This document presents a case study of a 70-year-old male patient diagnosed with chronic obstructive airway disease who is undergoing physiotherapy treatment. It includes details of the patient's history, symptoms, examination findings, physiotherapy assessment, treatment plan and progress updates. The treatment plan involves chest physiotherapy techniques like percussion and vibration, breathing exercises, posture correction, and improving exercise tolerance. Over follow-up visits the patient is noted to improve in symptoms and functional ability with continued physiotherapy management.

1. CARDIORESPIRATORY CASE
PRESENTATION: CHRONIC
OBTRUCTIVE AIRWAY
DISEASES
NAME: ELDAWATI BINTI HESAPIL
DIP: IN PHYSIOTHERAPY
ID NO:03-200901-00375

2. INTRODUCTION
DEFINITION:
- Chronic Obstructive Airway Disease is a
combination of chronic bronchitis and
emphysema. Both of these conditions are airway
constricting and worsen over time.
ETIOLOGY
- long-term smoking
- secondhand smoke
- air pollution
- extended exposure to occupational chemical fumes.

3. -
PERMANEN DILATATION

4. CLINICAL FEATURE
1. Chronic cough
2. Expectoration of mucus
3. Wheezing
4. Dyspnea on exertion
5. Decrease in expiratory flow rate
6. Increase in residual volume (RV)

5. PATHOLOGY CHANGES
• Increase mucus production or impairment of
mucus clearance
• Inflammation of the mucosal lining of the
bronchi and bronchioles
• Mucosal thickening
• Spasm of the bronchial smooth muscle

6. SYMPTOM
- shortness of breath
- wheezing
- chest tightness
- chronic coughing
- Dyspnea on exertion
- Decrease in expiratory flow rates
- Increase in residual volume

7. TREATMENT
- Although no cure has been discovered for this
condition, symptoms can be treated using:
- bronchodilators,
- inhaled steroids and antibiotics.
- In some cases, oxygen therapy or surgery may
be required.

8. CARDIORESPIRATORY
ASSESSMENT
SUBJECTIVE
Name: MR. N
Age: 70 years old
Sex: Male
Race: Bidayuh
Marital status: Married
Date of assessment: 11/07/2011
Date of admission: 07/07/2011
Doctor diagnosis: Chronic obstructive airway diseases
Doctor management: On Medication

9. PROBLEM
- Difficulty in breathing
HISTORY
Present illness:
- Patient given a nebulizer
- Patient currently cough with whitish sputum associated
with shortness of breath
Past history:
- Multiple admission before with same problem
Past medical history:
- Chest X-Ray: Done on: - 2/01/2011, 27/05/2011,
23/06/2011, and 06/07/2011 for chest
- finding: -the trachea is become lateral shift

10. Past surgical history:- NIL
Drug/steroid:- Neb A:V:N 2:2:2
- salbutamol
- atovent
- nacl 0.9%
Social / occupational history:
- (warga emas) / farming, always use tools like the
mattock
Smoking/Alcohol consumption:- No
Investigation:
- Chest x-ray: Done on: - 2/01/2011, 27/05/2011,
23/06/2011, and 06/07/2011 for chest.
- finding: -the trachea is become lateral shift
-Seen HAZZINESS on the chest x-ray

11. OBJECTIVE ASSESSMENT
OBSERVATION
Vital signs: temperature: 36.7’c
: Respiratory Rate:22/min
: Pulse Rate:112/min
: Blood pressure:
~Interpretation:- taken from nursing chart

12. General observation
i. General health: hypertension
ii. Built: mesomorphic (moderate)
iii. Walking aids: no walking aids
iv. External appliances: no external appliances
v. Internal fixation: no internal fixation
vi. Posture: normal
vii.Gait: normal

13. Local observation
Breathing: pattern:
: Level: apical / diaphragmatic/basal
Chest deformity: Y / N
Coughing: productive/non-productive
effective/ineffective
Sputum: -colour = whitish
-amount = minimal
-consistency = loose
O2 treatment: Yes
Type: nasal cannulae/nasal pronge
= 1 liter / minute

14. PALPATION
Chest expansion: good/ moderate/ poor
Chest measurement:
MEASUREMENT INHALE EXHALE DIFFERENT
AXILLA 81 80 1
NIPPLE 80 79.5 0.5
XIPHI STERNUM 78 77.5 0.5
NO ABNORMAL MEASUREMENT FINDING

15. Percussion note: can’t do to more. Because it maybe increased
sob to the patient
- normal/ hyper resonance/ hypo resonance/ dull
Auscultation: ronchi sound (left lower lobe)
Crepitation: mild / moderate/ coarse/ ronchi/ wheezing/
clear
SPECIAL TEST
Exercise tolerance test:
6 minutes walking test…
3 minutes step test……..
Pulse ratio: 1 min + 2 min
rest
= unable to test to the patient because the patient can’t
walking for long time due to short of breath (SOB). Always
feeling tired.

16. PHYSIOTHERAPY IMPRESSION
- Short of breath
- Secretion retention
- Decreased chest mobility retentions
SHORT TERM GOALS
1. To facilitate removal of secretion
2. To prevent further bronchi spasm
3. To improve pattern of breathing control
4. To teach local relaxation and improve posture
5. To mobilize treatment to shoulder girdle
6. to improve exercise tolerance
7. To give advice

17. LONG TERM GOAL
1. To regain optimal functional activity
2. To prevent cardio respiratory activity
3. To achieve independent functional with out SOB
PLAN OF TREATMENT
1. Chest physio
2. ACBT
3. Posture correction
4. Exercise tolerance
5. Patient education

18. 11/07/2011
S
O
A
P
SAME AS INITIAL ASSESSMENT

19. INTERVENTION
1. Chest physio
* Percussion
- patient in lying position
- doing percussion on the apical chest of
patient, cover with towel (1 layer)
- doing for 1-2 minute
* Vibration
- patient in lying position
- doing vibration on the apical chest of patient
- doing for 3 times

20. 2. ACBT
* Breathing control
- patient in sitting position
- ask patient to breath in and out (inspiration +
expiration)
- do 5 times 3 session daily
* thoracic expansion exercise
- Patient in half lying position
- Shoulder flex through expiration with inspiration
- Shoulder lowering expiration
- Do 5 times, 3 session daily

21. * Effective huffing
- Do 2 to 3 times , 3 session daily
* Effective coughing
- Do 2 to 3 times , 3 session daily
* Relaxation position
- Relax sitting position on bed
- Relax high side lying
- Forward lean sitting
- Relaxed standing
- Forward lean standing
PATIE NT DOING FOR A FEW
MINUTES

22. 3. Posture correction
* using mirror feedback
- patient in sitting position
- ask patient to stabilize their shoulder level.
Do retraction and lateral rotation of the arms
4. Improve Exercise tolerance
- ask the patient to walking slowly around the
bed area 6 time daily
5. Patient education
- ask the patient to continue the exercise 3
session daily.

23. EVALUATION
Patient cooperative and able to perform all
exercise.
REASSESSMENT
Review next visit

24. FOLLOW UP
12/07/2011 – Tuesday
S – patient fell slightly weak for today
- fell pain when breath
- give medication for cough and asthma (-3x/day)
O - look puffiness of the face
- palpation: -chest expansion
= axilla 80-81
= nipple79.5-80
= xiphi sternum 77.5-78
- percussion note: dull sound
- Auscultation: ronchi and wheezing

25. - Functionally: independent
- Breath: have sound present
- Shoulder level: asymmetrical
- Walking aids: NIL
A-still in physiotherapy treatment
P - blowing tissue: but can’t blow for long time
- thoracic expansion exercises
- breathing exercises
- ACBT-deep breathing exercises, huffing ( to
clearing secretion)
- Patient education

26. 13/07/2011 - Wednesday
S- patient fell fever and using nebulizer
- medication: BUSE/ Creatinine
Vital sign =
Temperature: 36.5’c
Blood pressure: 170/90 mhg
Pulse rate: 117
Respiratory rate:23/min
Spo2: 96%
O – No shortness of breath at rest
= taken from nursing chart

27. Auscultation: still ronchi sound
A – continue physiotherapy treatment
P – breathing control
- thoracic expansion exercises
- blowing tissue exercises
- free active exercises
- hold= 1 until 5 only and stop to inhale
- patient education.

28. 15/07/2011-Friday
S- patient felling better today. Face seen cheerful
and cooperative.
- still use nebulizer (on and off )
O- Auscultations:-wheezing
- ronchi
- Vital sign: temperature-36.6’c
blood pressure- 150/90mmhg
pulse rate- 92/min
respiratory- 22/min
spo2- 93%
= from nursing observation chart.

29. A- still continue physiotherapy treatment
P- walking around the bed area(exercises
tolerance)
- hold = 1 until 6 and stop to inhale
- breathing control
- thoracic expansion exercises
- Patient Education
-END-