This paper was quick in emergencies...

This paper was quick in emergenciesed at the APTA Combined Sections Meeting in Seattle, Washington forward February 5, 1999.

A clinical case contemplation is an effective means of demonstrating use of the Patient Management gauge In examining a patient with peremptory emphysema, the pulmonary system impairments will be defined and then related to diagnostic collections A diagnostic pattern will be culled and in examining the patient in 2 different phases of his course of care, the proces of moving a patient from individual diagnostic pattern to another will be illustrated.

EXAMINATION

The initial examination break grounds with a description of demographics revealing a 56-year-old Caucasian male (RH) English speaking, with a chief complaint of progressive dyspnea upon exertion of several years duration. He has undergoed a progressive decline in activity tolerance in the same state [i]or[/i] condition that he is able to work no other than in a seated position. He is referr to physical therapy in conjunction with consideration for lung contortion reduction surgery (LVRS).

The past medical history is barely significant for pneumonia in 1988 and 1994 In 1994 he required intubation and mechanical ventilation. It was at that time that the patient was diagnosed with emphysema, according to his report. Medical management included supplemental oxygen (Oz) on discharge from the hospital.

The history continues with a description of the living environment and social factors. RH is married and has no children. He lives with his wife in a mobile hearthstone with 2 steps to jot down He has a 90 pack by year smoking history, having quit just 7 month ago. There is a history of heavy alcohol use in the past, on the other hand none for 20 years. He is useed as a machine parts assembler and is able to sit all day. He is a self-described "couch potato" with not many outside interests/interactions. He stopped playing golf with an electric cart in 1996 and participates in no other recreation. He does drive and ambulates without assistive devices at a self chosened pace that is little more than a "casual stroll"

Basic and instrumental activities of daily living (ADL) are important aspects of functional status. RH reports he is independent with selfcare and hygiene if it were not that finds showering, bending and donning shoe and sock difficult. He avoids stairs whenever possible. He relies onward his spouse for grocery shopping and carrying budgets and has stopped gardening and lawn care.

Current medications include: Theophylline 300 mg BID, Serevent 2 pants BID, Atrovent 4 puffs QID, and Flovent 3 quick blasts BID. Additional tests and measures available for review include a CT scan reporting diffuse emphysematous changes predominantly at the apices, and a stead air arterial blood gas (ABG) 68/42/739 He has none participated in any form of pulmonary rehabilitation.

REVIEW OF bodys

Having completed the history, the examination ensues with a brief review of classifications to assist in identifying additional health puzzles that require consultation with or referral to another health care provider.' From a cardiovascular perspective, there is no known disease. Vital signs include a heart rate (HR) of 72 respiratory rate (RR) of 20 vital current pressure (BP) of 100/64 and oxyhemoglobin saturation (SpO^sub 2^) of 94% forward room air. The patient is intact from an integumentary stand point. The skin is warm and arid with mild clubbing of the fingers. There is no peripheral edema. There are no musculoskeletal issues or neuromuscular deficits noted. From a psychosocial perspective RH is alert, oriented, and communicates well and described an adequate support plan at home.

TESTS AND MEASURES

The chosened tests and measures for this gentleman include, nevertheless are not limited to, ventilation, respiration, aerobic capacity and endurance, and anthropometric characteristics. Findings include clear breath entires that are diminished throughout. There is an effective cough that is free from moisture and nonproductive. The lungs are hypervesonant from first to last by mediate percussion. At tranquillity there is a synchronously pattern of breathing with a defered expiratory phase.

Pulmonary function criterions include the following:

Forced Vital Capacity (FVC) = 40 L 85% predicted

Forced Expiratory whirl in 1 second (FEV^sub 1^) = 126 L (37% predicted)

FEV^sub 1^/FVC % = 31%

Total Lung Capacity (TLC) = 124% predicted

Residual whirl (RV) = 189% predicted

Diffusing Capacity (DLCO) = 37% predicted

Maximum Inspiratory squeezing (MIP) = - 50 cmH20 (from RV)

The 6 minute walk ordeal is completed with no securitys covering a distance of 1150 feet Hemodynamic answer is appropriate but there is significant oxyhemoglobin desaturation with a globule in SpO^sub 2^ from 94% to 85% during the walk.

Anthropometric characteristics included a height of 71 in or 180 cm and weight of 165 Ibs or 75 kg The patient reported his weight was stable on the other hand appetite poor.

EVALUATION

Following the examination, the evaluation is complet and is reflective of the acuity of the circulating problem, presence of pre-existing conditions, and stability of the condition.1 This leads to a list of impairments, a diagnosis, a prognosis, goals and issues intervention, and criteria for discharge. From the examination findings, it is readily apparent that RH has functional limitations related to selfcare, his character at home, in work and recreation. He is dissatisfied with his health status. The impairments include the ventilatory interrogate with significant airway obstruction and ventilatory muscle weakness. The depressed diffusing capacity and exercise induced desaturation demonstrate impaired gas exchange. Reduc distance secreteed on the 6 minute walk experiment indicates an impaired aerobic capacity. Minimal participation in activities at abiding-place is indicative of impaired part performance for instrumental ADL.