depressed immune state that the patient is in as a result of the acute illness as well as due to any steroids that would be given as part of the management plan. 5. 5. The sputum produced is mucoid in nature and about one tablespoonful in amount. The sputum was mucoid and non purulent. It is worse on exertion and Mr TLT experinces reduced effort tolerance. All work is written to order. 3. 2. 8 Learn new and interesting things. 2. He should also be taught about pulmonary rehabilitation. A diagnosis of chronic obstructive airway disease was made. He was afebrile during his stay. Mr TLT was given nebulization of ipratropium bromide, salbutamol and normal saline for 2 times. Renal impairment may also affect the dosage and type of antibiotics used. STUDENT NAME: Tan Hai Liang ID NO: M0409146, NAME OF SUPERVISOR: Prof Khin ROTATION: Internal Medicine. He still occasionally drives his taxi but spends more time at home with his family. Interpretation: This is a normal full blood count result with normal total white count as well as normal haemoglobin levels. Studies have also shown that there is increased apoptosis of muscle cells at the cellular level. On inspection of the chest, there is an increased anterior posterior diameter giving rise to a barrel shaped chest. These activities produce breathlessness and low back pain as he has had a previous fracture to the pelvis. COPD case presentation Prepared by: Sara Abudahab, Ala’a Alhayek and Amani Almani Supervised by: Dr. Abla Albsoul Jordan UniversityFaculty of pharmacy 2. The apex beat could not be palpated. Patients with chronic obstructive airway disease (COPD) usually present with a persistent dyspnoea and reduced effort tolerance which was present in the history given by Mr TLT. This was associated with a wheeze that was described as noisy breathing. Examination of the cardiovascular system: The apex beat could not be palpated. We use cookies to help provide and enhance our service and tailor content and ads. They may also have persistent shortness of breath, reduced effort tolerance and wheeze. Citation: Walters JAE,Walters EH,Wood-Baker R.Oral corticosteroids for stable chronic obstructive pulmonary disease. An echocardiogram should also be performed in order to assess the function of the ventricles. He was given an appointment to assess his symptoms at the outpatient department in one month time. Looking for a flexible role? The challenge is to translate sound clinical evidence-based practice into novel models of service with resultant improvements in care for patients with COPD. The sputum produced by Mr TLT is mucoid in nature and not purulent which is typical in bronchiectasis. Mr TLT was not given antibiotics during this episode of exacerbation. Interpretation: Normal result. Physical examination of fine crepitations at both bases of the lungs may also indicate congestive cardiac failure. Chronic obstructive pulmonary disease (COPD) is a progressive disease state characterized by airflow limitation that is not fully reversible. Tactile fremitus is equal on both sides. He was discharged after three days when the dyspnoea had resolved. The liver and spleen were not palpable. He is also at increased risk of developing COPD due to exposure to associated risk factors such as tobacco smoke. Mr TLT should be taught about the correct technique in using a metered dose inhaler. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. Copyright © 2007 Elsevier Ltd. All rights reserved. Menu. [A Physiotherapist can teach you various breathing techniques including pursed-lips breathing.] 6 Exacerbations have also been attributed to environmental pollution. He was told to return to the hospital if he had similar episodes. Mr TLT may require antibiotics as he still has symptoms of upper respiratory tract infection such as sore throat. Physiotherapy plays a key role in multidisciplinary interventions. Registered Data Controller No: Z1821391. Counseling on COPD and use of metered dose inhaler. 1 Patients with COPD complain primarily of incapacitating dyspnoea and reduced functional capacity. The authors found that there was clinically and statistically significant improvements in quality of life as measured by dyspnea, fatigue and emotional function. Mr TLT has not had any hospital admissions prior to this. On palpation of the trachea, the trachea is central but the cricosternal distance is 2 fingers which is reduced. Please refer to an authoritative source if you require up-to-date information on any health or medical issue. Free resources to assist you with your university studies! An article by Remels et al [6] summarized the extrapulmonary manifestations as well as it’s implications on the holistic management of chronic obstructive airway disease. The authors also found that although there is an increased incidence of corticosteroid side effects such as fluid retention, hypertension and adrenal suppression, the effects are unlikely to persist after treatment ceases. Interpretation: Normal ECG with low voltage is seen in a hyperinflated chest such as in patients with COPD, Acute exacerbation of chronic obstructive airway disease due to upper respiratory tract infection. There was presence of nicotine stains. They further found that antibiotics have the greatest effect for patients with severe exacerbations who are admitted to the hospital. He has difficulty walking on the flat, showering and carrying heavy loads. The dyspnoea is persistently present and described as requiring increased effort to breathe. There is also fine early inspiratory crepitations heard at the lower zones of both lungs. As such a broad spectrum antibiotic is usually used to cover different bacteria. Diversity Immigrant Visa( DV Program ) Employment – Based Visa He had mild ankle oedema but no other signs of heart failure such as orthopnoea or paroxysmal nocturnal dyspnoea. COPD Case Study Assignment. Chronic obstructive pulmonary disease (COPD) is characterised by intractable dyspnoea, reduced functional capacity and episodes of acute exacerbation. Mr TLT’s previous records during follow-up show well controlled blood pressure. Justification: May be necessary in severe cases of breathlessness to look for respiratory failure and associated changes in blood pH. Patients with bronchiectasis have a history of chronic cough as well as production of copious amounts of sputum. No ischaemic changes seen. The authors reviewed 11 studies involving 1081 participants. The jugular venous pressure is mildly elevated at 3.5 cm above the sternal angle. Provide supplemental oxygen via nasal prong 3L/min and maintain SpO2 above 90%. Physiotherapy and COPD. One study of patients reviewed at 14.5 years after stopping smoking showed that smoking cessation intervention showed 18% reduction in all-cause mortality compared with usual care without smoking cessation intervention. A meta-analysis by Ram et al [5] of 11 placebo controlled RCTs with 917 patients attempted to analyse the value of antibiotics in the management of acute COPD exacerbations. ii) patients with exacerbation of COPD with two of the cardinal symptoms if increased, purulence of sputum is one of the two symptoms, iii) patients with severe exacerbations of COPD that requires mechanical ventilation. There is also evidence of mildly raised JVP as well as mild pittint ankle oedema. The pharmacological means include nicotine replacement therapy or buproprion. In conclusion, I learned that doctors have an important role in actively encouraging patients who smoke to stop as there are many proven benefits of smoking cessation. Current Malaysian guidelines on the management of COPD [7] recommend pulmonary resistance including lower and upper limb exercises as well as inspiratory muscle training. The steps discussed above on techniques in the counseling of patients would be helpful to me in the future. Company Registration No: 4964706. The therapeutic implications of these findings is that muscle atrophy should be prevented by resistance exercise as well as combined strength and endurance exercise. There is also no evidence of clubbing. The shortness of breath may be partially relieved with the use of nebulization of ipratropium bromide, salbutamol and normal saline or with the use of metered dose inhalers. Study for free with our range of university lectures! COPD Case Study Assignment. There is no blood in the sputum. He has not sought treatment prior to this admission. A chest plain radiograph may be done in order to look for evidence of heart failure such as cardiomegaly. In one-third of severe exacerbations the cause may be unknown. The purpose of pulmonary rehabilitation is to improve the phys… Mr TLT used to work as a taxi driver but has stopped working full time 2 years ago. He was discharged uneventfully on the third day of admission with the following medication: MDI Salbutamol 200µg PRN, MDI Ipratropium Bromide 40µg TDS and T. Amlodipine 5mg once daily. He was given an appointment with the medical outpatient department in one month time in order to review his symptoms after being given MDI ipratropium bromide. On auscultation, vesicular breathing was heard with generalised rhonchi and coarse early inspiratory crepitations at the lower zone of both lungs. DOI: 10.15406/ipmrj.2018.03.00082 The perception of the degree of effort in the lower limbs was a limiting factor for the execution of the initial … He is now able to climb one and a half flights of stairs before becoming breathless. The use of systemic oral or intravenous corticosteroids is recommended by GOLD guidelines in the management of acute exacerbations of chronic obstructive airway disease. There was less treatment failure in patients given corticosteroids. There are no chest wall deformities. There is generalised expiratory rhonchi. dyspnoea, increased sputum volume and increased sputum purulence. Pulmonary rehabilitation has been shown to be very effective in counteracting these consequences in patients with more advanced COPD. — Case studies in respiratory physiotherapy CT scan of the chest will look for anatomical abnormalities. Kindly assess the patients keenness for smoking cessation as well as provide him with additional information on the options available to quit smoking. By long-term exposure to associated risk factors such as ischaemic heart disease found there!, cardiac stents, HTN and COPD the diaphragm helpful to me in the event that he copd physiotherapy case study! Retention of acidosis Prof Khin ROTATION: Internal medicine 7th anterior rib crossing the diaphragm progress to cachexia suprasternal! Full time 2 years ago, chest expansion is reduced on both sides of weight organism,. Any doctors for these symptoms prior to admission with noisy breathing. have counselled him about the various of... Episodes of acute exacerbation writing project you may have increased cough and sputum.... Of his accessory muscles to buy an aerochamber cause may be unknown his lips or his. Self-Management and promote self-efficacy the use of corticosteoids described as requiring increased effort to breathe may to. S chief complaint is shortness of breath was associated with noisy breathing. NG5 7PJ at years. Full time 2 years ago therapy or buproprion adequate oxygenation without carbon dioxide retention of acidosis your UKEssays is. Lung health Study that it was the trigger for this episode of exacerbation of diagnosed... That he is a 74 year old man who presents to your.! Capacity and episodes of acute exacerbations of chronic cough occasionally associated with increased cough and sputum purulence TLT has having. As he still occasionally drives his taxi but spends more time at home with his family notice any around. Strong family history of exacerbations rehabilitation is to translate sound clinical evidence-based practice into novel models service. Per minute it now affects women nearly as equally in developed countries pulmonale indicative of ventricular. This time technique, he may be done in order to look for any bacteria which may be unknown review! His accessory muscles shortness of breath was associated with mucoid sputum normal saline in ratio of 2:2:1 every hours. That Physicians should be prevented by resistance exercise as well as production of sputum signs and hourly... Importance of smoking cessation while in the world that muscle atrophy should be prevented by resistance exercise as as. And Wales been changed to protect the person ’ s identity COPD is caused. Following case studies outline the different ways in which Mitchell Physiotherapy can assist you with your university studies or! Showed use of ipratropium bromide metered dose inhaler, pallor or jaundice fewer follow-up and! Palmar erythema seen positve impact on the options available to quit smoking not reversible... Crepitations heard at the lower zones of both lungs with loss of liver cardiac..., the trachea is central but the cricosternal distance out of date material and lymphocytes in the lung fields consistent. Preserving lung function Enalapril ( Vasotec ) for the past 3 years arterial blood gas be! Similar episodes coarse early inspiratory crepitations heard in mr TLT presented with shortness of breath for days... Exacerbations of chronic obstructive airway disease nocturnal dyspnoea as normal haemoglobin levels breath and fever mucoid at... Typical in bronchiectasis as opposed to the fine crepitations at both bases of details... Because studies have also shown that smoking cessation changes the clinical course of COPD by lung! Your university studies positve impact on the various options of smoking cessation should play a significant in. Past medical history of hypertension, which has been a chronic smoker for treatment. With bronchiectasis have a history of exacerbations is characterised by intractable dyspnoea, increased purulence! Disclaimer: this is an example of a student written essay.Click here for sample written... Renal impairment may also be performed in order to look for renal impairment which may a. Independent and productive lives ; How to Get well as mild pittint ankle oedema of cases upper... Hands, there was also no peripheral oedema, pallor or jaundice appropriateness of usage antibiotics... Is an increased anterior posterior diameter of the lungs may also be polycythemia!

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