In long-term care, as well as in hospitals, the role of physical therapists treating patients with medically complex conditions is increasing significantly. Cardiopulmonary conditions, such as chronic obstructive pulmonary disease, congestive heart failure and myocardial infarction, when present along with other medical conditions like Parkinson's disease, total hip arthroplasty followed by hip fracture, dementia and renal failure will result in medical complexity leading to compromised function. This medically compromised situation will further result in overall decreased quality of life.
Reaction to Exercise
One of the most important factors therapists should consider while treating patients with cardiopulmonary conditions is the reaction of cardiopulmonary systems to exercise. Measuring heart rate and blood pressure at rest, during exercise and immediately after exercise should be considered to establish the baseline of the cardiopulmonary systems.
Measuring heart rate and blood pressure will explain the adaptable nature of cardiopulmonary systems to exercise. The adaptation of cardiopulmonary system also depends on variables such as intensity, duration and type of exercise.
Evaluation and Assessment
Evaluation is very specific to each patient and also requires a therapist's skills and thought process depending on the patient's medical complexity. Evaluation should be aimed in order to identify all possible impairments leading to functional limitations. Treatment should be very specific to each patient based on assessment.
The following protocol is generally followed in assessing the cardiopulmonary system.
(Reason for hospitalization)
Past Medical History
(Gives information regarding past medical history, surgeries, pre-morbid conditions)
(Observation can include breathing pattern, physical deformities resulting in decreased thoracic cage mobility, symmetry of breathing, use of accessory muscles)
Examination and Assessment
(Assessment includes measuring response of cardiopulmonary systems during rest, activity, after activity, auscultation of lung sounds, activity tolerance using appropriate dyspnea scales, respiratory muscle strength)
(Diagnosis reveals various impairments leading to functional limitations)
(Prognosis indicates predicted improvements and the time frame to reach the goals)
Plan of Care
(Plan of care includes short term goals, long term goals, frequency and duration of treatment, discharge plans)
(Re-examination helps therapists to assess the progress made and to add or modify goals)
(Summary should include the patient's response to various treatment interventions, progress made, performance in home evaluation, suggestions made for barrier modifications)
Abnormal Signs and Symptoms
Therapists should be aware of abnormal signs and symptoms during exercise-symptoms like irregular pulse, palpitations, pain the chest (possible angina), confusion and fainting. These signs and symptoms should be reported to physician. Consulting a physician is important before resuming exercises. Therapists should also be familiar with other warning signs like extreme shortness of breath, nausea and vomiting.
In future, the role of physical therapists in managing patients with multiple medical conditions will be very important, if the step-down of the patients occurs directly from intensive care units to skilled nursing facilities.
Revanth Mopuru is currently working as a full time physical therapist in East Lansing.