back to basics

Wk 1 at cardiopulmonary placement.
First week at cardiopulmonary placement, I saw a 60y.o. patien, day one post open cholecystectomy with epigastric hernia repair. It was via a midline incision, upper abdomen. He had quite severe pain level and had gotten a intercostals nerve block earlier in the morning to deal with the pain. When I saw him, he only had pain with movement, around 4-5/10. I did all the subjective and objective pretty alright. As he tolerated well enough with SOEOB, sats was 93-94% with 3L oxygen, all other obs were stable as well, I decided to have him SOOB (of course with help of my supervisor). When it came to environment planning, with all the drains, IV drips, PCA, I felt really disorganize & clumsy. Has been some time since I practiced transfer with an actual patient, really need to do more practice of that.

Anyway, back to this patient, we managed to sit him out of bed, he seemed quite uncomfortable due to the pain but he claimed he could manage and try sitting out for a while. As he seemed really exhausted at that point in time and we did not think he could concentrate any more, we decided that we would come back to him in the afternoon to teach him the DB ex’s & supported cough.

In the afternoon, I found out that the patient did not tolerate SOOB very long, about 15mins. Initially I was afraid that patient would be unwilling to be seen by me again as he may think that I’ve made him feel worse. So I had to brace myself to convince him the importance of getting him up early and what he is experiencing is absolutely normal post op. At the beginning he did seem unwilling to have physio again, but thankfully he did listen to me and understood where I was coming from. So I went on with the DB ex’s. Though not fantastic, he still managed to do fairly well with those ex’s. As he seemed exhausted, I thought I would do the supported cough tomorrow morning. Luckily I did not do that, as my supervisor pointed out to me that he has had an upper abdominal incision, and he was at risk of sputum rentention, if any present.

I would always remember now that it is really important to do all the basics—breathing ex’s and supported cough on day one post op, even if mobilization is not possible. If mobilization is not possible, at least sitting up in bed would be helpful. It is also very relevant to ensure that patients understand the importance of doing all those things, which may seemingly look easy or unnecessary. Besides, it would be a good way to gain compliance as well as rappot.

Have a good 2nd week!