Histоry: Pt is а 24-yeаr-оld femаle with Cystic Fibrоsis, who was recently in the hospital due to an exacerbation of her lung disease. She was hospitalized for 2 weeks for intravenous antibiotics, optimization of pulmonary and nutritional status. She is subsequently referred to outpatient PT for resumption of her Pulmonary Rehabilitation program that was underway prior to her hospitalization. PMH/PSH: Cystic fibrosis, bronchiectasis, asthma, CF related diabetes, allergic rhinitis, pancreatic insufficiency, history of small bowel obstruction Medications: Albuterol, Advair, *TOBI nebulizer, Zithromax (Z-pac antibiotic), Creon (pancreatic enzyme replacement), Omeprazole (PPI), Flonase, Novolog, Insulin, Lactulose, Miralax *TOBI is an antibiotic that is inhaled into the lungs using a nebulizer, used to treat lung infections in patients with CF. Social History: Single, lives with supportive significant other and they plan to relocate to a new apartment in the next couple of weeks which will be a 15-minute walk to and from the train. Recently had to stop her gym membership due to financial constraints. Lifelong non-smoker. No ETOH. Works as a medical assistant. Airway Clearance Program: primary form is the VEST; uses it 1-2x/day for 30 minutes @ frequency of 12-16 Hz, pressure of 4 mmHg CXR: bilateral bronchiectatic changes; no focal infiltrates; minimal blunting of R costophrenic angle. Labs: WBC 14 x 109/mm3 ↑ HgB 5 g/dL ↓ Hct 44% ↓ Glucose 130 mg/dl ↑ Albumin 5 g/dL ↓ PFT’s: Actual Predicted FVC 2.15L 3.58L FEV1 1.41L 3.19L FEV1/FVC% 66% Patient Goals: Achieve independent exercise program she can follow at home. Improve posture. Improve endurance. Reduce the “gurgling noise with my breaths”. Chief Complaint: fatigue with exertion Aerobic Capacity: Modified Bruce Test done with patient breathing room air, completing 14 minutes 10 seconds. Limiting symptom was LE fatigue > DOE Intensity HR BP RR Sp02 RPE DOE Rest 76 112/68 12 99 6 0 2.5 mph 12% 122 130/68 24 97 13 2 3.4 mph 14% 150 148/68 28 89 16 3 *RPE 6-20, DOE 0-10 Practical Exam: Patient is referred to outpatient PT for resumption of her Pulmonary Rehabilitation program that was underway prior to her hospitalization. This is her first day back to therapy, proceed with your evaluation/assessment/interventions/education. I have read the above case and am prepared for the practical exam: