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In patient pneumonia protocol

 
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In patient pneumonia protocol - April 23, 2006 9:43:00 AM   
Dr.Wagner


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How many Hospital PT's use a protocol or regularly ambulate pneumonia patients?

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Re: In patient pneumonia protocol - April 23, 2006 10:43:00 AM   
jma

 

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I don't know of any protocols, except for Standard Precautions. If there are any, I would appreciate any info on it.

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Re: In patient pneumonia protocol - April 23, 2006 11:24:00 PM   
tucker

 

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Why would one need a protocol for a patient with pneumonia?

Airborne precautions for these patients?

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Re: In patient pneumonia protocol - April 24, 2006 12:00:00 AM   
nari

 

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About six years ago I was involved with development of protocols which excluded ambulation with a PT of any patient unless they had a deficit. That included, naturally, patients with pneumonia; it is the nurses' job to get them up and around, and they were quite happy with that.

Apart from that, we do not see any patients with pneumonia unless they have difficulty clearing secretions. Once treated, it is then up to the nurses to check they are moving about.
It freed up busy staff who had more time to do effective therapy with those who needed our specific skills.

Just a thought to consider.

Nari

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Re: In patient pneumonia protocol - April 24, 2006 8:50:00 AM   
tucker

 

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Same here Nari. We are generally not consulted for patients with pneumonia as they do not have a decline in function...nurses walk them in the hallways. The only exception is on the geriatrics floor where a day or 2 of inactivity can easily bring a patient down to requiring assistance to get out of bed or stand. For these patients, skilled PT may be indicated to restore independence.

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Re: In patient pneumonia protocol - April 24, 2006 6:20:00 PM   
tucker

 

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Dr. Wagner,

Are you referring to community-acquired or hospital-acquired pneumonia? My guess is CAP.

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Re: In patient pneumonia protocol - April 24, 2006 8:57:00 PM   
Dr.Wagner


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I was referring to CAP, but hospital acquired would need said treatment as well.

I am surprised at this, there is such a fantastic benefit in ambulation and increasing endurance with CAP patients and such a dramatic decline in ability with those patients with COPD. At several of the hospitals I have worked, there is a standard evaluation for inpatients (not 23 hour observations).

It is exceedingly important for these patients do NOT decline...and bounce back in one week. I would not rely on nursing.

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Re: In patient pneumonia protocol - April 24, 2006 9:05:00 PM   
SJBird55

 

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Hey, wags... your message box is stuffed!

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Re: In patient pneumonia protocol - April 24, 2006 9:21:00 PM   
Dr.Wagner


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not now!

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Re: In patient pneumonia protocol - April 25, 2006 8:01:00 PM   
Tom Reeves DPT ATC

 

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If its not skilled, the nurses do it. I don't have time or inclination to walk someone who does not require me to help them when a CNA could do it just as well. Heck, half the time when it is ordered, the nurses have already walked them to the tub.

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Re: In patient pneumonia protocol - April 25, 2006 8:44:00 PM   
nari

 

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Tom, I agree totally. We have more specific things to do in the acute area; besides, if a patient deteriorates in function, we can be informed of this.
Communication is everything; and if it doesn't work well, it is still no excuse for PTs to be walking COPD patients just for some CV fitness. There is not the time for this, despite all the preventative potential, as Dr Wagner recognises.
That is a nursing issue, or a job for the PTAs.
I don't know what a CNA is, but assume it is a nonregistered nurse??

Nari

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Re: In patient pneumonia protocol - April 25, 2006 10:43:00 PM   
tucker

 

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Yes Nari. Great post Tom!

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Re: In patient pneumonia protocol - April 26, 2006 3:55:00 AM   
nari

 

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Junction

Yikes. Are you kidding? Killing or curing?

In an Aged Care unit, category 3 might be possible...but I doubt it. Far too agressive IMHO.

It has been shown that increased mobility can be just as effective as all the banging/thumping and other interventions by PT; some education and regular walking has been done as a routine for some years here successfully, for post-cardiac surgery, pneumonia and COPD. COPD responds very well for the ambulatory patient of all ages by simple graded walking programs. Nothing else.

In fact, PD is done only for cystic fibrosis and uncontrolled bronchiectasis. The flutter has replaced almost all respiratory care with good results and self-management by the patient is also very good, because they are doing it themselves and it is very easy. Even the fragile oldies can do it.

Nari

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Re: In patient pneumonia protocol - April 26, 2006 12:53:00 PM   
jma

 

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Is this protocol from the place you work. If so, can you provide the reference for it? Would be nice to show it to the MD's down here

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Re: In patient pneumonia protocol - April 26, 2006 4:16:00 PM   
nari

 

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A Flutter is something that looks like a short fat peacepipe, made of steel with a solid ball bearing in the 'pipe'. Breathing is slowly done through the mouthpiece, the ball bearing vibrates and it has been shown to be just as effective or better than all the hands-on stuff; the vibrations rattle gently through the respiratory tract.

It's been around for about ten years or more and has largely replaced the old time consuming therapy of applying vibrations externally. Extremely effective for mobilising secretions, and PD can be done as well - but no banging and pushing. The PT does nothing except show the patient how to hold it and to breathe deeply and slowly.
Costs about $200AU - most chronic patients are more than happy to pay once they have trialed it.

I haven't got the references with me - but look it up and you may be surprised!


Nari

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Re: In patient pneumonia protocol - April 26, 2006 8:53:00 PM   
nari

 

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Junction

PubMed is a good source for studies on the flutter; and some of these are quite recent. Since about 1999 at our local hospital it has been extensively used for inpatients, outpatients and in the community. Once the respiratory doctors got used to another weird idea from PTs, they loved it.

nari

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Re: In patient pneumonia protocol - April 27, 2006 10:21:00 PM   
Dr.Wagner


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Perhaps the jist was to evaluate the patient, then discuss who can best treat the patient. In no way was I insinuating that "walking" a patient was a PT's job, but rather developing a treatment plan for hospital and home and allowing the PTA or tech to initiate the plan.

This is a HUGE potential area for treatment and seeing the benefit of exercise.

The "Flutter", I have seen many RT's use the device, they seem to really like it.

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Re: In patient pneumonia protocol - April 28, 2006 3:45:00 PM   
Tom Reeves DPT ATC

 

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I didn 't take it that way anyway Wags. I agree that they could/should be screened by the admitting doc, or the RN when they do their initial evaluations. If there are red flags or if the patient worries the nursing staff, a PT assessment could be triggered. I think a more important trigger might be for the SLP to do a swallow study to see if they are aspirating. That would maybe prevent a pneumonia rather than just treating it.

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Re: In patient pneumonia protocol - May 1, 2006 12:54:00 AM   
rich porterville

 

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so thats what walking pnuemonia is?? wow

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Re: In patient pneumonia protocol - May 1, 2006 2:20:00 PM   
Dr.Wagner


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I was speaking of the 60-75 year old Community Acquired pneumonia type with COPD and obesity...but it could work with Aspiration Pneumonia as well.

One of the reasons I was interested in this, was because of old pneumonia protocols in the old Osteopathic Hospitals that included lymphatic treatment and early exercise. Apprently it had great success and I was hoping many of the PT's had picked it up.

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