Physical interventions

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RESPIRATORY DRUGS Brief History. V.C., a 63-year-old man, has a long history of COPD and hypertension. Twelve years ago, he was diagnosed with emphysema. During the past 5 years, his symptoms of shortness of breath, wheezing, and bronchospasm have become progressively worse. He is also a chronic cigarette smoker and has had a cough for many years, which produces large amounts of sputum daily. Although his physician advised him repeatedly to quit smoking, the patient was unable to kick the habit. To control his bronchospasm, the patient self-administers an inhaled anticholinergic agent, tiotropium (Spiriva), via a dry powder inhaler (18 mcg/inhalation) once each day. To help resolve acute bronchospasm, he uses an inhaled beta2 agonist, albuterol (Ventolin), via two inhalations from a metered dose inhaler (90 mcg/inhalation) at the onset of an attack. He is also taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor to control his hypertension. Two days ago, he was admitted to the hospital with weakness and incoordination in his left arm and leg. Subsequent medical tests indicated that he had suffered a cerebral vascular accident. Physical therapy was ordered to begin at the patient’s bedside to facilitate optimal recovery from the stroke. The physical therapist began treating the patient with passive and active exercises to encourage motor return. The patient was also under the care of a respiratory therapist. The respiratory therapy treatments included administration of the mucolytic drug acetylcysteine (Mucomyst) via a nebulizer at a dose of 5 ml of 20 percent solution three times daily. The patient continued to self-administer the beta-2 agonist at the onset of bronchospasms.
Problem/Influence of Medication. Despite the program of respiratory therapy, bronchial secretions began to accumulate in the patient’s airways. The patient had been instructed in deep-breathing and coughing exercises, and he was told by the respiratory therapist to perform these exercises periodically throughout the day. However, no postural drainage was being performed to encourage ejection of sputum.
1. What additional physical interventions can be used to complement the drug therapy?
2. When should these physical interventions be administered to take optimal advantage of the effects of the pulmonary drugs?

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