I had a patient who was producing a lot of secretions but unable to get them out. When I first saw her, she was extremely short of breath. She could barely finish three words before she needed to gasp for breath. All I was able to do the first day was to teach her supported deep breathing exercise and positioning. Those were also limited due to plueritic pain that she was experiencing both sides. She was given the nebuliser but was just unable to generate sufficient energy for an effective cough. The next day, I got her out of bed and ambulated her. She was only able to ambulate from one side of her bed to the foot of the other. Her colour was alright, saturation was good, respiratory rate did not change to much but was just feeling "funny" due to her low blood pressure. However, she was still very short of breath. The following day however, she was much better and able to generate a strong effective cough. Still, nothing was coming out. All these time, the doctors were waiting on sputum specimen for tests.
It was fortunate that I had lots more time that day and I spent almost one and a half hours with her doing acbts combined with percusion, positioning and the huff and ambulation. Patient was also very motivated and it definitely helped that I planned my session just after the analgesics. Finally, we managed to get 2 teaspoons of M3 sputum out. My first sputum!! I was equally excited as the patient and not to mention exhausted.
Prior to this, I discussed this patient with my supervior and I felt that she would definitely benefit from short bouts of treatment when she was really sick. However, that was not possible due to the heavy caseload we had. That got me thinking. There would be times where you are able to prioritise or get help from colleagues. However, if that was not possible, some patient would not be able to get as much benefits as they had potential for. For instance, the first two days although she had been good in terms of sitting out of bed and working on her deep breathing exercises and cough, there was not enough manpower to ambulate her. Also, if we had given up after 1 hour of manual chest therapy, we would not have got that sputum out for testing.
I believe that this will be a dillema that will always exist but this experience has made me aware that if I have time, to persist with treatment depending on how much patient is tolerating.
1 comment:
This is a difficult situation that occurs very often. When pain is complicating the chest condition it makes frequent, short treatments difficult to fit in with analgesia to gain maximum benefit. You did all you could to persist with the treatment options available to you and eventually got the result so well done!
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