In pt Rx utilising the pts HEP

My placement at the moment is cardio at Charlies and the other day I was assessing and treating a newly admitted patient who had an exacerbation of Bronchiectasis. So i completed my subjective and objective thoroughly before heading out to speak to my supervisor. During the subjective I went into great detail about the pts home program of secretion clearance as apparently all Bronchiectatic pts have a very thorough and detailed home program aimed at clearing secretions independently on a daily basis in a bid to prevent exacerbations and infections and ultimately keep them out of hospitals.

The pt explained to me about the time, positions, duration and other activities she does during this program. She reported she had a neb half hr prior, then completed 10minutes in each sidelying plus percussions as she felt fit at 2pm each afternoon. She completed ACBT's in these positions. During my discussion with my supervisor we were discussing problem lists and treatment options for this lady and since one of her [problems was impaired airway clearance then an obvious treatment was ACBT's to clear secretions heard on auscultation.

So when i returned to the patient to complete the airway clearance techniques I suggested using the tilting of the bed to adopt a head down tilt position to optimise the use of gravity to assist drainage. However, the pt was very apprehensive of this as she has been doing her home program for years now and does not like changing it one bit. I tried explaining to her the advantages of using the head down positions but she did not want to give in and refused to change her program.

So to avoid a confrontation I gave in and simply assisted her through her program as she does at home. Upon completion I was speaking to my supervisor and she was telling me how a lot of these sort of patients can sometimes be pretty stubborn as they have dealt with their condition for years and feel they can handle it independently. So when they come into hospital and there are nurses and doctors doing a million things do them they can get a bit apprehensive towards other people that try and change something of theirs which they feel they can do thoroughly on their own. So they kind of feel its the only way they can keep their independence!

So when visiting her next day I sat down prior to treatment and revisited the benefits of the different positions and told her that this is simply an extension to her program and that its not me changing her program because she cant do it successfully anymore (which she saw it as). SHe took this fairly well and that session went smoothly and produced possibly a bit more sputum than normal which was good as she sore immediate effects. So from there she can incorporate that into her HEP and can maintain her independence.