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Pneumonia (Plan of Care (Early mobility (Walking, Resistance training …
Pneumonia
Plan of Care
Early mobility
Walking, Resistance training based on pt tolerance
safe and well tolerated and resulted in better functional performance upon discharge (Brahmbhatt, N., Murugan, R., & Milbrandt, E. B. 2010)
Increased time of PT intervention was shown to increase Ventilator weaning success rate (Yang et. al, 2010)
Chest PT would not be included in the plan of care. Research shows that there is little evidence for the effectiveness of chest physical therapy (including percussion and postural drainage) for patients with pneumonia. (Yang M, Yuping Y, Yin X, et al. 2010)
Although chest PT alone is not effective, active cycle of breathing and forced expiratory technique are effective in conjunction with chest PT(Fink J, 2007).
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Starting less difficult and gradually increasing intensity- supine positioning will be transitioned to sitting and standing. Beginning sessions will start with PROM movements to help blood flow and decrease loss of range, breathing techniques i.e. diaphragmatic breathing.
As we advance, we will work on more functional training based on patient goals, transfers and progression of PNF techniques.
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ICF
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Body Structure- Lungs, Heart, Kidneys, Pancreas
Activities- Plays bridge with wife and friends, watches sports
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Personal Factors- 20 pounds overweight, Type 2 diabetes, 75 pack years (1.5 packs x 50 years)
Initial Evaluation
Vital signs: looking at SaO2, blood pressure, respiratory rate, and heart rate
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Functional mobility: Encourage ambulation as tolerated. With patients on mechanical ventilation, research shows that initiating this early on allows patients to return more quickly to ambulating and achieving independence functionally as well. (Brahmbhatt, Murugan, Milbrandt, 2010)
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Outcome Measures
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Manual Muscle Test (MMT)- Muscle strength must be tested to see ability to perform activities of daily living as well as help circulate blood
Two Minute Walk Test (2MWT)- Important to see improvement in endurance, 6 minute walk test may be too intense for our patient
Five Time Sit to Stand (FTSST)- Sit to stand and vis versa transfers are important in ADL's as well as our ability to analyze biomechanics of movement
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Discharge
Subacute rehab seems the most appropriate for this patient. If he is too weak to go home and is not to his prior level of function, a subacute facility will be able to get him strong enough to be discharged home.
If he makes a full recovery, he will be discharged home with home PT. They will focus on functional goals and educate him and his wife on proper techniques for movement.