Week 1 STARES - Joondalup Cardio

Situation
Mrs X is a 39 yr female admitted 2 days prior with suspected panceatitis. Following hospitalization she suffered from significant SOB and decreased exercise tolerance with no known cause for the condition. Chest physiotherapy was requested to assess her cardiorespriratory limitations and intervene with appropriate treatment.

Task
Chest physiotherapy was requested to improve her SOB and exercise tolerance so that she may be able to cope with surgery to treat her pancreatitis and the expected post-op deconditioning / complications more effectively. This involved assessment to determine her current status from a cardiorespiratory point of view and then determining a treatment regime to address these concerns.

Action
Initially subjective questioning was used to gain an insight into the patient’s history. ie. any Hx of SOB, previous exercise tolerance, cough, sputum production, pain, dizziness, home environment & other Social History questioning. I then assessed the patient’s vitals and carried out auscultation posteriorly and assessed the movement of the chest. I had the patient cough & noted if it was productive, moist and it’s strength.

Based on the assessment results and the patient’s previous activity levels I determined that mobilization and deep breathing exercises would be the best intervention based on her presentation and assessment results.

Result
Prior to physiotherapy intervention the patient was significantly SOB so with mobilization this increased. The patient was noticeably shakey and required very close assistance to provide support and reassurance. Re-auscultation did not show any changes.

Evaluation
The desired outcome was mobilization of the patient which was achieved but there were a couple of things that could be worked on. The patient had a number of attachments; IDC, PCA, IV line and O2 supply. I found myself trying to figure out on the spot quickly how to organise things. It is a very simple thing but if one gets it wrong the patient can quickly lose confidence in what the therapist is doing for them.

Also during auscultation I was measuring posteriorly and during the process the patient predictably became SOB. I had warned the patient to let me know if she did feel SOB but I should have constantly been checking on her. Because I had to wait for the patient to recover the session was extended thus lengthening an already long process for the patient.

Strategies
In the next situation I will be prepared to know how to arrange the attachments effectively and efficiently without putting the patient in harms way. I will look at the notes to identify likely scenarios and also upon entering a room I will immediately identify the equipment and how to organize it
With the auscultation, a patient that is markedly SOB there should be planned rest periods so either break the assessment in halves or even thirds so that effect and similar depth breathing occurs throughout to achieve an accurate assessment of the lungs.