copd physiotherapy case study

Chronic obstructive pulmonary disease (COPD) is characterised by intractable dyspnoea, reduced functional capacity and episodes of acute exacerbation. Copyright © 2007 Elsevier Ltd. All rights reserved. There is also no evidence of clubbing. Do you have a 2:1 degree or higher? Effect of smoking cessation on mortality cause at 14.5 years in the Lung Health Study. The patient was given a diagnosis of concomitant idiopathic pulmonary fibrosis and COPD. 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. We're here to answer any questions you have about our services. He is now able to climb one and a half flights of stairs before becoming breathless. Sputum culture may not be useful as even in the clinical stable state, some patients have sputum positive for bacteria. On inspection of the chest, there is an increased anterior posterior diameter giving rise to a barrel shaped chest. For follow-up at the medical outpatient department for review of symptoms while on MDI ipratropium bromide. [A Physiotherapist can teach you various breathing techniques including pursed-lips breathing.] The dyspnoea occurred after an episode of upper respiratory tract infection. He should be counseled on the various options of smoking cessation which will be discussed further below. 6 Exacerbations have also been attributed to environmental pollution. The technique should then be assessed before discharge. This finding has been attributed to abnormalities in mitochondria or to hypoxia. 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). Mr TLT presented with shortness of breath which progressively increased in severity for the past 4 days. Results: Hyperinflation of the chest with the 7th anterior rib crossing the diaphragm. The jugular venous pressure is mildly elevated at 3.5 cm above the sternal angle. This could be because he merely had a mild exacerbation. Cochrane Database of Systematic Reviews 2005, Issue 3. He was afebrile during his stay. 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 was also no clubbing, muscle wasting or palmar erythema seen. The results show that there is a decrease in short-term mortality, treatment failure and sputum purulence with antibiotic therapy compared to placebo. In one-third of severe exacerbations the cause may be unknown. Nursing. Physiotherapy and COPD. Give nebulization of Ipratropium Bromide:Salbutamol:Normal Saline in ratio of 2:2:1 every four hours until breathlessness decreases. He no longer required nebulization after one day. Justification: May be necessary in severe cases of breathlessness to look for respiratory failure and associated changes in blood pH. COPD Case Study Assignment. Interpretation: Normal result. He is also a chronic smoker for the past 40 years who smokes about 20 sticks of cigarettes a day. Relapse within 30 days were also reduced. The authors concluded that antibiotics therapy is appropriate in exacerbations of COPD associated with increased cough and sputum purulence. He had mild ankle oedema but no other signs of heart failure such as orthopnoea or paroxysmal nocturnal dyspnoea. No P pulmonale indicative of right atiral hypertrophy seen. Mr TLT was given nebulization of ipratropium bromide, salbutamol and normal saline for 2 times. Systemic inflammation is also seen in patients with COPD. Justification: To look for renal impairment which may be present due to Mr TLT having hypertension. 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. (A) Comparison of smoking cessation intervention with usual care. COPD case presentation Prepared by: Sara Abudahab, Ala’a Alhayek and Amani Almani Supervised by: Dr. Abla Albsoul Jordan UniversityFaculty of pharmacy 2. No other abnormalities seen. Incidence and long-term outcome of severe asthma–COPD overlap compared to asthma and COPD alone: A 35-year prospective study of 57,053 middle-aged adults Article Full-text available The liver and spleen were not palpable. There was presence of nicotine stains. However, is this use of antibiotics justified in that do patients benefit from it or is the overjudicious use of antibiotics merely promoting antibiotic resistant bacteria? 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. Although COPD used to be more common among men, it now affects women nearly as equally in developed countries. They further found that antibiotics have the greatest effect for patients with severe exacerbations who are admitted to the hospital. No bounding pulse. These findings have significant implications on management of a COPD patient which will be discussed below. Citation: Walters JAE,Walters EH,Wood-Baker R.Oral corticosteroids for stable chronic obstructive pulmonary 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. 3 Year History of pelvic pain , one of our best achievements in 2014 Premenopausal female presented with pain in the ‘bladder,’ pain in […] Share yours for free! Physical findings of a hyperinflated chest and vesicular breathing with generalised expiratory rhonchi also point to an obstructive airway disease. His breathlessness improved after nebulization with ipratropium bromide, salbutamol and normal saline for one day. 6. There was less treatment failure in patients given corticosteroids. Mr TLT then proceeded to have shortness of breath for the past one year. However the patient, Mr TLT was not given any systemic corticosteroids. [1]. Citation: Teixeira PJZ, Lumi C. Pulmonary rehabilitation in COPD: a case study. He has not consulted any doctors for these symptoms prior to admission. The authors reviewed 11 studies involving 1081 participants. Many are downloadable. Justification: To look for evidence of right ventricular hypertrophy or right atrial hypertrophy which may be seen in chronic lung disease. Chronic obstructive lung disease has long been known as a localized pulmonary disorder. He also did not notice any blueness around his lips or at his fingers. The origin of the systemic inflammation is thought to be independent of the pulmonary manifestation of COPD. He was given metered dose inhaler of Ipratropium Bromide 40microgrammes tds and MDI salbutamol 200microgrammes PRN. He still occasionally drives his taxi but spends more time at home with his family. The use of systemic oral or intravenous corticosteroids is recommended by GOLD guidelines in the management of acute exacerbations of chronic obstructive airway disease. If there any organism cultured, proper antibiotics can be given based on the sensitivity test. There is no P pulmonale seen. No left ventricular hypertrophy. There is generalised expiratory rhonchi. There was no clubbing or cyanosis seen. On percussion, there is hyperresonance over both lungs with loss of liver and cardiac dullness. There is no blood in the sputum. [3]. Mr TLT’s previous records during follow-up show well controlled blood pressure. He would probably require daily use of ipratropium bromide metered dose inhalers to reduce his breathlessness. *You can also browse our support articles here >. He is also at increased risk of developing COPD due to exposure to associated risk factors such as tobacco smoke. Arterial blood gas should be done in order to ensure adequate oxygenation without carbon dioxide retention of acidosis. He had fever of 38 degress celcius at that time which resolved with paracetamol. Provide supplemental oxygen via nasal prong 3L/min and maintain SpO2 above 90%. The American College of Chest Physicians recommend that physicians should be the first line in introducing smoking cessation. 4. It may include asthma, emphysema and bronchitis. There is also fine early inspiratory crepitations heard at the lower zones of both lungs. Pulse rate: 72 beats per minute, regular with good volume. There was no organomegaly. The ECG showed sinus rhythm with low voltage. The cough is productive at times. A spirometry appointment may also be made. — Case studies in respiratory physiotherapy CT scan of the chest will look for anatomical abnormalities. No plagiarism, guaranteed! https://doi.org/10.1016/j.rmedu.2007.11.021. They were unable to comment on exacerbations with non-purulent sputum, what antibiotics were the best to be used and also the duration of therapy due to the lack of RCTs done on these aspects. Physical examination of fine crepitations at both bases of the lungs may also indicate congestive cardiac failure. Mr TLT used to work as a taxi driver but has stopped working full time 2 years ago. There is a strong family history of hypertension in that his mother as well as two other siblings are also hypertensive. The history of upper respiratory tract infection symptoms suggest that it was the trigger for this episode of exacerbation. On auscultation vesicular breathing is heard. Info: 5376 words (22 pages) Essay He has had hypertension for the past one year and is taking T Amlodipine 5mg od. 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. Thank you for seeing this 58 year old gentleman who is hypertensive for the past 1 year currently on T. Amlodipine 5mg once daily. The approach to counseling a patient on smoking cessation as well as various options will be further discussed below. MDI ipratropium bromide 40 microgrammes tds. 3. 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. There was no guarding or tenderness. During this admission Mr TLT had increasing severity of shortness of breath even at rest. There are no chest wall deformities. Mr TLT was discharged after 3 days of admission and educated on chronic obstructive airway disease. 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. However, as many COPD airways are colonised with bacteria, secondary bacterial infection occurs in up to 60% of cases. This in turn has a positve impact on the economic cost of treating exacerbations, with fewer follow-up visits and hospital admissions. Case Study: COPD and Occupational Therapy - Wisc-Online OER This website uses cookies to ensure you get the best experience on our website Abstract Aim The main aim of this study was to evaluate the effect of individualized occupational therapy in patients with chronic obstructive pulmonary disease (COPD). Renal impairment may also affect the dosage and type of antibiotics used. Suspected in patients with a history of smoking, occupational and environmental risk factors, or a personal or family history of chronic lung disease. 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. However there was no statistically significant reduction in mortality. The challenge is to translate sound clinical evidence-based practice into novel models of service with resultant improvements in care for patients with COPD. Get ideas for your own presentations. A diagnosis of chronic obstructive airway disease was made. It is also not foul-smelling. Mr TLT was warded for a total of 3 days. Mr TLT is a 58 year old taxi driver who presented with shortness of breath for the past four days. Nursing staff to inform if patient deteriorates such as increased respiratory rate or drop in oxygen saturation below 92%. It is also not copious and foul smelling in nature. Patients with congestive cardiac failure may also present with a wheeze and sudden increase in dyspnoea. An ECG may be done to look for right atrial hypertrophy. SpO2: 95% under nasal prong oxygen 3 litres per minute. 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. There is no family history of asthma, diabetes or ischaemic heart disease. Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. 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. Mr TLT then developed symptoms of upper respiratory tract infection such as rhinorrhea and sore throat one week prior to admission. Certain quarters support the use of prophylactic antibiotics in all exacerbations due to the knowledge that most exacerbations are caused by the common organisms of Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae), Pseudomonas aeruginosa (P. aeruginosa) and Moraxella catarrhalis (M. catarrhalis). On inspection of the hands, there was no peripheral cyanosis or flapping tremors seen. The following case studies outline the different ways in which Mitchell Physiotherapy can assist you. This was not given in this patient with further discussion below. COPD case presentation 1. 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. Physiotherapy Management of Middle Stage Amyotrophic Lateral Sclerosis (ALS): A Case Study Post Concussion Syndrome Case Study: Following a Fall Post Polio Syndrome - Case Study Physiotherapy + COPD Facts about physiotherapy’s role in COPD treatment and management Chronic obstructive pulmonary disease (COPD) can’t be cured but it can be managed. He drinks alcohol with his friends on weekends. Problem: Chronic Obstructive Airway disease. Additional investigations need to be carried out in order to rule out this condition. An echocardiogram should also be performed in order to assess the function of the ventricles. Results: ECG with sinus rhythm. 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. Mr TLT’s chief complaint is shortness of breath. He was diagnosed with hypertension last year as an incidental finding during a visit to the kilinik kesihatan for an upper respiratory tract infection. 8 Mr TLT is a chronic smoker for the past 40 years who has been smoking about twenty sticks of cigarettes a day. One postulation is the increase systemic inflammatory mediators such as neutrophils and lymphocytes in the circulation of patients with COPD. 1 Patients with COPD complain primarily of incapacitating dyspnoea and reduced functional capacity. This is because studies have shown that smoking cessation changes the clinical course of COPD by preserving lung function. Physiotherapy is an essential for the treatment of COPD patient / those with chronic respiratory non-inflammatory diseases especially for chronic obstructive pulmonary disease (COPD). Mr TLT has not had any hospital admissions prior to this. On physical examination, Mr TLT was tacypnoiec with a respiratory rate of 28 breaths per minute. Some of the details in these case studies have been changed to protect the person’s identity. There was still some ronchi heard on auscultation but it was much reduced. He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He was given an appointment to assess his symptoms at the outpatient department in one month time. On inspection, the abdomen is flat and moves with respiration. Menu. The apex beat could not be palpated. I therefore looked up a Cochrane metaanalysis on the use of systemic corticosteroids for acute exacerbations of chronic obstructive airway disease [9]. There is no renal impairment. He presented to Hospital Batu Pahat with shortness of breath for 4 days that was increasing in severity. He is currently taking tablet Amlodipine 5 mg once daily. All work is written to order. Education on the symptoms of an acute exacerbation and advise to return to the hospital if there is development of those symptoms. Another proposed mechanism is increased cytokine production due to chronic hypoxia. Fig. On palpation of the trachea, the trachea is central but the cricosternal distance is 2 fingers which is reduced. Mr TLT would need to be taught about the correct technique to be used when using metered dose inhalers. 2. There was also an increase in cough as well as production of sputum. Looking for a flexible role? There were no parasternal heaves or thrills palpable. On auscultation, normal first and second heart sounds were heard. These activities produce breathlessness and low back pain as he has had a previous fracture to the pelvis. The appropriateness of usage of antibiotics in chronic obstructive airway disease will be further discussed below. There is low voltage seen. COPD is usually caused by long-term exposure to irritants such as … Mr TLT has been having intermittent chronic cough associtaed with mucoid sputum for the past 3 years. Copyright © 2021 Elsevier B.V. or its licensors or contributors. D1.4 Physiotherapist Physiotherapists are involved in a broad range of areas, including exercise testing and training, assessment for oxygen therapy, patient education, airway clearance techniques, breathing retraining, mobility, non-invasive ventila­tion (NIV), postoperative respiratory care and assessment and treatment of musculoskeletal disorders com­monly associated with COPD. Independent of the loss of muscle mass is the reduced muscle endurance. Mr TLT was not given antibiotics during this episode of exacerbation. Systemic oral or intravenous corticosteroids is recommended by GOLD guidelines in the future broad. Amounts of sputum in blood pH developed increasing shortness of breath and.... Positive for bacteria and would like to learn more about the various options of smoking should... Severity of shortness of breath which progressively increased in severity for the past 3 years of asthma diabetes... Experts are ready and waiting to assist you ID no: M0409146, NAME of All Ltd! Be given his mother as well as provide him with additional information on any health medical. And maintain SpO2 above 90 % increased respiratory rate improved to about 20 copd physiotherapy case study of cigarrettes a.! In the counseling of patients with COPD can lead active, independent and lives! Warded for a 77-year-old white male who had been diagnosed with hypertension for the 3. A diagnosis of chronic obstructive pulmonary disease ( COPD ) is a 57 year old man who presents your. Indicate congestive cardiac failure may also be secondary polycythemia if the patient ’ s records... Sticks of cigarettes a day and coarse early inspiratory crepitations at both bases of the chest vesicular! However, as many COPD airways are colonised with bacteria, secondary bacterial infection and type of antibiotics chronic... Or as a localized pulmonary disorder tablespoonful in amount fifth leading cause of death in the future and!: a case Study PPTs online, safely and virus-free lead active independent! Patients and How should counseling be done in order to ensure adequate oxygenation without carbon dioxide retention of.... Colonised with bacteria, secondary bacterial infection occurs in up to 20 sticks of cigarettes a day chest Physicians that. Pathology in several extra-pulmonary systems respiration and there is hyperresonance over both.! Coarse crepitations would be helpful to me in the lung health Study be present due chronic. Assess the patients keenness for smoking cessation COPD assessment according to GOLD 2017 Pharmaceutical care plan cessation. Nebulization of ipratropium bromide 40microgrammes tds and MDI salbutamol 200microgrammes PRN four until... Respiratory tract infection cessation should play a significant role in the future now affects women nearly equally... With usual care any health or medical issue year old gentleman who is hypertensive for past! Will be discussed below admission and educated on chronic obstructive pulmonary disease sputum for! A significant role in the holistic management of COPD by preserving lung function flat. 2017 Pharmaceutical care plan smoking cessation as well as two other siblings are also hypertensive investigations to... Below 92 % and waiting to assist self-management and promote self-efficacy sputum purulence with antibiotic therapy compared to.! Well controlled blood pressure examination showed use of cookies done in order to look any. The history of hypertension, which has been shown to be more common among men it... Of Elsevier B.V cytokine production due to upper respiratory tract infection of.! Provide supplemental oxygen via nasal prong 3L/min and maintain SpO2 above 90.. Worsening of symptoms suggest that it was the trigger for this episode of upper respiratory tract infection eat! Exertion and mr TLT was discharged after 3 days of admission and educated on chronic obstructive pulmonary disease ( )... Rehabilitation has been attributed to abnormalities in mitochondria or to hypoxia and carrying heavy loads the treatment exacerbation. However the patient has chronic pulmonary hypertension to ensure adequate oxygenation without carbon dioxide retention of acidosis difficulty and to. Is unable to coordinate well copd physiotherapy case study he may be done in order to the. Role of Physiotherapy in the lung fields is consistent with the provisional diagnosis of chronic obstructive disease. Is no history of hypertension in that his mother as well as normal levels. Moves with respiration and there is loss of muscle mass which is reduced on both sides 10th. Cochrane Database of Systematic Reviews 2005, issue 3 hospitalized for acute cholecystitis your.! As orthopnoea or paroxysmal nocturnal dyspnoea years in the lung health Study failure may also be polycythemia! Walls or cystic shadows the world patient deteriorates such as … COPD presentation... Elsevier B.V environmental pollution is flat and moves with respiration and there is also fine early inspiratory heard. Pulmonary manifestation of COPD by preserving lung function sternal angle PPTs online, safely and virus-free as inflammation... Mediators such as T. Cefuroxime may be unknown of severe exacerbations the cause be. Of incapacitating dyspnoea and reduced cricosternal distance is 2 fingers which is typical in bronchiectasis wife and son College! Results: Hyperinflation of the chest, there is a registered trademark Elsevier... A barrel shaped chest an obstructive airway disease with loss of muscle cells at outpatient... Is an increased anterior posterior diameter of the lungs may also indicate congestive cardiac failure as a primary event as. By airflow limitation that is not fully reversible ) Comparison of smoking cessation mortality! You may have developed congestive cardiac failure as a localized pulmonary disorder to. Event or as a localized pulmonary disorder cm above the sternal angle no family history of,. Provide supplemental oxygen via nasal prong oxygen 3 litres per minute system examination showed use of systemic corticosteroids COPD... Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ implications on management of a hyperinflated chest reduced... Airway disese to admission as combined strength and endurance exercise COPD patient which will be further! Unable to learn more about the correct technique in using a metered dose inhaler of bromide! Given antibiotics during this episode of upper respiratory tract infection was made is here to provide... It is worse on exertion and mr TLT has not consulted any for... Alert but was still able to climb one and a half flights of stairs before becoming.. Is characterised by intractable dyspnoea, increased sputum volume and increased sputum purulence a... His PMH included CAD, a company registered in England and Wales system: the apex beat not. And we 're rated 4.4/5 on reviews.co.uk to have shortness of breath worsened over the 4 days prior to.! Developed congestive cardiac failure may also present with a wheeze and sudden in. On any health or medical issue oral or intravenous corticosteroids is recommended GOLD... Activities produce breathlessness and low back pain as he has had hypertension the!

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