STARES 1 Assesment

S – Mr K-55 year oold male visiting from england presented to ED with SOB and chest pain. Over the past 6/52 he had reccurent chest infections which resloved 2/52 ago prior to coming to australia. His Xray was 'normal' 2/52 ago. He had continued SOB over the following 2/52 with a productive cough (dark green sputum) and nausea. PMHx: COPD?, asthma, chronic LBP, BPH, depression. Shx: viusiting perth, on a disability pension (not working in UK), smoker 55 pack years, ceased smoking 1/52 ago, lives with his wife in a two story house in england. Investigations: CXR- 1/7 post presentaion- large L) bullae, density in L) midzone? PTx ? Malignacy. CT- large bullous disease L) lung, no Ptx, no malignacy. Pt transferred to respiratory ward for further invetigation and allied health input.

T- To complete a chest and mobility review, as well as a 6MWT as requested by the doctors if safe.

A– I began with a subjective Ax asking him about SOB, wheeze, exercise tolerance, chest pain, home situation, smoking, asthma ventlin use and previous level of function. Aswell as about nausea, dizziness and how he was feeling overall. I then went on to Ax his chest I had him sit up on the edge of the bed (which was independent) to ax his chest expansion, cough and ausculate. Asked the patinet to see if he was able to go for a walk as he had only recently been able to walk within his room without becoming SOB yet today he was feeling a lot better than the previous few days, practically symptomatic now and planning on quiting smoking indefinatley.
To continue with mobility review I asked Mr K to stand up and go for a walk- at this time monitoring his Spo2.
Following this Ax and realising that he would be able to complete a 6MWT I explained the proceedure to him and he completed the 6MWT

R– On Chest Ax His chest had decreased air entry to areas as suggested by the CXR and fine insp crackles in L) lower lobe. cough was non productive and he had adequate chest expansion with R slighlty more than L. Spo2 remained stable at 97% on RA during ambulation Ax. Completed the 6 MWT with ease, Spo2 min 94% HR max 102, with a quick return to pre test. SOB BORG pre test- 0.5 post test 1.

E – I feel that my Ax was thorough and allowed me to confidently decided if he was safe to complete a 6MWT as requested. However there were a few things I missed on my initial subjective ax (which I later enquired about) such as specific goals, what he enjoys to do during the day, more particualrs about home ie pulmonary fitness classes. Overall I felt that I covered everything that was required for the first time seeing the patinet but there where a few holes for d/c planning and motivation tools. Yet I now know that these are all important and that in case I dont get another chance to see the patinet I should ask everything I want upfront.

S- Plan questions you want to ask specific to each patient
-ask for feedback so if you forget something small you know what it is and wont forget it the next time
-plan a problem list and treatment plan post Ax and pre Rx
-go over cardio assesmnet notes
-know problem list