Nowadays, the national defense is the primary focus of the f…

Questions

Nоwаdаys, the nаtiоnal defense is the primary fоcus of the federal government.

Histоry оf Present Cоndition: 65-yeаr-old femаle with obesity аnd complaints of shortness of breath for approximately 2 years, worsening over the last 4 months. She has had an extensive workup and the etiology of the shortness of breath appears multifactorial. She has referral for home health PT for a progressive activity program. PMH/PSH: Hypothyroidism, Melanoma of nose 2 years ago, Polymyositis 20 years ago, Raynaud’s syndrome, Glaucoma, Mastectomy 12 years ago, Hysterectomy, Bil. THR due to Avascular Necrosis 1 year ago and 2 years ago, Spinal fusion L5S1 Medications: Noroxin, lasix, naproxen, norvasc, benadryl, xalatan eye drops Social History/Habits: Retired psychiatric nurse; married and lives with husband in split entry home ,  5 steps to enter; bathroom and bedroom on upper level; laundry on lower level; pt rests on landings 2˚ to SOB. Smoked 1ppd x 40 years, quit 11 years ago. No ETOH. Does not drive. Functional Status/Activity level: Independent with basic ADL; shops with a cart to lean on; difficulty walking beyond that. Systems Review: Alert, oriented x3, good historian. Learns by verbal instruction and demo Ht 63.5 inches   Wt 247 lbs   BMI 43.1 Vitals: HR 80 and regular (see telemetry strip)   RR 16, BP 156/76 R, SpO2 98% on room air. Labs/Tests: PFT’s: recent tests reported mild restrictive abnormality, TLC 81% predicted; normal FEV1/FVC ratio Stress Echo: Normal function in all segments, mildly hypertrophied L ventricle, estimated LVEF 60%, no outflow tract gradient or AR, mild MR, PA pressure > 58 mmHg. Dobutamine Stress: (1 month ago) Peak HR 133, BP 142/86, RR 38 Sinus rhythm, occasional premature atrial contractions (PAC)   Aerobic Capacity and Endurance: Performed 6 minute walk test, covering 910 feet; rested x 3 for less than 20 seconds each time; notes chest pressure at peak of walk.                          HR       RR       BP          SpO2 (RA)      Dyspnea Rating (0-10 scale) Rest                 84         16         150/80         98%                       2/10 Peak                130       32         170/74         99%                       8/10 Practical Exam: You are the assigned physical therapist arriving for the patient’s first home health physical therapy appointment, proceed with your evaluation/assessment/interventions/education. I have read the above case and am prepared for the practical exam: