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Case Presentation - 1

A 75-year-old male presented with shortness of breath and dry cough for 10 days. Investigations revealed a pleural effusion on the left side of his lungs. Physiotherapy management included patient education, breathing exercises to reduce work of breathing and improve thoracic mobility, and exercises to increase aerobic capacity and respiratory muscle strength. The goals were to reduce symptoms, improve lung function, and increase independence with daily activities.

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Praneetha
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62 views20 pages

Case Presentation - 1

A 75-year-old male presented with shortness of breath and dry cough for 10 days. Investigations revealed a pleural effusion on the left side of his lungs. Physiotherapy management included patient education, breathing exercises to reduce work of breathing and improve thoracic mobility, and exercises to increase aerobic capacity and respiratory muscle strength. The goals were to reduce symptoms, improve lung function, and increase independence with daily activities.

Uploaded by

Praneetha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Case presentation

-By
Akanksha P.
Akshay w.
Demographic data

Name : Suhas ramchandra Pawgi


Age : 75 yrs
Gender : Male
Occupation : retired (government worker)
Address : suncity,pune
DOA : 27/11/18
DOE : 7/12/18

Chief complaints : breathelessness,with dry cough since 10 days .


HOPI :Patient was apparently well before 25/11/18 ,when he started
suffering from cough (without expectoration).Then in the afternoon of
27/11/18 he experinced severe difficulty in breathing,and also
experinced coughing.As the patient’s breathlessness aggrevated his
daughter in law took him to the hospital.There the doctor told the patient
to get admit.Then the patient was admitted in ICU & investigations were
done.Also medication was started.He was under observation in ICU for
3 days .On 30th december he was shifted to semi private ward and now
currently is under medical and physiotherapy treatment.
Past H/o : Dm since 11 years.
Hypertension
Surgical h/o : none
Drug h/o :INJ.Pan 40; INJ.emset ;INJ azee.
Family h/o : none
Personal h/o :
Sleep : not disturbed
Appetite : reduced
Diet : veg
Addictions : none
Bowel :incontinent
Bladder : clear
Environmental h/o :
Patient lives on 1st floor
Lift available;Indian toilet system;Good ventilation;
Socio economic status
total family members : 6
total earning member : 1
occupation score : 10
income score : 10
education score : 6
according to modified kuppu swami scale patient belongs to upper class
General examination:

BP- 110/60mmhg Temp:afebrile

PR- 86b/min
RR-13b/min
Pallor-present

Oedema –absent
Lymphdenopathy-absent
Icterus-absent

Cynosis-absent
Clubbing-absent
On inspection
Shape of chest: bulging of chest at left side
Movement of chest : symmetrical
Type of breathing : abdomino-thoracic
Expansion of chest : reduced on left side.

Accessory muscles used for respiration

Position of trachea : shifted to right side

On palpation :
-trail’s sign positive
Chest expansion :
2nd intercoastal space -1cm
4th intercoastal space – 2cm
6th intercoastal space – 1cm
Diameter – AP - 24cm
-Transverse – 30cm
ratio:AP-transverse = 4:5

Chest excursion
Anteriorly
2nd intercoastal space – b/l equal.
4th intercoastal space – reduced at left side
6th intercoastal space – reduced at left side
Posteriorly
suprascapular level – reduced at left side
mid scapular level – reduced at lefft side
infrascapular level – reduced at left side

Tactile vocal fermitus


suprascapular level- reduced at left side
mid scapular level – absent at left side
infrascapular level – reduced at left lobe

Anteriorly:
upper lobe: reduced on left side
middle lobe : absent on left side
lower lobe : absent on left side
on percursion

Lobes right lung left lung


Upper lobe resonant resonant
Middle lobe resonant dull
Lower lobe resonant dull

On auscultation
Air entry right lung left lung
Upper lobe normal normal
Middle lobe normal reduced
Lower lobe normal reduced
Posteriorly

Lobes right left


Upper lobe B/l equal
Middle lobe normal reduced
Lower lobe normal reduced

Abnormal sound – not heard.


Vocal resonance : absent in middle & lowerlobe
Functional evaluation : Barthel index score
60/100
Interpretation : patient is minimally dependent

Systemic examination
Cough : present
Expectoration : absent
Breathlessness : grade 2 (according to mmrc ) when hurrying on level or walking
uphill.
Onset: gradual duration:10 days
Investigations:

X-ray:
Pleural fluid in left lower lobe,with compressive volume loss of left
lung with an area of consolidation is seen in left lower lobe
Right lung shows clear parenchyema

Pleural tapping was done on the left lung on 28th november & again on
1st december .there was 1200 cc fluid accumalated in the lungs ‘By first
tapping 60cc was removed and then 50cc of fluid was removed by
second tapping .
Diffrential diagnosis: Pleural effusion
pneumothorax
empyema

Provisional diagnosis: breathlessness secondary to pleural effusion


Physiotherapy diagnosis : breathlessness.
ICIDH2
STRUCTURAL IMPAIRMENTS FUNCTIONAL IMPAIRMENTS
- use of accessory muscles
- air entry reduced to the left side lung
-Fluid filled in pleural space -Drycough
-mediastinal shift
(due to relaxation deep
Fascia of left side) -breathlessness
-chest movement reduced at left lower
lobe(due to pleural efussion present

ACTIVITY LIMITATION
Basic – standing,walking
Instrumental – stair climbing

PARTICIPATION RESTRICTIONS
Personal : basic & instrumental ADL’s
Social : affected since hospitalized
Economic : not affected
Contextual factors

Buffers Barriers
- Patient willing for treatment -Age
-Good family support -comorbid factors
-educated -DM since 11years
-can afford treatment -un-coperative patient

GOALS
-Short term goals - long term goals
1.Patient education 1.increase aerobic capacity
2. increase strength of respiratory
muscles
2.To reduce work of breathing 3.improve endurance
3. To increase thoracic mobilty
Physiotherapy management
Patient education
1.)Patient education & counselling.
Patient must consume high calorie diet which is easy to swallow.
Education of patient & family will help to reduce activity and allow
them to be active particpate in there care

2.)To reduce work of breathing


Following aspiration,breathing exercises to encourage localized
expansion of the affected side are given.

3.)To increase thoracic mobility.


goal: to gain expansion of chest.
Intervention : Thoracic mobility exercises such as side flexion and
trunk rotations.
Rationale: These are exercises which will improve the mobility &
expansion of the chest which ultimately helps for better air-entry into
the lungs.
To increase aerobic capacity

Intervention: spirometry
The patient is instructed how to do spirometry,the spirometer is held
by patient & the patient is instructed to take deep inspiration with lips
sealed around mouthpiece.The ongoing expiration is by a visual
feedback.
Rationale:short inspiration activates flow generated incentric
spirometry with increase in tidal volume
Increase strength of respiratory muscles
intervention:Diaphragmatic breathing;segmental breathing
Rationale : to reduce breathelessness
Patient in lying with semi-fowlers position .

If patient indicates breathing pattern with accessory muscles of


inspiration teach the patient how to relax those muscles.
Segmental breathing
By applying resistance during inspiration
By assisting with pressure along the duribcage ring expiration
Dyspnoea reliveing positions

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