1.
**Increased Work of Breathing**: The patient is noted to be using
accessory muscles, which is often a compensatory mechanism to
overcome respiratory difficulty, suggesting increased work of breathing.
2. **Elevated Respiratory Rate**: The patient’s respiratory rate is recorded
at 32 breaths per minute, significantly above the normal range (12-20
bpm for adults), indicating respiratory distress.
3. **Secretion Retention**: The patient has a moderately ineffective cough
and is producing thick yellow/green secretions. Additionally, reduced
breath sounds on the left base and scattered crepitations are noted,
possibly indicating retained secretions or partial lung collapse (atelectasis)
due to mucus plugging.
4. **Ineffective Cough**: Described as “moderately ineffective,” the cough
is insufficient for clearing secretions effectively. The patient is fatigued,
which further impacts the cough strength.
Other Relevant Issues for Physiotherapy
1. **Post-surgical Recovery (e.g., after ORIF for hip fracture)**: Impacts
mobility, and bedrest can exacerbate respiratory issues.
2. **Pre-existing Health Conditions**: Long COVID, vascular dementia, and
a history of TIAs increase patient susceptibility to respiratory and physical
complications.
3. **Ineffective Cough and Mucus Clearance**: Due to fatigue and weak
cough reflex.
4. **Use of High Oxygen Flow**: This may increase the risk of respiratory
muscle fatigue and requires careful monitoring.
5. **Fatigue and Anxiety**: Compounding the effectiveness of respiratory
and overall physical therapy.
Intervention Plan:
For this patient, a physiotherapy treatment plan should prioritize airway
clearance, improving ventilation, and addressing fatigue to help manage
the ineffective cough, retained secretions, and increased work of
breathing. Here’s a tailored plan:
### 1. **Airway Clearance Techniques**
- **Positioning**:
- Semi-upright (45°-60°) positioning promotes lung expansion.
- Use side-lying with the left side elevated to encourage secretion
drainage from the left lung, where decreased breath sounds were noted.
- **Chest Percussion and Vibrations**: Gentle percussion and vibrations
over the left lung base can help mobilize secretions.
- **Manual and/or Assisted Cough Techniques**: Since the patient has an
ineffective cough, assisted techniques can help, such as gentle manual
assistance on the abdomen to support coughing.
- **Suctioning**: Consider using nasopharyngeal suctioning if secretions
are thick or difficult to clear with other techniques. The patient has
tolerated this before and shown slight improvement.
### 2. **Breathing Exercises**
- **Diaphragmatic Breathing**: Encourage diaphragmatic breathing to
help reduce accessory muscle use and improve breathing efficiency.
- **Pursed-lip Breathing**: This can help control the elevated respiratory
rate and reduce the sensation of breathlessness by improving
oxygenation.
### 3. **Incentive Spirometry or Inspiratory Muscle Training** (if
tolerated)
- This can improve lung volume and support deep breathing, which may
help prevent atelectasis and promote secretion clearance.
### 4. **Functional Mobility and Graded Activity**
- Start with bed exercises for circulation and muscle activation, such as
ankle pumps and isometric exercises for the lower limbs.
- Gradually progress to sitting at the edge of the bed as tolerated to
reduce deconditioning and support overall respiratory function.
### 5. **Energy Conservation and Relaxation Techniques**
- Teach energy conservation strategies to manage fatigue and improve
tolerance for therapy sessions.
- Relaxation exercises to reduce anxiety may help to ease the work of
breathing.
### 6. **Continuous Monitoring**
- Regularly assess oxygen saturation, respiratory rate, and cough
effectiveness during sessions.
- Adjust oxygen therapy as needed based on respiratory status and
patient response to therapy.
This multi-modal approach aims to address the physical limitations and
underlying respiratory issues, improving both respiratory function and the
patient’s overall condition.
