Past medical history

I’m on cardio placement and more and more I see how important is to have a big picture of the patient. Initially we tend to focus on the problems related to the area that we are doing the placement on or on the reason for the referral. In cardiopulmonary we often tend to focus on those 10 problems and sometimes “forget” all the other conditions of the patient or just have as “considerations for treatment”. I found that in a lot of cases the other conditions, related or not related to cardiopulmonary needs to be really high up on the problem list. Examples of that are OA (that can affect on mobility and exercise), effect of medications (eg. Decrease consciousness, nausea),Hb level, patient orientation (eg. confusion or dementia), etc. Also if the patient main problems are pulmonary we cannot forget the cardiac part as well. A lot of the respiratory patients have cardiac hx as well. Today I had a patient that was admitted with increased cough and SOB. He has severe bronchiectasis, emphysema,ex-smoker, IHD,OA, Hx TIA. The focus of previous physios was on his airway clearance, strategies to reduce WOB and exercise tolerance. A 6MWT was done and there was no information regarding leg pain (which in his Hx was one of the limiting factors of his walking, not only SOB).In this patient definitely the pulmonary side needs to be treated first, but the cardiovascular symptoms need to kept in mind and addressed accordingly in a mid-long term.
Other example is one of my “mobility” patients, which also has bilateral atelectasis. I have been doing breathing exercises with him, active exercises for ULs, LLs and a walking program. He also has Hx of IHD and recurrent TIAs. Everything was going fine and today when I went to see him, he was having speech problems. He was extremely upset because he couldn’t communicate as normal and was sometimes dysarthric. No one noticed that and I actually was the only one to pick that up (even though it was obvious) and record on the notes. He possibly had another TIA overnight. I informed the staff and hopefully something will be done. He was supposed to be one of the “easy” patients, but what I learnt from that is how important is to keep reassessing the patient and be aware of past medical history.

I hope the last week of placement goes well for everyone!