Example Case Study

MrSapphireisa63yearoldmaleadmittedwithalowerrespiratorytractinfection.

HistoryofPresentingIllness
cough,sputumandshortnessofbreathfor1/52priortoadmission

PastMedicalHistory
Chronicbronchitis
Exsmoker

SocialHistory
Livesathomewithwife
Occupationownbusiness
IndependentwithallADLs

PhysiotherapyAssessment:
MrSapphirereportshiscoughiscurrentlyproductiveofcupthick,greensputum.
Hereportshavingdifficultyclearingsecretionsatthemoment,particularlywhenhe
isbreathless.Henormallycoughsonlyoccasionallythroughoutthedayandis
productiveofasmallamountofcreamysputum.

Onexamination:
Resp: Ausc:widespreadcoarsecrackles(R)>(L)
RR:16/min
Cough:fair,moist,nonproductive
Sputum:thick,green,difficulttoclear

Temp: 37.4oC

Attachments: Intravenous(IV)lineforfluids

Medications Salbutamol(bronchodilator)
Qvar(corticosteroid)
AugmentinDuo(antibiotic)

Example Case Study Clinical Questions

1. From the observation chart, record this patients oxygen saturation (SpO2),
blood pressure (BP) and heart rate (HR) at 14:10.
SpO2:95%on4L/minO2vianasalprongs
BP155/82
HR86

2. Based on the case study and observations from the obs chart, identify this
patients primary respiratory impairment. Provide evidence to support your
decision (2 signs and 2 symptoms).
Decreasedsecretionmovement,generally(R)>(L)
Symptom: increasedcough
Thickgreensputum
Difficultyclearing
Signs: widespreadcoarsecrackles(R)>(L)onauscultation
Cough:fair,moist,nonproductive
Sputum:thick,green,difficulttoclear

3. Identify the physiotherapy techniques you will use, and the order in which
you will perform them, to effectively treat this patient. Provide a brief
rationale for your treatment choices.

You will be expected to demonstrate some, or all, of your chosen treatment

strategies.**
IwouldperformtheACBTinamodified(L)sidelyingposition.
TheACBTisacombinationofthoracicexpansionexercises,breathingcontroland
huff.Itimprovesaerationofalveoliwhichallowsairtogetbehindsecretionsand
increaseexpflowratestoincreasesecretionmovement.Themodified(L)sidelyng
positionwillhelptodrainsecretionsfromthemostaffectedside(therightside).

PRECAUTIONS:systolicBP>150mmHgnotappropriateforheaddowntilt

**thetechniquetobedemonstratedintheexamwouldbeACBT

Notealternativestrategiescouldbepercussion/vibrations,breathingcontroland
huff.Ifthestudentsuggestedthesestrategies,allthreetechniqueswouldneedto
bedemonstratedintheexam(basedoncomplexityweightingsforeachtechnique).