Take Time To Explain

WARMEST greetings to all of you.

Time passes so quickly. Cardio placements are over(for me). I have really learnt a lot from my placement and don't think I'll ever stop learning. There's always something new to pick up, something new to explore and ask.

During this placement, I've got the opportunity to see many respiratory cases. And it seems that for every respiratory case seen, its almost always a different treatment and management to be done/taught tailored to the individual's needs/signs/symptoms.

Guess I'll just do a comparison of treatment/management for two cases with similar medical diagnosis ie. Asthma, Bronchiectasis. Both had previous hospital admissions for the same problem.

Both of them were 30 year old females and had been admitted for unresolved infection of the lungs and were both super productive and with sputum of similar properties(thick, greenish-yellow).

For Miss A, she was independent in clearing her airway but found the sputum production too much for her to cope due to the long running infection. She is educated by her physio to perform ACBT and postural drainage positions with percussion on the lower lobes which is effective but because of "laziness" she seldom does it.

So treatment/management for her was very much hands-off approach, just reviewed her ACBT technique(some mistakes there: her huff was wrong), corrected her huff and her postural drainage positions. Gave her an Acapella(something like a Flutter) which worked wonders for her as she could expectorate effectively with less effort. Also educated her on long term management of her problems - to exercise regularly such as jogging, hiking and swimming as well as regular application of her ACBT/Acapella to get rid of any secretions. All done in one session.

Miss B's management was quite different as even though she had an almost similar presentation with Miss A, she was not as well educated as Miss A so it was a more hands-on approach with her. She didn't know much of her condition too.

Had to do manual techniques on her in postural drainage positions(left side lying). Taught her the ACBT cycle(which she didn't really understand and kept going into coughing fits). And because she kept wanting to stay in bed, I had to ambulate long distances with her. Couldn't give her an Acapella cos she didn't really know how to use it(incorporate the use of an Acapella in a ACBT cycle). At the end of it all, I was just glad she managed to do an effective full ACBT cycle on her own after 3 sessions and she was quite thankful for that.

Anyway, this 2 case scenarios have made me realize how important patient education is as it was clear that Miss A was well taught by the previous physio who attended to her and could manage independently quickly while Miss B was not well educated properly and slowed down the process of her getting better.

So, I guess, no matter how long it takes you to explain/demo to a patient who maybe less educated than the other, always do it properly as it will in the time to come affect them and the next physiotherapist who may be seeing them again.