Case Study:
Case I:
23 y/o male s/p motor vehicle accident. Arrived unconscious with a left tension pneumothorax, fractured pelvis, and left femur, absent bowel sounds and hematuria. CxR showed fracture of first and second right ribs. Pt. went to OR for laparotomy which revealed a ruptured spleen and renal contusion, he also underwent placement of ICP monitor (intracranial pressure) secondary to cerebral contusion. Nine days after admission Pseudomonas aeruginosa was grown out of tracheal cultures. Pt. is unconscious. On the twelfth day Physical Therapy was consulted. The patient is in the ICU, on a ventilator with IMV 4, PEEP 5, FiO2 = 40%, RR = 16. CxR shows infiltrates in the right middle and lower lobes. Temperature is 101.2. MEDS included: tobramycin and ticarillen (both antibiotics). Lab values were significant for leukocytosis.
- What PT interventions will you consider for this patient? Are these for short term benefit, for long term benefit, or both? How will you monitor progress?
Case II:
22 y/o male with C4 quadraplegia admitted with sudden onset of SOB and diaphoresis after one week of low grade temp. He was being treated at home with antibiotics for an upper respiratory infection (URI) and receiving his standard pulmonary hygiene by his PCA (personal care attendant). On admission has absent breath sounds in the left lung, there is dullness to percussion. CxR reveals complete left lung atelectasis. Temp = 101, ABG's = PaO2 55, PaCO2 50, pH 7.33. He is treated with nasal O2. Physical therapy is consulted for chest PT in the ER. The patient reveals to you that he has missed his last few pulmonary hygiene treatments by the PCA.
- What do you think the problem is based on the above information? (incorporate all info; CxR, ABG's, percussion, breath sounds, recent history, etc.)
- What do you (based on the above information) plan on doing during PT for this problem? What are your priorities?
- How will you monitor for improvement? (think about what you are treating at this point).
Your answer must be typed, double-spaced, Times New Roman font (size 12), one-inch margins on all sides, APA format.