Im on my prac at the moment in a surgical ward so the case load is quite varied and there are people who are acutely unwell and then people who are simply recovering from a routine procedure (such as a colonoscopy). Obviously not everybody will need physio so it is based on prioritising who needs what and it works fairly well most of the time.
One of my patients was admitted for gastrointestinal problems and consequently had abdominal surgery. I was seeing this patient for cardiorespiratory issues following his abdominal surgery. On inital assessment auscultation found inspiratory wheezes throughout both left and right lungs. I commenced treatment of the ACBT technique with ambulationa around the ward between ACBT cycles.
This appeared to be working and the patient was productive of P2 M2 sputum and auscultation after a few days was reduced to inspiratory wheezes only in the left lower lobe bases. The following morning after i had assessed my patient and found he was becoming better i arrived and found out (by reading his notes) that he had been throwing up all night and now had a NG tube for draining. I decided to miss the morning session as he was sleeping when i arrived and i proceeded with the afternoon session as planned. On re-assessment in the afternoon the patient's O2 saturation was in the 80's and on auscultation there was widespread inspiratory wheezes throughout both left and right lungs and late inspiratory crackles in his left lower lobes.
I couldn't believe the vast change since the previous day. It was a slow progression to improve but he had definitely made gains and i suspected he would be heading home in a couple of days if he kept improving like he was.
It just proves to me now even more that it's so vital to keep an eye on people's chest once they have had any sprt of abdominal surgery. I didn't think his chest would sound any better after throwing up all night and then lying supine for the morning to rest after his sleepless night. But i was definitely surprised at how quicky he declined.
Over the next couple of days we started again performing ACBT's with ambulation between cycles to try and assist airway clearance and i think only now (about 5 days later) we're almost back on track.
Looking back it just reinforces how important it is to continually monitor someones chest and also how effective the ACBT's and ambulation/repositions (i.e. sitting upright) is in managing chest condiditons. It's great to start to realise the cardio stuff we learnt in uni is so effective. It makes me feel like im able to help someone and that's pretty important to me.
1 comment:
It's good to know it actually works!!! I agree.
When i had my cardio placement it was more mobility Ax and very little chest physio. Most of my patients were well over 70 and had more issues with ambulation and balance than sputum production. I only saw a couple of pneumonia patients who weren't very compliant with the ACBT cycle and the "cough and spit" routine so it's good to hear that someone else has had some success.
I did have one lady who was progressing quite well (with her chest PT) so I encouraged her to continue the deep breathing ex's and the walking and decided I didn't need to see her twice a day. I came back to review her case a few days later and her cough was so much more productive than it a few days earlier. That's when I realised how quickly a chest can decline.
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