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Title of Part A Essay;
Pneumonia in the ventilated patient: identify the pathophysiological changes, connect them to pertinent signs and symptoms, and justify a chest physiotherapy/physical rehabilitation program for an ITU patient.
Study of a case
Female student, 19 years old. 10 cigarettes every day.
ITU admission 2 days ago with cracked ribs on the left; ribs 4-9. The injury was caused by an RTA (passenger), and the patient was very SOB with a sat of 81% at the scene. Fractures and L haemopneumothorax were identified at A&E, and a broken L clavicle was seen on CXR. Chest drain inserted; Type I respiratory failure progressed simultaneously to the point that the patient was intubated and ventilated because oxygen levels could not be maintained properly; patient moved to ITU.
Patient was sedated and mechanically ventilated on SIMV for two days; she got two units of blood since her hemoglobin was low (78).
The patient has now developed ventilator-acquired pneumonia on the left side (VAP). Nurses have observed thick secretions and wheezing, and supplementary oxygen requirements have increased to 40%. Pt has primarily been nursed supine, and is rousable and can react/respond to order when sedation is being reduced. She is now breathing spontaneously, with the ventilator aiding each breath, and her CO2 levels are normal. Pt can move limbs on demand. During interventions with SOBOE, little desaturation was detected. Pt is nervous and irritated since he is unable to communicate vocally.
PMH Nil, renowned daily smoker of ten cigarettes.
CXR- L-sided lung volume decrease and opacities within the lung field
Consider this:
Pathophysiology of VAP in Pneumonia
Consider the negative impacts of mechanical ventilation.
Connect symptoms and indications to pathogenic processes.
Consider appropriate chest physiotherapy procedures, EBP/effective physiological treatment strategy- explanation
Consider additional concurrent techniques that may increase the efficacy of chest physiotherapy.
Consider your exercise and rehabilitation goals/needs from now until the hospital DC.
Consider the patient’s physical objectives and needs.
Consider the constraints of the situation.
Consider safety while using ANY therapy.
Consider making changes to ALL treatments- how? What? Why?
Considerations of an ethical/legal nature
Take into account psychological concerns.
Emotional problems?
LO1,3,4 of the ITU environment
Part BPractical
Case study based- case studies covering a range of pathology, issues and treatment strategies
LO1, 2, 3, 4. Pathophysiology, analysis of S&S, problem recognition/ solving, appropriate treatment planning, physiological and evidence based justification of treatment.
Practical exam; 10min read of case study selected by examiner, 30min questions to demonstrate clinical reasoning, application of therapy and practical skills.
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