Holistic Physiotherapy Management - Essay Example

Compare and Contrast the Holistic Physiotherapy Management of a Teenage CF Patient Admitted with a Worsening Productive Cough and an Elderly Patient Admitted with Pneumonia Introduction It is apparent that the case of a teenage cystic fibrosis (CF) patient admitted to hospital with a worsening productive cough has several similar traits with the case of elderly patient admitted with pneumonia. Nevertheless significant differences are also present. Pathologies of the Systems One of the pathologies occurring in respiratory system is CF syndrome. CF is told to be inherited genetic disorder spread mainly among white people. CF develops when two faulty genes are present in the human body. CF is considered a chronic obstructive disorder hurting the exocrine glands. It is necessary to mention that CF disorder causes abnormal ions and water diffusion in the epithelial surface of the body. In the result obstruction of the lumens and dehydration of secretions are caused by disorder(Brown 2004). It is observed that the accumulation of viscous secretions is obstructing the exocrine ducts rather slowly and in such a way pulmonary disease is caused. If CF disorder progresses it may cause also pancreatic insufficiency and focal biliary cirrhosis. Related clinical features are often demonstrated by patients with CF disorder. It is known that sodium and chloride ions in the lungs are not able to diffuse from epithelial cells into the human airways. In the result water is not able to osmosis out from the cells and can't function normally maintaining the necessary hydration of the mucus. Mucus becomes thick and sticky. Patients are found with increased production of sputum and chronic cough. If respiratory infection is present, then the symptoms will significantly aggravate(Murphy 2005). In contrast to CF syndrome, pneumonia is a restrictive respiratory disorder. Pneumonia is acute inflammation of lung parenchyma. Parenchyma causes consolidation of alveoli by filling them with inflammatory products. Lungs inflammation can be caused by various microbes including bacteria and viruses. Two categories of pneumonia are known: 1. community-acquired pneumonias 2. hospital-acquired pneumonias(Murray 2000) The paper is focusing on the patient with a community-acquired form of pneumonia. That is why it is necessary to say that such form of pneumonia is caused mostly by viruses and bacteria. For example, streptococcus pneumonia is the most common bacteria pneumonia which affects mostly elder population. Nevertheless elder population is also susceptible to other bacterial infections such as Klebsiella pneumoniae, Haemophilus Influenzae and Legionella pneumophilia(Cassell 2004). Viral infections can also cause pneumonia. Both categories of pneumonia have similar clinical features. The symptoms of bacterial pneumonia are productive cough which is not usual in virus pneumonia. Virus cab lead to loss of mucociliary functions and the patient will be predisposed to bacterial pneumonia. It is the evidence that clinical feature can be the same afterwards(Price 1995). Speaking about pneumonia and CF disorder, it is necessary to note that pneumonia is more variable than CF disorder. The main reason is that viral and bacterial pneumonia can cause CF disorder. The next reason is that the pneumonia can come from viral and bacterial forms which are resistant to antibiotics and in such a way they are more difficultly treated. Physiotherapy Assessment It is a matter of fact that physiotherapy assessment is the most important step, because its aim is to define the most accurate and proper plan of treatment. It is necessary to discuss patient's expected outcome during the assessment in order to maximize the adherence and especially to improve the patient's quality of life, because actually patients suffers greatly and feels constant discomfort because of either CF disorder or pneumonia. It is admitted (Wilfond 1995) that "the measuring of quality of life needs to result in an outcome that is meaningful to health professionals and to patients and their families, compliments existing clinical measures, and is an effective way of determining the impact of treatment on how patients feel and function". Physiotherapeutic assessment of CF patient will also include the following tests: stool analysis in order to find out how well the teenage patient absorbs and digests fat and other nutrients sputum culture in order to examine the samples of mucus and define types of bacteria that caused the infection chest X-ray in order to see the structure of chest walls, heart and lungs arterial blood gas analysis in order to measure the oxygen and carbon dioxide levels in the blood and to observe the work of lungs lung function tests in order find out whether lungs are healthy blood tests to determine complications if they are present Physiological examination of the elder patient with pneumonia will involve the following: Heart rate in order to point out if it is dehydrated or not Chest X-ray tests Temperature and breathing Level of oxygen Chest assessment in order to determine if there are complications or pains Both patients have been admitted to hospital and the physiotherapists have to obtain some necessary information about past and current medical history and only then to define proper medical treatment. This information is very important to physiotherapists, because they will be able to set the functional goals and to point home situation of the patients(Henderson 1986). The physiotherapist must also carry out qualitative assessment. It means that he/she has to ask patient questions whether he feels pain, have a cough with sputum, experience breathlessness. If the patient's cough is with sputum it is necessary to define its color. Such questions are useful, because they help to identify the method which will be the best suited for the patient. Questions are also used as an outcome measure aimed at monitoring the treatment progress(Lewis 1993). It is a well-known fact that in both cases (CF and pneumonia) the physiotherapeutic assessment has to be made before any treatment is provided. Assessment of the patients will involve the observance of general appearance of the patient (postural, fatigue and any breathlessness). Types of sputum and its color will be also investigated by the physiotherapist. It is necessary to mention that in case of the teenage CF, the teenage may have large quantity of purulent sputum of either yellow or green color. It would be the indicator of infection. The next indicator is the worsening productive cough. The elder patient with pneumonia may also have sputum because of infection. Sputum has to be monitored, because it can help to assess whether symptoms are improving or not. It can also help in defining proper antibiotics. After assessment took place, it is necessary to decide what assessment technique to use in order to "clarify the finding, such as auscultation, palpation of the chest and percussion"(Murphy 2005). Physiotherapist must also make notes regarding patient's blood gases, temperature, heart rate, blood pressure and chest X-ray before any treatment and assessment takes place. Such information suggests the problems of the patient. Chest X-ray is looked at the first visit, because it provides for the physiotherapist the necessary information about the structure of the chest walls and lungs of the patient. Physiotherapists don't rely only on the X-rays, because symptoms of diseases development can take weeks and even months(Price 1995). Percussion is used for the teenage patient with CF, because it is necessary to check whether the teenage is hyper inflated or just has pneumothorax. Pneumothorax is the complication of CF. The sound indicating the complication is booming sound. Such sound is negative, because he is the evidence, that there is an excess air in the lungs. Nevertheless it is not for sure and patient's diagnosis must be confirmed by chest X-ray(Henderson 1986). Percussion is used for elder patient with pneumonia t identify the consolidated areas of alveoli and then to check if atelectasis of lungs is possible. If the chest expansion of the patient is decreased, he may have atelectasis of lungs and has to be additional checked. The sound indicating the atelectasis is dull over the affected area. In order to confirm the observed finding the physiotherapist uses auscultation and only chooses the right treatment. The consolidation areas are indicated by the characteristic sound of hollow blowing on expiration in bronchi. Consolidation areas influence significantly the side on which the patient is going to lie or to sleep(Murray 2000). Wheezing and crackling sounds in the chest can be found both in and teenager with CF. physical fitness of both patients can be assessed by functional assessment. After 5-6 minutes walk of the patients the physiotherapist will check their physical fitness and its progression before discharge from the hospital. Holistic Approach to Treatment Treatment is the most serious and important step, because all outcomes depend on it. Teenage with CF has this disorder form young age and treatment techniques "may already be apparent and they will already be familiar with their own usual forms of treatment". Physiotherapists must find the best treatment technique and son on. In the two cases of pneumonia and CF disorder the initial treatment is antibiotics. Specific antibiotics are used for the virus or bacteria, because they are the causes of infection. It is possible to use multiple antibiotics when the cause of infection remains still unknown. The aim of physiotherapy treatment for the CF patient is: To clear the excess secretion To maintain the clearance of airways(Murphy 2005) The first step is to give the teenage patient a certain dosage of specific antibiotics, because they will prevent the worsening of cough. The next treatments are chest percussion, use of postural drainage, positioning, active cycle of breathing techniques. They can be also used for elder patient suffering from pneumonia. Physiotherapy plays only a supportive role. Postural drainage helps the drainage of secretion. It is used for 10 minutes in each position. It will help also to clear the secretion which can lead to significant discomfort and difficulties of breathing. The treatment should be stopped if the patients complain on constant headaches and giddiness during the treatment. Such techniques is effective only if the levels of secretion are higher the 30ml per day(Wilfond 1995). Other possible treatment techniques are chest percussions, vibration and shaking. The teenage patient will have rhythmic clapping on his chest. In the result the secretion in the chest will be loosened up. During vibration and shaking techniques the teenage patient will be applied hands onto his chest and compressed during exhaling(Brown 2004). One more treatment method is digestive therapy, because it works with the purpose to replace digestive enzymes and reassure that patient's body absorbs all the minerals and vitamins he needs and to prevent and to treat intestinal blockages. Such therapy involves: nutritional therapy in order to replace lost nutrients (taking vitamins, drinking nutritional drinks, eating high-calorie, high-fat foods, feeding through a tube in the stomach, receiving intravenous nutrient supplementation) digestive therapy of enzyme replacement to assist intestine absorbing nutrients from food stool softeners(Murphy 2005) It is necessary to admit the importance of respiratory therapy, because it slows down the damage of lungs and improves breathing. The focus of respiratory therapy is to reduce the infection impact and then to get rid of mucus in order to make lungs clean and healthy. Respiratory therapy uses such medicine as: Deep breathing exercises to strengthen the muscles which are used for breathing and to help breathing out Bronchodilators to make it easier for patient to cough and breath DNase to thin the mucus gathered in the lungs Directed cough to clean mucus by coughing and breathing in a certain ways Aerobic exercises to improve lungs work(Murphy 2005) New modern treatments are protein repair therapy and protein assist therapy. This therapy involves taking such medicines which will help the defective protein to operate normally and to allow salt and water to be removed from cells. The next modern therapy is gene transfer therapy aimed at introducing healthy genes instead of defected ones into the lungs of the patient. For the elder patient with pneumonia the similar techniques will be used while treatment. They are postural drainage, percussion, vibration and shaking. Nevertheless treatment will be a little bit different, because the patient will be additionally treated by the assisted coughing technique. It means that the elder patient will be taught hot to perform a cycle of breathing techniques(Murray 2000). For patient with pneumonia it is possible to use oxygen therapy if the cells of the body don't receive enough quantity of oxygen. This therapy is used to increase the amount of oxygen in the bloodstream and in the lungs. Oxygen therapy can be used either at hospital or at home, because there are a lot of delivery systems and breathing devices. The patient will be taught, because such knowledge will assist the coughing and in result will remove sputum from infected areas of the lungs. The patient with pneumonia may have in the result decreased lung compliance, increased inspiratory pressures and reduced lung volume. These problems must be alleviated with the use of positioning technique. The patient will be positioned in a certain ways and will be helped by physiotherapists to reduce the work of breathing. It will reduce the abdominal pressure and in such a way increase volume of the lungs(Price 1995). The patient can be also advised to use spirometry. It is used to measure the amount of air in the patient's lungs and to allow lungs to move in and out. During this treatment the patient places his mouth on the mouthpiece of the flexible tube attached to spirometer. Then he inhales as deeply as possible. Then the patient exhales as fast and as hard as possible. The process is not painful and can be made either at home or at the hospital. Mechanical methods will be also used to promote the clearance of airways and drainage. The patient will use flutter and expiratory pressure mask. CF patient produces three times more sputum with flutter. It is clear that the treatment of pneumonia and CF is rather similar. Nevertheless, physiotherapy is more important for CF and has to be carried out every day in comparison to pneumonia(Brown 2004). The patient with CF will be taught physiotherapy techniques, because they will carry them themselves. Emphasis is made on the motivation and stimulation of the patient to carry out techniques, because they will prevent the worsening of condition. The patient with pneumonia needs finite treatment necessary for recovery process. Elder patient won't recovery quickly because of his age. Therefore the physiotherapy will be implied to make the process of recovery faster(Murphy 2005). References Brown, Ronald. (2004). Handbook of Pediatric Psychology in School Settings. Mahwah, NJ: Lawrence Erlbaum Associates. Cassell, Eric J. (2004).The Nature of Suffering and the Goals of Medicine. New York: Oxford University Press. Drotar, Dennis. (2000). Promoting Adherence to Medical Treatment in Chronic Childhood Illness: Concepts, Methods, and Interventions. 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