At Northeast Nursing and Rehabilitation, we cared for a 77-year-old white male who had been recently hospitalized for acute cholecystitis. His PMH included CAD, a pacemaker, cardiac stents, HTN and COPD. The patient presented with a variety of problems, including debility, decreased ADLs, poor static/dynamic and sitting/standing balance, decreased mobility, decreased aerobic endurance and breathing abilities, and poor phonation.The patient also had decreased breath control, able to produce only three words without taking a breath. He required constant oxygen and had little diaphragmatic breathing, possibly related to the secondary effects of COPD.

Prior Level of Function

Prior to admission, the patient was ambulatory with a cane for household distances. He was I with ADLs, bed mobility and toileting, as well as I with dressing and hygiene/grooming. He consumed a regular diet, had good aerobic condition and did not require oxygen.

Interventions

We employed several strategies to help the patient, including physical, occupational and speech therapy interventions. For example:

  • PT provided family education on safety/sequencing, continual monitoring of vitals during treatment sessions, kinesio taping to address knee pain, and patellar mobilization.
  • OT addressed ADLs, LB dressing, donning/doffing shoes, UE strength, gross/fine motor UB control to manipulate objects, hygiene/grooming activities, toileting, and safe decision making.
  • ST placed the patient on a COPD program, worked on pursed lip breathing, diaphragmatic breathing, deep breathing exercises, huff cough technique, stretching and strengthening exercises, instruction in use of inspironmeter, fluency and intelligibility exercises in conversational speech.

Outcomes

As as result of our interventions, the patient showed marked improvement in several areas, including functional gait distances with use of a cane, improved dexterity and fine motor control, LB dressing, toileting and more. His phonation improved, and the patient did not require oxygen at home. Ultimately, the patient was able to return home with the support of his family and thanks to the combined efforts of our therapy teams.

By Rochelle Lefton, MA, OTR; Michelle Scribner, MSLP; Heather Cox, DPT; Susan Garcia, COTA; Jesusa Herrera, PTA, Northeast Nursing and Rehabilitation, San Antonio, TX