Beverly Holden Flashcards
Mrs Holden has COPD. Explain what COPD is to your examiner as if they are Mrs Holden. Your answer should include the causes of COPD and an explanation of the underlying disease process.
COPD or Chronic Obstructive Pulmonary Disorder is a lung condition associated with inflammation of the airways. Symptoms associated with is condition include SOB, coughing, sputum production which contributes to airway blockage. Can be caused by smoking, exposure to occupational dust/chemicals/fumes, environmental tobacco smoke and occupational or household air pollution.
Symptoms can vary on a spectrum. On one side is emphysema and on the other is chronic bronchitis. Emphysema is characterised by damage to the air sacs in the lungs which leads to the feeling of breathlessness. Chronic bronchitis is characterised by the inflammation and narrowing of the bronchial tubes which are the airways that carry air to and from the lungs. This causes excessive mucus production. In which individuals which produce more sputum are more likely to have chronic bronchitis, while those with structural lung changes in the air sacs are more likely to have emphysema.
Mrs Holden’s goals include going home from hospital, maintaining her independence, and reducing her breathlessness. Using language that Mrs Holden would understand, explain the role of physiotherapy while she is in hospital. Your answer should show your understanding of how physiotherapy interventions can help to Mrs Holden achieve her goals.
- My role is to create a physiotherapy program which will help alleviate some of the symptoms you are experiencing due to your condition. I will also equip you with some techniques which you will be able to perform yourself once you are discharged from the hospital. The treatment plan will focus on breathing exercises to reduce your shortness of breath and help to expand your lungs. The treatment plan will also focus on trying to clear the secretions and phlegm within your lungs
- I’ll be introducing you to two interventions today to hopefully help to reduce your breathlessness
List ONE risk factor for the development of COPD and ONE prognostic factor that may lead to worse outcomes for people with COPD.
Risk Factor: Smoking tobacco
Prognostic Factor: Readmission to hospital
What are Mrs Holden’s respiratory impairments? Provide evidence to support your decision (TWO signs and TWO symptoms). Which is the primary respiratory impairment?
Primary impairment - Gas movement impairment
- Signs: Increase RR (22 at rest) & CXR hyperinflation indicated by low flat hemidiaphragm
Symptoms: SOB at rest & difficulty walking (has to stop to catch breath)
Other impairment - Secretion movement impairments
- Signs: Upon auscultation patient had scattered course crackles & upon spirometry, patient has obstruction
- Symptoms: difficulty clearing sputum and 1tbsp of yellow sputum per day
List ONE of Mrs Holden’s non-respiratory impairments. Describe TWO of her activity limitations and TWO participation restrictions.
- Non-respiratory impairment: GORD
- Activity limitations: walking (can only tolerate 400m walking on slowly on flat ground), & climbing stairs
- Participation limitations: Book club and playing bridge
Choose TWO interventions that you would use for Mrs Holden in your initial treatment session. Explain how your chosen interventions would address her respiratory impairments.
- Upper limb support with forward lean position – Mrs Holden’s CXR shows low flat hemidiaphragms. Forward lean position with push up the diaphragm and encourage a more dome shape so that it works more efficiently and make it easier to breath.
- Breathing control (relaxed breathing) – to reduce the use of the neck and shoulder accessory muscles to reduce upper chest breathing and to calm the nervous system
Choose ONE medication that may assist your treatment effectiveness. Explain your choice.
Bronchodilator (to reduce airway narrowing and to increase expiratory flow rate which will also make it easier to cough)
Choose ONE outcome measure that you would use to assess the effectiveness of your treatment. What findings would you expect if your treatment has been effective?
RR – I would count her respiratory rate as it would be expected that it reduces due to trying to control her breathing and help with her breathlessness so that she reduces the amount of upper chest movement. It indicates that she is breathing more easily and more efficiently.
You would like to refer Mrs Holden to pulmonary rehabilitation. List TWO signs that would suggest Mrs Holden has a ventilatory limitation to exercise.
- Stop exercise due to breathlessness
- Breathing near max capacity (VE/MVV > 85%)
