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Respiratory Intervention for Elderly Patient with COPD: A Case Study

This case study discusses the background, evaluation, challenges, and beneficial interventions for an 80-year-old female with COPD admitted to the hospital for pneumonia and shortness of breath. The recommended interventions include upper extremity strengthening, modifying tasks and environment, stress management, and discharge recommendations.

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Respiratory Intervention for Elderly Patient with COPD: A Case Study

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  1. CASE STUDY : s.f. Level II Fieldwork: Baptist Memorial Hospital

  2. background • Name: S.F. • Sex: Female • Age: 80 y/o • Reason for Admit: • o Pneumonia • o SOB for one month • o Recent fall • PMHx: A-fib, breast cancer, CHF, COPD, RA, emphysema, B pleural effusion

  3. PRIOR LEVEL OF FUNCTION • Living Environment: • o Assisted Living Facility (Independent side), lives alone • o 3 rd floor (uses elevator) • o Walk-in shower with grab bars and a shower bench • o Pt uses RW, WC, electric scooter, and O2. Uses RW the most. • ADLs: I/mod I with all ADLs

  4. Evaluation • AROM: WFL Evaluation Goals • Strength: 4/5 Transfer to toilet/tub/WC : SBA, Mod I • Static sit balance: good- Bathing: SBA , Mod I • Dynamic sit balance: fair + Dressing: SBA, Mod I • Standing static/dynamic : Fair Toileting: SBA, Mod I • Bed mobility: CGA/Min A Sitting EOB ADL: 10 min, 20 min • Sit to stand: CGA with HHA • Assist needed with ADLs: Min/Mod A

  5. Progression

  6. CHALLENGES • Decreased respiratory status with movement • Constant oxygen monitoring • Increased RB’s to recover to 90’s • Hard to keep medically stable when sitting up in chair • Anxious with movement • Constant reinforcement that oxygen is within limits >75 • Encouragement needed to sit EOB, increased agitation when pushed to do more • Limited motivation to do activities, due to the discomfort of being SOB • Can lead to depression

  7. Beneficial interventions • Pursed-lip breathing exercises and techniques • Start by practicing technique at rest • Practice in sitting while playing a board game or activity with limited movement • Upper extremity activity, such as donning a shirt or brushing hair • Standing static activity • Brushing teeth at sink, putting on make-up, etc,. • Dynamic standing activity • IADLs, such as cooking or cleaning the house

  8. beneficial INTERVENTIONS • Upper Extremity Strengthening • Pt’s with COPD often use accessory muscles of the shoulder girdle to help them breath • Using these muscles make it harder to engage in unsupported UE activities • UE strengthening by theraband, free weights, etc will: • Increase capacity and endurance to perform ADLs • Reducing oxygen requirement of UE activity • Overall improve quality of life due to participating in ADLs more easily

  9. Beneficial interventions • Modifying the task or environment to fit needs • Schedule activities that require more energy expenditure early in the day • Schedule activities right after bronchodilator use to decrease SOB/fatigue • Support arms during UE activities, such as combing hair, brushing teeth, etc. • Using adaptive equipment or DME if needed • Shower chair in the bathroom • Reacher, sock aide, and shoe horn to donn/doff clothing • Stress Management • Visualization relaxation technique • Well-practiced plan of action if they have a panic attack, so they feel like they have some control • Pursed lip-breathing

  10. Interventions in acute care • Educate client on breathing techniques • Have them demonstrate at rest and with activity • UE strengthening • Theraband exercises • Seated UE aerobic exercise, while using breathing technique • ADL’s with using a modified technique • Seated grooming, bathing, and dressing • Supporting UE’s while performing activity • Teaching them how to use AE if needed

  11. Recommendations for discharge • Discharge to assisted living facility • Utilize energy conservation techniques • Use WC on days when feeling SOB • Shower in a seated position and use AE when needed • Use BSC at night or as needed for energy conservation • Continue to be social and participate in activities offered

  12. Learned experience • With pts who are in respiratory distress you must… • Keep oxygen line connected at all times and monitor closely • Slightest change of position can cause decrease in sats • The pt usually knows their own tolerance, going above that can cause panic/anxiety • When performing transfers pt’s can become dizzy and very SOB • Rest breaks are needed frequently • Make sure the pt utilizes correct breathing techniques, when SOB it is easy to start hyperventilating

  13. References • Radomski, M. and Trombly, C. (2014).Occupational Therapy for Physical Dysfunction.Philadelphia: Wolters Kluwer Health; Lippincott Williams &Williams.

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