4. Past medical history:
Difficulty in breathing is present since 4 years
and he was using inhaler since the same,
initially the difficulty was on severe exertion
only.
It became worsen on 02-10-2017, immediately
he got admitted in MM hospital
During the time of admission patient was
having difficulty in breathing, patient is
conscious ,oriented and obeying commands
on that day he was ventilated in SIMV mode
with the help of ET tube.
5. Cont…
06-10-2017 he was done tracheostomy and
connected to a ‘T’ piece connector to the
ventilator
6. Present medical status:
Patient is now(10-10-2017) connected to a ‘T’
piece towards a O2 with 3 liters of O2 on flow
along with atmospheric air.
On and off nebulization is given in addition to
the chest percussion.
7. Associated medical problems:
No associated medical problems.
Socio economic history
patient affordable
Family history
No relevant family history
Personnel history:
Chronic smoker since his age 10,
No habit of drinking.
8. On observation
Body built – mesomorphic
Shape of the chest
Barrel shape
Shoulders forward protruded right 1 inch elevated
than the left.
Spine – functionally kyphosis present
spino-scapular distance left 3 inches
right 3 ½ inches
slump posture in high sitting, forward lean posture
while standing.
9. Respiratory movements:
Respiratory rate - 18 breaths per minute
Rhythm - wheezing
Character - abdomino thorasic
Equality - bilateral diminished
movement
Accessory muscle usage - found
Intercostal retraction – ribs found crowded
posteriorly.
10. Mediastinum:
Apex beat not visible
Miscellaneous:
No sign of scars, sinuses, pulsations and no shiny
over lining of the skin.
12. Palpation:
Apex beat felt.
No signs of oedema found.
No palpable rhonchi, rales found.
Chest movements found symmetrical.
Tactile and vocal fremitus not done due to
tracheostomy.
Miscellaneous:
No signs of tenderness and other
vibrations noticed.
13. On examination:
Percussion:
anteriorly rt side resonant
lt side resonant
posteriorly rt side dull
lt side dull
in axilla rt side dull
lt side dull
14. Auscultation:
Bilateral air entry clear
Type vesicular with prolonged expiration.
Foreign bodies rales, rhonchi or rub not
present
Vocal resonance abscent (tracheostomy).
s1 s2 heard normal there is a pause
between s1 and s2.
22. Both the lung fields are hyper inflated.
lower zones of both the lungs are hazy with
dilated bronchioles.
Dirty lung appearance due to intestinal
alveolar opacities in lower zones.
29. Physiotherapy management:
Respiratory system:
Clearance of airways
Improve chest expansion
Improve cough effectiveness
Improve breathing pattern
Musculoskeletal:
Improve muscle strength and endurance
Circulatory system:
Prevent DVT
Improve and maintain level of functional status
within patient tolerance.
30. Physiotherapy exercises:
mobilization
Made him to sit in a chair upright
Made him to stand from the chair
Instructed to do active movements for lower
extremities
Asked to do wrist clockwise and anticlockwise
rotation
Every 2 hourly 20 reps 2 sets each.
31. Body positioning:
The upright position is optimal
A schedule of four point turning(supine, left
sided and right sided is administered.
The head down position is most suitable for him
Over head abduction of arm while performing
breathing exercise.
Supplemental oxygen:
Low level of O2 deliverd to avoid corbondioxide
narcosis.
32. Bagging:
Positive pressure is initiated by manually
hyperinflating and helps avoiding of
secretions
Breathing and coughing maneuvers taught.
Upper limb strengthening using finger ball
and lower limb endurance are encouraged.