Hello all,
I have seen a lot of very complicated surg patients this week, in the ICU and on the ward. Have had a chance to do some manual hyperinflation and some suctioning, a neuro assessment on my day 2 CABG patient who had a stroke and a look at surgical emphysema.
Following my mid-placement assessment i asked to see some medical (COPD) patients as our CCT said they would be good for the PCR. I was given an end stage COPD patient admitted with a chronic exacerbation who I saw with the CCT. He was a textbook patient with all the usual problems: dyspnoea, airflow limitation, decreased ex tolerance. O/E widespread expiratory polyphonic wheeze, sats 88-90% fixed upper resp breathing pattern... you get the idea. Someone I thought could really have benefited from physio.
Well when i got to the treatment (breathing control, ACBT, amb etc) he let me know in no uncertain terms how useless “huffing and puffing’ was and that every physio in the last 25 years had tried the same treatment to no avail. I persevered, had him go for a walk then asked him to show me how he recovered from his dyspnoea. I suggested some fixed forward lean positions which he declined to try, but I did notice he was already pursed lip breathing and recovering quite well.
Following the treatment his sats were up to 96% and he was reporting less SOB, his wheeze was significantly quieter too. The frustrating part about this session was that by all objective signs my treatment had made a difference, but my patient refused to acknowledge this change, continuing to believe that physio could not help him. I have to admit, at the beginning of the session I was almost in agreeance with him, what could I offer him that someone else had not already tried? I guess just having confidence in your treatment and approaching this patient not claiming to cure or solve all his problems, but maybe just to offer some suggestions on how best to manage can be helpful. any comments on similar experiences would be appreciated!
Subscribe to:
Post Comments (Atom)
2 comments:
Hi Jess,
i had a similar experience but then was during my neuro placement instead. He was a GBS patient undergoing rehab in the hospital and my treatment consist of strengthening exercises and some stretches. He did have improvement: from unable to take the stairs to being able to go up three flight of stairs. However, he commented that this is not an improvement. He could do climb stairs prior to GBS and so must be due to natural recovery. Unfortunately, i still did not manage to convince the pt that Physio did make a difference to his condition. Sorry, not able to offer any suggestions but i definitely can understand how you feel.
Hi Jess,
I too had a patient with an exacerbation of COPD, as with your patient he had had many physio treatments and had tried all the breathing techniques, relaxation, huffing - refused even though the secretions were clearly there and needed to be cleared, etc. Here we come along as PT students and try and teach someone with a chronic condition who has seen and heard it all before. Sounds like you did well to get him to do anything, even though he didn't agree at least you know you made a difference. Maybe we could ask what would be considered an improvement by the patient at the start! To make them think about it a little more objectively rather than being dismissive at the end.
Post a Comment