Physio Initial Inpatient

Physiotherapist Reason for referral: Functional decline post viral illness. HOPC: - Patient admitted due to severe community-acquired pneumonia, resulting in significant deconditioning and respiratory compromise. - Requires physiotherapy to address reduced mobility, impaired respiratory function, and deconditioning to facilitate safe discharge. - Patient reports persistent generalised weakness and shortness of breath with minimal exertion. - Medications: See med chart PMHx: - Hypertension (controlled with medication) - Type 2 Diabetes Mellitus (well-controlled) - Previous appendicectomy (20 years ago) SH: - Lives in an RDP home with husband and two adult children. - Has access to running water and electricity. - Prior to admission, independent with all personal and domestic ADLs; mobilised independently without aid. - Able to walk to local church (approx. 500m) and attend weekly community group meetings. - Receives family support; no formal home support services. - No falls in past 12 months. Objective: - Found patient resting in bed (RIB), Alert + Oriented (A+O), saturating comfortably on 2L O₂ via nasal prongs. - Vitals observations: Between the Flags (BTF) - Has a peripheral IV line in situ in the left forearm and oxygen tubing. - Auscultation: Decreased breath sounds LLZ with inspiratory crackles. - Lateral Basal Expansion (LBE): Decreased bilaterally, more pronounced on the left. - Cough: Weak and ineffective, dry. - CXR: Patchy consolidation in the left lower lobe, consistent with resolving pneumonia. - Pain score: 2/10 at rest, 5/10 with movement (leg weakness). Mobility: - Supine → SOEOB: Requires moderate assistance (x1 therapist) due to generalised weakness. - Sit Bal: Poor static and dynamic sitting balance, requires continuous verbal cues and standby assistance. - STS: Unable to perform independently, requires maximal assistance (x2 therapists) with hoist for safety. - Stand Bal: Unable to maintain standing balance without maximal assistance and parallel bars. - Transfer: Requires hoist for all transfers (bed to chair, chair to bed). - Walking: Unable to ambulate even with maximal assistance; significant shortness of breath and fatigue on attempting any movement. Treatment: - Education on risks of prolonged bedrest and importance of early mobilisation. - Active Cycle of Breathing Techniques (ACBT) focusing on thoracic expansion exercises and controlled breathing x2 rounds. - Passive range of motion (PROM) exercises to all four limbs. - Mobilised from bed to armchair using hoist; tolerated sitting for 15 minutes with frequent verbal cues for posture correction. - Leg strengthening exercises (quadriceps sets, ankle pumps) in supine. Assessment: - Nurses should transfer the patient using a hoist with 2x assist for all transfers; patient to be encouraged to sit out of bed for at least 30 minutes twice daily. - Patient is not at baseline function. - Patient is not safe for discharge from physiotherapy due to profound deconditioning, inability to mobilise, and high fall risk. - Barriers affecting discharge from physiotherapy: Significant deconditioning, inability to mobilise independently, poor sitting balance, and ineffective cough. Patient lives in a two-storey RDP home with 12 stairs to the bedroom, no handrail, and no access to a walking aid. Plan: - Request Occupational Therapy for ADL assessment and home setup assessment. - Review analgesia for mobility with medical team. - Re-assess in 2 days. - Goal of next physiotherapy session: Improve sitting balance to allow for independent supported sitting for 30 minutes, attempt sit-to-stand with assistance.