Co A At P.docx

Paguio, Krizdan R.

A:> Pt. imp: Pt. was Dx c moderate chronic bronchitis, is willing and cooperative to undergo PT Mx, and has a fair rehab potential d/t willingness to change smoking habits, progressive state of the disease, absence of cardiac problem, absence of mm atrophy and contracture, and absence of neurologic involvement. PT Mx will focus on teaching breathing patterns, decreasing mucus on airways, strengthening mm of respiration, and helping the Pt. return to function independently s difficulty. Problem list:  Supervision in all aspects of transfers such as in bed, chair, toilet, tub, and shower transfers, and in walking, and requires moderate assistance (50%) in stair climbing.  Soft, shallow, productive cough  ↓ cardiopulmonary endurance  ↑ mucus production (yellow-green purulent sputum)  Dyspnea  Abdominal mm and diaphragm weakness  Forward head c rounded shoulders  Hypertrophy of B SCM and trapezium mm  Mm spasm of B trapezius and SCM  Crackles  Decreased cadence  ↓ tactile fremitus  Dull, flat resonance  Mediastinal shift to the R  Compensated respiratory acidosis  Barrel chest  Slight nasal flaring  Slight nail clubbing LTG:> p 2 mos of PT Mx (4x/week session), Pt. will achieve the ff:  Perform all aspects of transfers, walking, and stair climbing independently, s difficulty and safely.  Prevent 2° complications such as cardiac problems, and acute exacerbations of chronic bronchitis.  Perform proper breathing and sputum drainage techniques

STG:> p 1 mos of PT Mx (4x/week session), Pt. will achieve the ff:

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↓ difficulty in all aspects of transfers and walking from supervision  complete independence, and in stair climbing from moderate assistance  supervision ↑ cardiopulmonary endurance ↑ abdominal mm and diaphragm mm strength (3+/5  5/5) Demonstrate proper posture ↓ mm spasm of B trapezius and SCM mm Demonstrate proper gait (↑ cadence) ↓ nasal flaring

P:> 1. Postural drainage to remove accumulated secretions from the lungs x 5 to 10’/ position or as long as px is productive (should not exceed 45-60’) a. Percussion, vibration, and shaking 2. Breathing ex x 3-4 cycles to Improve the strength, endurance, and coordination of the muscles of ventilation & decreases respiratory rate and work of breathing & relive episodes of dyspnea. a. Diaphragmatic breathing b. Segmental breathing i. Lateral Costal Expansion/ Lateral Basal Expansion ii. Posterior Basal Expansion c. Pursed-Lips Breathing 3. Positive Expiratory Pressure Beathing x 10-15 cycles x 4-6x x 15’ to mobilize accumulated accumulated secretions and improve their clearance 4. Ventilatory muscle training x 10-15 cycles x 4-6x x 15’ to improve muscles of ventilation: a. . Diaphragmatic training using weights i. application of weights (3-5 lb) over epigastric area ii. Inspiratory resistance training  patient inhales through a device made of narrow tubes of varying diameters. the narrower the tube the greater the resistance iii. Incentive Respiratory Spirometry iv. Glossopharyngeal Breathing x 6-10 gulps 5. Cardiopulmonary endurance tests as tolerated a. Treadmill test b. Walking c. Stationary bike d. Stair climbing e. Sit and stand f. Arm cycle ergometer