Self-assessment Cases

Chapter 44 The physiotherapist

An 81-year-old man with metastatic lung cancer is admitted in the evening to the hospice for symptom control and psychosocial support. In his history he reports recent falls. Since admission, he has not been out of bed at all, and his wife reports that prior to admission he was getting increasingly unsteady on his feet but was still walking independently around the house. You are on duty and he calls to ask if he can get up to go to the toilet.

• 1. What additional information would you want to know before helping him up to walk?

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  Correct answer:
  Whether he normally uses a mobility aid, for example, Zimmer frame or stick.

• 2.How might you go about assessing his ability to get up?

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  Correct answer:
  Remember mobility is a spectrum. Start with bed mobility and then sitting over the edge of the bed before trying to get up and walk. Use a Zimmer frame and possibly have another person present to be safe.

• 3. The patient gets up with your help and mobilises unsteadily with a frame to the toilet before returning to bed. He is very breathless on exertion. Having observed all these, what might you think about doing?

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  Correct answer:
  Physiotherapy referral.

• 4. From what we know already, what aspects will the physiotherapist wish to assess further?

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  Correct answer:
  

  • Balance
  • Falls history – frequency and nature of falls, was he able to get up off the floor, etc.
  • Mobility – does he have a suitable aid?
  • Breathlessness management – whether he has any strategies to deal with his breathlessness.
  • Potential to improve.

• 5. With regard to his breathlessness, give three possible strategies for coping that the Physio (or you) might suggest to him?

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  Correct answer:
  

  • Relaxation techniques
  • Fan or open window
  • Cold compress
  • Breathing control techniques
  • Pacing advice