Situation
Week one conducting mobility and
respiratory assessments in a secondary hospital rotating between surgical ward,
medical assessment ward and ICU.
Task
Conduct an initial respiratory assessment
in an outpatient setting. Provide the client with information about their
condition and implement airway clearance techniques. Determine the suitability
of the client to join a pulmonary rehabilitation class run at the hospital.
Action
I looked at the patient file in regards to
the referral and any previous admissions to hospital. The client had been a
patient 3 months prior for IV antibiotics to control an infective exacerbation
of COPD. This had progressed to hospital in the home and she was soon after
discharged from care.
I greeted the client in the outpatient
lounge and escorted her to the treatment room. She seemed agitated and out of
breath. When I enquired if she was all right she stated she had rushed from the
car park (approximately 30 meters) and it was her normal exercise tolerance.
Once she felt comfortable and rested I
conducted the subjective history gathering that she had a 40-pack year history
and had quit 10 years prior. Her husband works away but she has supportive
family and friends that live close by. Her respiratory physician had informed
her that she had emphysema and bronchiectasis. She was a little unsure of her condition and her husband was
concerned and anxious because she would wake up in coughing fits during the night.
She reports 2 specimen jars of sputum on a good day. She had been prescribed Seretide
and Ventolin as well as Predisterone to manage her condition. I asked if she could demonstrate the
use of her Ventolin inhaler which she did. Her method showed very little
inspiratory effort and I corrected her with education about deeper breaths
allowing the medication to go deeper into the bases of the lungs. Her second
attempt appeared more successful and gave her more relieve from her shortness
of breath symptoms. I informed her that the Ventolin should be used before the
Seretide inhaler as this would maximize the effect of the medication. I
discussed with the patient the pulmonary rehabilitation class that was run at
the hospital with physiotherapy staff and she seemed interested to participate.
She was having two week holiday with her husband starting the following
Saturday but would like to begin after that. I excused myself to consult with
my supervisor before beginning the objective history. My supervisor checked
over the history and Okayed for me to begin the objective and treatment if all
measures were in normal range. I
gathered the SpO2 monitor and a saline bottle and tubing to construct a bubble
PEP devise.
I returned to the client and placed the
SpO2 monitor on while discussing her goals. She informed me that she babysits
her grandchildren and would like to have more energy to keep up with them. She
would also like to be able to walk the dog again without feeling anxious or
excessively out of breath.
Her SpO2 is 96% and he pulse rate is 98bpm.
On auscultation she has decreased breath sounds throughout with course
inspiratory crackles bilateral midzones.
Good chest expansion left=right. Cough was strong, moist and productive
of ½ tablespoon green sputum (M1-P2). The client reported feeling that the
sputum was sticky and she was finding it hard to clear. She became anxious and
short of breath and I asked her if she could try and control her breathing. She
was able to do this and I put together the bubble PEP device and explained its
use in splinting open the airways during exhalation to allow a greater gas
exchange, mobilize secretions and reduce the feeling of breathlessness. She
tried the device and after a couple of false starts she got the hang of it.
After two cycles of relaxed breathing followed by bubble PEP she spontaneously
began to cough. She produced two table spoons green sputum into a tissue and
then reported feeling like her chest was better. Her SpO2 remained at 96% but
her pulse rate had reduced to 88bpm. On re-auscultation she had no added
sounds. I handed some education pamphlets onto her, described various postures
and sleeping positions to alleviate her symptoms as well as some home care
advice for her bubble PEP device. I rebooked her for the following week and
introduced her to the coordinator of the pulmonary rehabilitation group.
Result
The patient had been able to clear her
airways after a few cycles of controlled breathing with bubble PEP. Her mood
and attitude toward her condition seemed improved and the use of her
medications had been optimized.
Evaluation
I was happy with my performance as an
educator and health professional and felt I had made a difference to someone
living with a chronic illness.
Strategies
Knowing more about how to describe the
conditions to the patient in layman terms would have been useful as I feel I
avoided this topic and passed over less personalised printed material.
