Problem #14

Fred is a 93 y.o. male who is a resident of Blue Bird Retirement Facility. Previously Fred's diagnosis was COPD-Chronic Obstructive Pulmonary Disease(emphysema), but now is demonstrating Parkinson like symptoms. Fred is involved with the therapuetic recreational daily exercise program but he is now referred to physical therapy for a reassessment because of the change in his physical condition. According to the new Total Quality Management guidelines Fred must be assessed within twenty-four hours of referral.

Subjective:

• You learn from the nursing notes that Fred recently changed physicians - four different doctors within the last six months

Objective:

• Motor: resting tremor in both upper extremities, difficulty initiating and stopping movements
• Respiratory: Fred demonstrates a puffing breathing pattern, and an overexpanded thorax
• Gait: prior to the new symptoms Fred was independent without device. Now he requires assistance to rise from the chair and to stop walking.

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