STARES 2 Intervention

S- 74 year old female presented with increased SOB and increased production of green sputum.
HPC: Hx of recurrent exacerbations of bronchiectasis. Sputum production worst prior to bed and during the day.
PMHx: bronchiectasis since 18 years old, RA for 20 years, HTN, hyperlipidaemia
SHx: lives with husband in Ravenswood, non-smoker, Independent ADL’s and mobility nil aid, normally able to walk 1km with no difficulty, but recently decreased.
Investigations: CXR (1/7/10) peri bronchial inflammatory changes with minor dilation of central bronchi consistent with bronchiectasis. Nil areas of pneumonic consolidation.

T- To assess and treat this patinet appropiately for the short and long term.

A- Began with a chest review and mobilty review. The patinet is independent with all mobilty and her chest findings were:
Resp: Spo2 98% on RA RR 20,
Cough: strong, moist, n.p occasionally
CE: adequate bibasal chest expansion
Ausc: expiratory crackles bibasally, BS t/o
As a result the treatment consisted of percussion in both left and right sidelying, ACBT cycles with vibes and cough.
Also taught pateint appropriate GADP for where her most productive areas are. Then decided for long term airway clearnace an accapella would be suitbale therefore prescibed and taught patient how to use it and clean it. the patient was given handouts on acapella and GADP.

R- The paitent was productive of 7x small ammounts yellow m2p2 sputum during percs and vibes.
the patient was effective at using the accapella in both sitting and GADP after a few practices and a recheck and the next morning prioe to discharge.

E- I feel that from my assessment I completed an acurate and through patient focused intervention and thought forward to when she was discharge and wasn't able to always get someone to do percussions on her, rather than just about what I wanted to do in a single treatment session.
I also thought that choosing acapella over a flutter due to the fact that the best position for her o do airway clearance would be in sidelying rather than upright(which is required for flutter).

S-Think about whether the patient is able to succesfully expectorate on their own.
-know your options and find out if their are added costs
-be bale to give patient some information to read and take home as they wont remember everything you tell them
-go back to cardio notes for other details on airway clearance