Pauline Fleming

Question 1

Describe what you would expect to see on a chest x-ray (CXR) in a person with bronchiectasis
compared to a person with pneumonia/consolidation.

Answer 1

• Consolidation: increased opacity in the area of the consolidation, no shift in structures
• Bronchiectasis: thickening and dilation of bronchi (fibrosis)

Question 2

Describe TWO other objective assessment findings that would help you differentiate between
bronchiectasis and pneumonia/consolidation.

Answer 2

Auscultation
Bronchiectasis: course crackles
Consolidation: bronchial breath sounds

CT
Bronchiectasis: Bronchial dilation
Consolidation: no bronchial dilation

Question 3

Mrs Fleming has bronchiectasis. Explain what bronchiectasis is to your examiner as if they are Mrs Fleming. Your answer should include the causes of bronchiectasis and an explanation of the underlying disease process.

Answer 3

• Bronchiectasis is the condition that occurs when the airways which carry air in and out of the lungs get damaged, causing them to widen and become loose. It can be caused as a result of previous infections which affect the airways. Once these airways become loose, they lose their ability to clear out mucus which then causes it to buildup in the lungs which may lead to flare-ups from lung infections.

Question 4

Mrs Fleming’s goals include preventing respiratory infections, reducing her cough, and improving her fitness. Using language that Mrs Fleming would understand, explain how physiotherapy interventions can help Mrs Fleming to achieve these goals

Answer 4

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. The treatment plan will focus on clearing your airway from sputum which will clear the bacteria to reduce the risk of infections. These techniques will include breathing exercises, huffing and coughing techniques to clear the sputum and using a device to break up the sputum in your lungs. I understand that you also want to improve your fitness so using these techniques can help with reducing your breathlessness during exercise but also exercise can help to clear secretions as well. We can also provide you with an exercise regime as a part of your treatment to improve your fitness

Question 5

List TWO prognostic factors that may lead to worse outcomes for people with bronchiectasis

Answer 5

• Frequent exacerbations of lung disease
• Poor adherence to treatment regimes and meds

Question 6

What are Mrs Fleming’s respiratory impairments? Provide evidence to support your decision (TWO signs and TWO symptoms). Which is the primary respiratory impairment?

Answer 6

Primary respiratory impairment - Secretion movement impairment
- Signs: Auscultation show coarse crackles (R)MZ anteriorly & CXR and HRCT show cystic bronchiectasis in the RML and lingula
- Symptoms: daily cough which interrupts her work (despite medication) & 1/2 cup of sputum when well
- Reduced Mucociliary clearance is the main contributor of secretion movement impairment

Other respiratory impairment - Gas movement impairment
- Signs: spirometry show mild restriction + fibrosis which causes breathing difficulty
- Symptoms: SOB during exercise & feels she isn’t as fit

Question 7

Choose TWO interventions that you would use for Mrs Fleming in your initial treatment session. Explain how your chosen interventions would address her primary respiratory impairment.

Answer 7

• Active cycle of breathing technique with huff – to help control breathing and also to get the air behind the mucus via collateral channels which connect alveoli and to then clear them with a huff.
• Acapella – to break up thick and sticky mucus lining airway walls to make it easier to clear with a cough or huff

Question 8

Mrs Fleming has an inguinal hernia and stress urinary incontinence. Explain ONE modification you
would make to Mrs Fleming’s treatment considering these comorbidities.

Answer 8

For hernia, either applying some pressure on area using towel or hands during coughing or huff

Question 9

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?

Answer 9

Auscultation: I would expect a reduction in abnormal added sounds such as course cracking, particularly in the RML