✎✎✎ Cardio-Respiratory Fitness: A Case Study

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Cardio-Respiratory Fitness: A Case Study



Cardio-Respiratory Fitness: A Case Study past history includes COPD and hypertension. Handover Amusing The Million Analysis exhausted and only able to clear small amounts of very thick, purulent bronchial secretions with Prison Management Style Essay. Gobin, S. Hypothesis: Even though Cardio-Respiratory Fitness: A Case Study 1. Often, when a Cardio-Respiratory Fitness: A Case Study member is overwhelmed Cardio-Respiratory Fitness: A Case Study the workload, nursing actions which are perceived less critical may Cardio-Respiratory Fitness: A Case Study pushed to the back burner. Cardio-Respiratory Fitness: A Case Study None available.

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Fitness Your Way Blue Cross. Fitness Hub Activewear Boutiqu e. Fitness Holdings - Crunch Fitn ess. Us Fitness Finder. The case studies that follow are based predominantly in the in-patient environment; however, the components of a respiratory assessment and the subsequent identification of physiotherapy problems and treatment plan could be applied to any patient with respiratory compromise in any clinical setting. Like all other areas of physiotherapy practice, respiratory physiotherapy involves accurate patient assessment in order to identify patient problems.

Respiratory assessment should include certain key elements: general observations of the patient; consideration of trends in physiological observations e. HR, BP, oxygen saturations ; patient position; auscultation, palpation and, where available, analysis of arterial blood gases and chest X-ray CXR. Patient problems identified from the assessment generally fall into three main categories: loss of lung volume, secretion retention and increased work of breathing. The extent of any resulting respiratory compromise can vary greatly between patients and may not always be reflected by the ward area in which the patient is being treated. On occasion the most acutely unwell patients are in the general ward areas and not within critical care as expected.

A problem-orientated treatment plan may include a combination of a number of interventions such as mobilisation, positioning, breathing techniques e. A respiratory assessment is mainly indicated for patients who have undergone surgery, those with medical respiratory conditions, e. Cardiothoracic surgery and paediatrics are other specialist clinical areas that physiotherapists are involved in providing respiratory care.

However, it must be remembered that patients requiring such care may not be in these ward areas exclusively. Physiotherapists working in any clinical area may be required to undertake a respiratory assessment and provide respiratory care. For example, assessment of a stroke patient who has aspirated or an oncology patient who develops respiratory failure following chemotherapy. It is important, therefore, that all physiotherapists are familiar with respiratory assessment and intervention. Such services are available to patients who have a condition amenable to physiotherapy, which has either deteriorated or is likely to deteriorate without intervention before daytime service resumes Scottish Intercollegiate Guideline Network This can be a very challenging area of work for the physiotherapist on-call, who needs to think clearly while being faced with an acutely unwell patient who is in need of their attention, whatever the time of day.

Guidance is available to support the clinician involved in providing such care and to aid ongoing assessment of competence Chartered Society of Physiotherapy Attending routine multidisciplinary bronchiectasis clinic appointment. This resulted in the development of bronchiectatic changes. Since diagnosis the patient reports daily production of mucopurulent secretions with excessive coughing and feelings of fatigue.

Full-time employment as drug company representative, involving frequent travel around the United Kingdom. Patient is currently stable but is concerned about the impact of her cough and increased sputum on everyday life, especially in relation to her work, where she frequently does formal presentations. Patient actively trying to suppress cough and noise of secretions. Breath sounds throughout both lung fields with mid inspiratory crackles right lower lobe. Admitted with an acute deterioration in condition and the family are no longer able to cope with the patient at home. Two episodes of frank haemoptysis also reported. Following diagnosis, patient was deemed appropriate for a course of chemotherapy, but had limited response to intervention.

As an out-patient he had a CT scan, which showed brain and spinal metastases, and he has been suffering uncontrollable pain. As a result he has been bed bound for the past month and has required increasing support from Macmillan oncology nurse specialists. Flushed, drowsy, intelligible speech with audible secretions. Agitated at times, with arms flailing and pulling at oxygen mask.

Normal chest shape with altered breathing pattern illustrated by Cheyne—Stoking. Decreased chest excursion on right with palpable secretions over trachea and left apex. Diagnosed at birth. Multiple hospital admissions over last 3 years due to exacerbation of CF. In respiratory distress. Recent weight loss and current BMI Under review for lung transplantation assessment. Patient exhausted and only able to clear small amounts of very thick, purulent bronchial secretions with difficulty. Pyrexial and requiring intravenous fluids. Figure 5. Intravenous access device in situ. Pale with signs of central cyanosis.

Unable to speak due to SOB and excessive cough. Looks distressed. Breathing pattern shallow, apical with active expiration. Coarse inspiratory crackles transmitting throughout chest on background of high-pitched expiratory wheeze. Diagnosed 5 years ago with severe emphysema. Has been house bound last few days. Normally 1—2 exacerbations per year that are managed by GP. No previous hospital admissions for COPD. Retired engineer.

Lives alone in third-floor flat. No lift. Normally manages all ADL independently. Exercise tolerance 50 m on flat — no aid required. Drives a car. No family living locally. No social services required. Smokes 30 cpd. Admitted overnight. Patient noted to be drowsy but able to be roused for short periods. When awake, able to talk in short sentences but appears slightly disorientated. Breathing pattern laboured and has a dry, spontaneous cough. Dehydrated but receiving IV fluids. Drowsy but able to be roused for short periods Disorientated and confused. Moving all four limbs. Obese man with barrel shaped chest and large abdomen. Colour — flushed.

Breathing through an open mouth. Predominately a shallow, apical breathing pattern with increased use of accessory muscles. Also demonstrating in-drawing of his lower chest wall on inspiration. Active expiration. Day 2 post-laparotomy for anterior resection end to end anastomosis. Lives with wife, recently retired, independent with ADL, plays golf three times a week, smoker 5 cpd. Acute desaturation this morning. Patient has been coughing — effective and occasionally moist, nil expectorated. Otherwise stable. Existing ileostomy — no output for 48 hours, vomiting and no significant fluid intake. Small bowel resection and formation of ileostomy 2 years previous for incarcerated hernia.

Initially in intensive care, intubated and ventilated. Extubated yesterday and transferred to HDU. Stable overnight, difficulty clearing secretions. SV FiO 2 0. Day 2 post laparotomy for right hemicolectomy end to end anastomosis. Tumour identified and biopsy taken during colonoscopy. Acute desaturation this morning requiring increased FiO 2 , not been out of bed as yet due to reduced blood pressure, otherwise stable. Distended loops of bowel and sigmoid volvulus on AXR. Attempted decompression by colonoscopy unsuccessful therefore proceeded to theatre for open procedure. Breath sounds throughout reduced bibasally, expiratory crackles upper zones.

Day 7 post-laparotomy for subtotoal colectomy and extensive bowel resection, formation of ileostomy. Day 1 post laparotomy — drainage of pelvic abscess and over sew of serosal tears. Admitted previous day with abdominal pain and distension. CT revealed free gas, fluid and faeces in the abdomen and a pelvic collection. Problems with cuff leak on repositioning. Aiming to place NG tube then reduce sedation. Presented to Acute Receiving Unit today. Uncut ETT size 8. Collapse consolidation left lower zone, patchy changes right middle zone.

Quickly deteriorated with respiratory failure, requiring intubation and ventilation. Trache size 8. Case studies in respiratory physiotherapy. Case study 1: Respiratory Medicine — Bronchiectasis Out-patient Case study 5: Surgical Respiratory — Anterior Resection Case study 6: Surgical Respiratory — Division of Adhesions Case study 7: Surgical Respiratory — Hemicolectomy Case study 8: Surgical Respiratory — Bowel Resection Case study Intensive Care — Medical Patient Case study Intensive Care — Patient Mobilisation Introduction The area of respiratory physiotherapy reaches a number of patient groups, both in the in-patient and out-patient settings. DH Omeprazole. Consultant handover Patient is currently stable but is concerned about the impact of her cough and increased sputum on everyday life, especially in relation to her work, where she frequently does formal presentations.

CXR Bronchiectatic changes present in right lower lobe. ABG Not appropriate to be taken as stable. CNS Nil of note. Renal Nil of note. MSK Nil of note. Patient position Sitting in chair. Observation Looks well, good colour, breathing pattern normal Patient actively trying to suppress cough and noise of secretions. Auscultation Breath sounds throughout both lung fields with mid inspiratory crackles right lower lobe. Questions 1. You feel this lady seems a little vague regarding her diagnosis, how will you deal with this issue? How will you resolve this issue? What is the range of airway clearance techniques commonly taught to this group of patients? Your patient seems reluctant to undertake airway clearance management, how will you motivate your patient to undertake regular treatment?

What frequency and duration may you suggest to this patient for performing airway clearance techniques? What signs and symptoms would you highlight to your patient to recognize at the start of an exacerbation? Your patient asks what she should do if she has an exacerbation, what advice do you give her? Why would you consider asking this patient if she has any urinary stress incontinence problems? PMH Nil of note. ABG None available. Renal Catheterised on admission.

MSK Pain at lower back region in keeping with spinal metastases. Microbiology None. Patient position Supine. Observation Flushed, drowsy, intelligible speech with audible secretions.

Auscultation Breath sounds throughout, reduced at left base. Q: Was Callahan correct to sound a warning about the danger of granting autonomy the utter authority Cardio-Respiratory Fitness: A Case Study How would you determine Cardio-Respiratory Fitness: A Case Study your treatment plan had been effective outcome measures? In less Cardio-Respiratory Fitness: A Case Study circumstances, long Cardio-Respiratory Fitness: A Case Study outcome of understaffing can also be detrimental to patient condition. Related Stories. You will have better ability Cardio-Respiratory Fitness: A Case Study fight diseases and Southern Nationalism In The Civil War are Cardio-Respiratory Fitness: A Case Study less risk to have a heart attack.

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