1.1 Developing a Rx Plan

Question 1

Overview of steps

Answer 1

1. Create a problem list
   will be refering to the whole list throughout Case 2
2. Select 2-3 Rx per problem
3. Verbalize each Tx and why you selected it.

Question 2

1. Problem list

John, 74yo retired postman
was transferred to an acute care hopsital after suffering an acute exacerbation of emphysema.

Prior to his exacerbation, John was able to ambulate to and from the grocery store without breathlessness or the need for a gait aid.

Currently, John is able to walk using a 4-wheeled walker and oxygen, but becomres quite SOB

Pt record indicates:
- Comorbities: HT, Type 2 DM
- Pt smokes 1 pack of cigerettes/day
- Pt has a productive cough
- Pt lives independently in a condominium and does not have stairs to enter his home
- Pt on 2L of O2 via nasal prongs

Answer 2

1. Dyspnea
2. Decreased functional mobility
3. Currently smoking
4. Presence of secretions
5. Co-morbidities: HT & Type 2 DM

Question 3

2. Select 2-3 Rx for each problem

Answer 3

1. Dyspnea
   - PLB
   - Pacing & Planning
2. Decreased functional mobility
   - Strength exercise (bed, sitting or standing)
   - Practice the functional task or components of the task
   –>Bed mobility (e.g. supine to sit)
   –>Sit to stand practice
   –>Ambulate practice with gait aid
   - Time Tx with medication if necessary
3. Currently smoking
   - Education on the effects of smoking on respiratory health
   - Refer to smoking cessation program if the Pt was ready to change
4. Presence of secretions
   - Secretion removal techniques
   –>PEP mask/oscillating PEP device
   –>Coughing/ huffing
   –>ACBT
5. Co-morbidities: HT & Type 2 DM
   General:
   - Educate the Pt on modifiable risk factors associated with their co-morbidities
   - Consult with the team to ensure appropriate medical management of their co-morbidities
   - Refer to a community health program to provide support for co-morbidities

HT:
- Monitor BP & ensure the Pt is at a safe levle to mobilize (under 200/110)
- Include cardiovascular exercise within safe intensity (Modified BORG 3-5)

DM:
- Montior for and educate about the signs and symptomes of hypoglycemia associate with DM & exercise

Question 4

You can almost always include these 4 Rxs in the Rx plan

Answer 4

1. Cardiovascular exercise
   - Address nearly every issue (general health, promotes healing, improves mood & coping, improve oxygenation, improve funcitons
2. Education
   - Always a part of Rx to empower the Pt
3. Exercise
   - Can be simple (isometric), advnaced (sport-specific)
   - Can always prescribe exercises to address above & below the affected area
4. Activity modification
   E.g. changing work setup
   - Changing how they are performing a task
   - Advice on ergonomics/posture

Question 5

3. Verbalize each treament and why you selected it

Answer 5

State the prolbem you are addressing when verbalizing your treatment strategies

State a detailed rationale for why you selected a Rx (state how it will solve the problem)

Examples:
I would treat this patient’s dyspnea(problem)

by teaching them pursed lip breathing(Rx) as it is an effective breathing strategy for patient’s with emphysema. This breathing technique keeps the airways open to allow for more air to exit during exhalation (Why).

I would educate the patient on pacing and planning strategies(Rx) such as prioritizing key ADLs they must accomplish in a day, resting when tired (Why) and managing their expectations for what can be accomplished in a day.

Usually do not need to explain HOW you would perform a Rx