Case study 1Your patient is a 76 year-old female who has been

admitted after experiencing a right embolic CVA. She presents with dysphagia and left sided hemiparesis. Physical therapy has been consulted to evaluate and treat this patient. On reading the chart you note the patient to have a temperature or 101.6 F, a consolidated left lower lobe on the chest x-ray, and a WBC count of 14,000.

1. What would you consider is a major medical complication for this patient other than the newly diagnosed stroke? Please consider the appropriate classification and type of condition for this patient’s pulmonary diagnosis. Provide rationale for your answer.

2. Name and provide rationale for 3 appropriate examination procedures you would perform for this patient during the initial evaluation.

Case Study 2Your patient is referred to your pulmonary

rehabilitation clinic with diagnosis of severe COPD. The patient has a 50 pack year smoking history and presents to your clinic with dyspnea, a barreled chest, digital clubbing, and poor functional capacity.

1. Based on your knowledge of this patient’s condition what single important test would be appropriate in helping you evaluate the extent of the disease process? Please provide rationale for your choice of test.

2. Based on the information provided for this patient, would you be interested in evaluating this patient’s SpO2? Please provide 2 reasons why this measure may or may not be important in examining?

Case Study 3You are consulted to treat a 55 year old male with

oxygen and steroid dependent COPD. On entering the room, you notice the patient to be experiencing shortness or breath, RR 26, and using his accessory muscles. The patient is lying in bed with HOB 45 degrees and being provided 4L of oxygen by nasal cannula.

1. What could be a possible reason for this patient’s symptoms of respiratory distress while lying in bed at rest? What medical test can best confirm your reasoning for this patient’s symptoms?

2. Name 2 examination procedures that would be necessary for you to perform to help this patient recover form his symptoms of shortness of breath?

Case Study 4 Your patient is a 40 year old male who has been

diagnosed with a bronchogenic carcinoma obstructing a bronchus as observed on the CT scan. The hospital resident (physician) contacts you to evaluate and treat this patient due to the presence of an infiltrate seen on the chest x-ray and the patient’s increasing symptoms of dyspnea and productive cough.

1. What would be important considerations to examine prior to treating the pneumonia? What 2 important laboratory values would you want to assess prior to treating this patient. Why?

2. Name and state rationale for any three examination tests you would include in the initial evaluation of this patient.

Case Study 5You are consulted to evaluate and treat a 75 year old

male who is admitted to the trauma service 3 days ago after sustaining multiple rib fractures during a motor vehicle accident. The patient now has been diagnosed as having an infiltrate in the right middle lobe. On examination you notice the patient to be dyspneic despite 3L of oxygen and SpO2 = 93%.

1. What do you believe is the physiology for the occurrence of the right middle lobe infiltrate? Explain.

2. What are important considerations to keep in mind during the initial evaluation of this patient?

3. Provide an appropriate treatment for this patient. Please provide a verbal explanation to the patient on the appropriate method of performing the technique and the physiological benefits of the technique.

Case Study 6

Your patient is admitted to the hospital with a medical diagnosis of an acute exacerbation of chronic bronchitis.

1. Based on your knowledge of this disease what would you expect this patient’s pulmonary function tests to demonstrate? Is this patient likely to have a productive cough? If yes, why? If no, why?

2. What questions would you include while conducting the interview and why?

3. Provide 2 appropriate treatment techniques for this patient. Please provide rationale.

Case Study 7You are consulted to treat a 50 year old male with a

medical diagnosis of severe COPD. On evaluating the chart you note the presence of polycythemia and an increase in pulmonary artery (PA) pressure. The patient’s primary compliant is dyspnea at rest with occasional productive cough of white secretions. The chest x-ray reveals bilateral hyperinflated lungs with flattened diaphragms.

1. Explain the physiology for the occurrence of the polcythemia, and elevated PA pressures.

2. What 2 examination procedures would need to be conducted to evaluate and presence of right heart involvement? Why would it be necessary to conduct these 2 tests?

3. Name and provide rationale for a specific intervention that can be utilized to help this patient.

Case Study 8You are consulted to treat a 50 year old male with a

medical diagnosis of severe COPD. On evaluating the chart you note that the chest x-ray reveals bilateral hyperinflated lungs with flattened diaphragms. The patient’s primary compliant is dyspnea at rest with occasional productive cough of white secretions.

1. What is the physiology for the occurrence of the flattened diaphragm?

2. Name 2 examination procedures that would be necessary for you to perform to help determine an appropriate plan of care?

3. Would it be appropriate to provide this patient with an incentive spirometer? Is yes why? If no, why?

Case Study 9You are consulted to treat a 60 year old male

with diagnosis of COPD and brochiectasis. The patient’s chief compliant is extensive productive cough of large amounts of mucopurulent secretions.

1. Your patient is curious to find out more about his disease. He asks, “What is bronchiectasis and what is the physiology for its occurrence?”

2. Name 2 important examination procedures you would employ during your initial evaluation of this patient?

3. Name 2 effective treatment techniques you could utilize in managing this patient? Please provide rationale for your choice of techniques.

Case Study 10You are consulted to treat a community

dwelling 88 year old female admitted to the hospital with shortness of breath. The physicians have diagnosed the patient to have a small infiltrate in the left lower lobe. On examination of the patient you notice that the patient has an extremely weak cough.

1. What important laboratory values and medical information would you be interested in obtaining prior to treating this patient?

2. Explain the components of a cough examination.

3. Name and demonstrate an effective treatment technique to help improve the effectiveness of this patient’s cough.

Case Study 11Your patient is on the surgical floor of your facility

POD#3 following a right lung wedge resection. Physical therapy was not consulted and the patient developed a consolidation in the right upper lobe.

1. What pertinent medical information would you be interested in obtaining prior to evaluating this patient? Please consider 2 important laboratory values and your interpretation of what the chest x-ray may reveal. Please provide rationale for your choices and interpretation.

2. Name 3 important examination procedures you would utilize during the initial evaluation of this patient. Please provide rationale.

3. Name 2 effective treatment techniques you could utilize in managing this patient? Please provide rationale for your choice of techniques.

Case Study 12Your patient presents to the hospital with

barreled chest, dyspnea, hypoxemia, cyanosis and clubbing and cor pulmonale. You are consulted to evaluate and treat this patient.

1. Based on these signs and symptoms, what do you believe is the medical diagnosis of this patient? What are the physiological principles for the occurrence of the above mentioned symptoms?

2. Would it be important to conduct a pulmonary function test? What might you expect to see?

3. Name an effective treatment technique you could utilize in managing this patient? Please provide rationale for your choice of technique.

Case Study 13You are consulted to treat an 80 year old female with

severe kyphoscoliosis and being prescribed with corticosteroids. She has recently developed an infiltrate in the left lower lobe.

1. Name 3 important laboratory values that would be important in examining prior to treating this patient. Provide rationale for your choices.

2. What pattern might you expect to note on a pulmonary function test performed on this patient? Provide 2 reasons for the occurrence of this pattern?

3. Would this patient benefit from bronchopulmonary hygiene? If yes what would you do and why? If no, what would you chose as an appropriate treatment technique?

Case study 14Your patient is a 75 year-old male admitted to the ER

with acute onset chest pain and diaphoresis. He was diagnosed with a NQMI and admitted to the floor in a stable condition on a heparin drip, atenolol (a beta blocker), and NTG as needed. Physical therapy is consulted to evaluate and treat.

1. Name one important laboratory values that would be essential in monitoring prior to treating this patient. Explain the physical therapy implications of atenolol and nitroglycerin.

2. Name any 3 evaluation procedures you would utilize in your initial examination of this patient? Please provide rationale for your choices.

3. What exercise recommendations would you not suggest this patient utilize? Why?

Case Study 15You are consulted to treat a 60 year-old male admitted

with an STEMI. During this admission, He underwent a CABG *2 with a graft from the left internal mammary artery (LIMA) to the completely occluded LAD, 2 days ago. The primary medications the patient is on are atenolol and lasix. The patient is not prescribed with any anticoagulants.

1. What 3 important laboratory values would you choose to check prior to seeing this patient? Why?

2. Name 3 important examination procedures you would utilize during the initial evaluation of this patient. Please provide rationale.

3. State 2 important treatment techniques you would employ for this patient post operatively. Please provide rationale.

Case Study 16You are consulted to treat a 60 year old female with

past medical history significant for coronary artery disease and diabetes, now admitted to your facility with a medical diagnosis of worsening left sided systolic heart failure and EF of 28%.

1. What is your understanding of this medical diagnosis? Explain 2 pathophysiological processes that you would expect to occur in this patient?

2. Name 3 important examination procedures you would utilize during the initial evaluation of this patient. Please provide rationale.

3. State 2 important treatment techniques you would employ for this patient. Please provide rationale.

Case Study 17Your patient is a 72 year-old male who has

undergone a total knee replacement 2 days ago. His past medical history is significant for coronary artery disease, IDDM, and left sided systolic CHF with an EF = 35%.

1. What 3 important laboratory values would you choose to check prior to seeing this patient? Why?

2. Name 3 important examination procedures you would utilize during the initial evaluation of this patient. Please provide rationale.

3. State 2 important treatment techniques you would employ for this patient post operatively. Please provide rationale.

Case Study 18You are treating a patient in the outpatient cardiac

rehabilitation clinic with a medical diagnosis of coronary artery disease. The patient sustained an STEMI one month ago due to 100% occlusion of the LAD, which was opened with PTCA and placement of a Stent. You notice that the patient’s rhythm on the telemetry monitor to demonstrate an irregularly irregular rhythm with bizarre QRS complexes.

Based on the medical complication of this patient what 2 laboratory values would you need to assess and why?

What 3 methods would you choose in helping you determine the activity tolerance for this patient? State rationale for your choices.

What would be appropriate procedures to employ of this patient demonstrated a run of 6 or more PVC’s in a row? Provide physiological rationale for procedures you choose.

Case Study 19You are consulted to treat a 60 year old male with

a medical diagnosis of stable angina. The patient has been prescribed a beta blocker and sent to your outpatient cardiac rehabilitation clinic for an evaluation and treatment.

1. What is stable angina? How does this differ from unstable angina?

2. What measurements would be important in assessing prior to prescribing exercise for this patient? Why?

3. What method would you employ for determining this patient’s target heart rate? State rationale for your choice.

Case Study 20You are consulted to treat an individual with EF =25%

and BNP = 900. The patient presents with dyspnea and has poor exercise tolerance.

1. Based on the information provided, what would you expect the primary medical complication to be? Support your answer with rationale. Why does this patient present with dyspnea and a low exercise tolerance?

2. Name 3 assessment procedures you would include in your initial examination of the patient to help you document the respiratory status of this patient? State rationale for your choices.

3. Name 2 appropriate treatment techniques you would employ to help this patient feel less short of breath.

Case Study 21Your patient is a 65 year old male with past medical

history significant for coronary artery disease. He is admitted with a medical diagnosis of NQMI and is being treated with a beta blocker and anticoagulation therapy. During your initial evaluation of the patient you notice a decline in the systolic blood pressure with a concomitant increase in heart rate as you help the patient move from supine to sitting at the edge of the bed. The patient complaints of some lightheadedness immediately after the transfer.

1. What do you propose the patient is experiencing? What are the pathophysiological processes involved?

2. What are the hemodynamic parameters for precisely documenting this condition?

3. Name 2 treatment choices to help this patient. State rational for your choices.

Case Study 22You are involved in treating a 70 year old male

who has sustained a myocardial infarction one month ago. Your patient is curious to find out whether he can participate in upper body strength training during his cardiac rehabilitation treatment.

1. What physiological principles do you need to be concerned with when responding to this patient’s concern?

2. What would you include in your evaluation of the patient to meet the specific needs of the patient? Please state rational.

3. Present your thoughts on prescribing an exercise program for this patient to meet the specific needs of the patient.

Case Study 23During the initial physical therapy evaluation of

your patient admitted with CHF in the skilled nursing facility, you observe the patient’s systolic blood pressure to drop 20 mm Hg below resting levels.

1. What do you believe is the pathophysiological process associated with the occurrence of this sign?

2. State 3 signs of exertional intolerance that you might want to monitor? Present rationale with your choices.

3. State 2 appropriate treatments that you could employ with the management of this patient. Please provide rationale for your choices.

Case Study 24In reading the medical record of a patient you are

consulted to treat, you read that the patient’s presented to the ER with dyspnea at rest, paroxysmal nocturnal dyspnea, and Orthopnea.

1. Based on these symptoms, what would you expect as this patient’s primary medical concern? What are the physiological processes involved the occurrence of each of these symptoms?

2. Name 3 assessment procedures you would include in your initial examination of the patient? State rationale for your choices.

3. Name 2 appropriate treatment techniques you would employ to help this patient feel less short of breath.

Case Study 25During an exercise session on the treadmill,

your patient complains of chest pain. You notice ST depression in leads II, III and aVF. The nurse notifies the attending physician who orders NTG and a beta adrenergic blocker (Atenolol).

1. What do you believe is happening to this patient? Explain.

2. What do you believe are the physical therapy implications of the medications being given to this patient? How would you monitor exercise tolerance in the future? State 2 methods and provide rationale.

3. What changes would you make in this patient’s exercise prescription? Why?

Case Study 26Your patient is admitted to the Emergency

room with complaints of chest pain and dyspnea. In reading the chart you observe the following values:

Troponin I = 1.5; CPK MB = 100; Index = 2.0 BNP = 900

1. Based on your knowledge of these values what would you determine the medical diagnosis? Explain.

2. During your evaluation what would you expect the patient’s heart rate at rest to be? Please explain the physiological principle involved?

3. What would you want to ensure prior to prescribing exercise for this patient?

Case Study 27

You are consulted to treat a 50 year-old obese gentleman with multiple risk factors for heart disease. Your goal is to reduce his weight through a combination of exercise and diet.

1. Name any 4 risk factors for heart disease?

2. Name any 3 evaluation procedures you would utilize in your initial examination of this patient? Please provide rationale for your choices.

3. What exercise recommendations would you suggest this patient utilize? Why?