Hi Everyone,
I saw an elderly patient one day post AAA repair in the ICU last week. His main physiotherapy problems were reduced lung volume and impaired airway clearance. My treatment plan was to increase his lung volumes by asking him to take deep breaths and to facilitate airway clearance by asking him to cough. However, when I went to treat him, he was confused +++ and not following many instructions, so this plan was clearly not going to work and I needed to find other ways to achieve these goals. Having come from only outpatient pracs where all my patients have been able to follow instructions and have been very compliant with treatments, this made me feel quite nervous and a bit panicked about what I was actually going to do for this man. I really wasn’t sure that I would be able to give him any effective treatment. To increase lung volume, I tried getting the patient to lift his arms with the thought that this would increase his tidal volumes. Since he wasn’t following instructions, I gave him a target to reach for and lifted his arms showing him the movement that I wanted him to do. At first this didn’t work either, but I continued with helping him move his arms and after about the third go, he got the hang of it and moved on his own. When I asked him to cough, he made an attempt, but it was not at all effective. So I demonstrated a big cough and asked him to copy which again was very ineffective. I tried to stimulate a cough using the tracheal rub technique, but got nothing, so resorted to a catheter tickle at the back of his throat which stimulated a good effective cough and let me suction the secretions straight after. After finishing the treatment I realized that I had in fact made a difference in treating this patient and that while it called for a bit of creativity it is still possible to achieve physio goals in patients who are not able to follow verbal instructions.
Has anyone had a similar experience and do you have any creative ways of achieving treatment aims.
Mel.
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1 comment:
Mel
I have a patient on my ward who has roughly the same problem as well, reduced lung volumes and an ineffective cough. I tried ACBT, percs, vibes, GADP, incentive spirometry, "reversed" incentive spirometry (RPH does not readily give out PEP devices), even the tracheal rub...LOL! I applaud that you were able to perform the catheter induced cough and was successful with your patient! I'd give it another go, and may try that technique as well!
Mark
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