Physiotherapy Treatment Plan - Assignment Example

PSYCHOTHERAPY Overview Mobility is an important aspect of holistic human life. This is an expected phenomenon as human are created to be both mobile and locomotive (Doughty et al., 2002). Any typical day for a person is therefore made up of several acts of movements from one place to another and from direction of the body to the other. Due to the important role that the ability to move and to be locomotive plays in the daily lives of a person, any restrictions to mobility that comes about comes with so much displeasure, discomfort and unhappiness. However, as the anatomical makeup of the human body is not made to be totally efficient, there are moments that deficiencies are experienced in the performance of daily roles, causing problems with mobility, functional ability and movement potential. As seen in the case, engaging in physical exercise is a common cause of all forms of impairments and disabilities that are recorded against mobility functions (Morillas et al., 2007). Once such impairments and disabilities come about, the work of physical therapists is very much needed in fostering quality of life. Quite importantly, physical therapists do not go about their roles as an event but a process that normally involve other multi-disciplinary team members. The following treatment plan is therefore prepared from a systematic and cross-functional perspective to redeem Mrs. Seddon from her current state of distress. Clinical features of Mr. Seddon Schoenenberger et al (2011) noted that the clinical features of a patient’s disease are basically the signs and symptoms that are manifested through physical examination and other medical procedures such as laboratory or x-ray workups. With this said, there are a number of clinical features of Mrs. Seddon that can be identified from her case that have direct reference to the aetiology and pathophysiology of ischemic heart disease. The following can be listed as part of the aetiology and pathophysiology of ischemic heart disease: Limited blood flow to the heart Lack of oxygen to the myocardial cells Damage to heart muscles Death of heart muscles Myocardial scarring Chronic stenosis of the coronary arteries (Niska, Bhuiya and Xu, 2010) From the aetiology and pathophysiology list given above, the corresponding clinical features in Mrs. Seddon that can be attributed to these include the following: High blood pressure level of 160/95 Tight chest pain Chest pain radiating down both arms and jaw line Sudden pale appearance and sweating Cold body temperature Myocardial infarction Any other signs and symptoms given above and as manifested in the activities and body functioning of Mrs. Seddon makes her prone to the aetiology and pathophysiology of ischemic heart disease. These thus account for her clinical features. Likely post-operative problems There are a number of postoperative problems that may be faced by the patient in the first three days of the postoperative period. Whiles some of these problems are potential problems, others are acute problems. Also importantly, these some of these problems may not be immediate but may develop in the nearest future if the most rapid steps are not taken. The list is thus presented to include the following: Hematologic dysfunction Cardiac arrhythmias Atrial fibrillation Platelet deposition on vein grafts Wound infection Fibrointimal hyperplasia Atherosclerosis Sepsis in the postoperative period Vasodilatory shock Pulmonary dysfunction Neurologic dysfunction Renal dysfunction Hematologic dysfunction Why patient might present with risk Hematologic dysfunction in the patient in the first three days after operation is likely to manifest or present in two major forms. These are bleeding or postoperative blood loss and thrombosis. The commonest of these is however bleeding or postoperative blood loss. Even though Zarich et al. (2006) posits that the cause of bleeding or hematologic dysfunction in general may be medical and thus difficult to find their cause, there are a number of factors that makes the patient at risk to the problem. One of these is residual heparinization, which is likely to cause the hematologic dysfunction or start bleeding after the cardiac surgery when there is insufficient protamine usage (Monney et al., 2011). What is more, in cases where there is transfusion of heparined pump blood during cardiopulmonary bypass (CPB), it is likely to be a cause of residual heparinization, which can also bring about hematologic dysfunction. Apart from this medical perspective of the potential cause of the risk with hematologic dysfunction, the patient might also be present with the problem due to excessive activity engagement for the first three days after she is operated. For example, lifting of heavy weights, attempts to lift heavy weights, engaging in dramatic physical exercise, experiencing a push, jumping, sudden fall, or wearing of tight clothing or belt could all lead to bleeding (Milionis et al., 2007). SMART goals for patient As far as the possible postoperative problem of hematologic dysfunction is concerned, there are very specific, measurable, appropriate, realistic, and timed goals that will be expected to be achieved with the patient. Cocker and Friedrich (2010) lamented hematologic dysfunction, particularly postoperative haemorrhage may either occur immediately after surgery or may be delayed. The idea that this pose is that when setting goals, it is important to have both short term and long term goals (Tungsubutra et al., 2007). With this said the goals that will be set for the patient will come both in the short term and the long term. The short term goals focus on the need to avoiding bleeding from the moment surgery is complete to the next 24 hours. The long term goals on the other hand look at the need to avoid bleeding after 24 hours and after discharge from the hospital. The table below presents the goals as short term and long term. Short term Long term Prevent the onset of bleeding by avoiding residual heparinization Achieve onset of normal blood clotting mechanism by means of medications , transfusion of blood products or clotting factors (Carrillo et al., 2011) Where bleeding occur, keep it below 400mL/hr during first hour after surgery Keep bleeding below 200mL/hr for each first 2 hours after surgery Keep bleeding below 100mL/hr over the first four hours Avoid ties around blood vessels becoming loose Achieve good eating habit that guarantees rapid replacement of lost blood Avoid postoperative injuries associated with body movement activities Management measures From the list of potential cause of hematologic dysfunction in the patient, it would be understood attempting to forestall the situation is not something that can be done by only one person or a single professional. This is because the problem is multi-situated, calling for the need to use management procedures that can be considered as equally multi-disciplinary (Knox, 2007). With this said the proposed management or treatment plan is one that will be made to be cross-functional or implemented according to the shared responsibility concept. In physiotherapy, Bakewell (1997) explained that shared responsibility is used to identify the role that different multi-disciplinary team members can play in the delivery of a patient’s intervention. With this said, the management will be made to include roles to be played by medical and non-medical experts including nurses, guidance and counselling coordinator, physiotherapist, radiologist, nutritionist, and a surgeon. Even if the services of all these people may not be required in the very immediate sense, having them on standby to cater for any emergencies will be very necessary. Again, whereas the role of some of these multi-disciplinary team members may be very direct, others may be required only to play indirect roles as far as hematologic dysfunction is concerned. Based on the background given above, the following specific management plan or procedures will be used in the patient. Reassurance of patient: Patient need to be reassured that the situation that she is currently going through will be contained and that the best form of procedures will be applied to make her well. This responsibility is expected to be played by the guidance and counselling coordinator. Pain management: Pain relief must be administered immediate to consolidate the reassurance. The most common form of pain management will be the use of anaesthesia and other drug regiment prescribed by the surgeon (McKenzie, 1998). Using antibiotics prophylactic, therapeutic, sedatives, antiemetics and anticoagulants may also be appropriate in managing pain. Monitoring: Monitoring is needed as part of the management and is expected to take the form of checking of vital signs, including blood pressure, pulse and respiratory state (Bialosky, Simon, Bishop and George, 2012). This role may be performed by the nurse. Monitoring is expected to include measurement and recording of important signs. Mobilisation: In direct relation to the function of the physiotherapist, early mobilisation will be encouraged in the patient. This will be done by making patients move around in a manner that their conditions allow so that there can be good pulmonary ventilation, which will reduce venous stasis (McKenzie, 2002). Evaluation methods It is expected that evaluation will take the form of both quantitative and qualitative assessment of patient. Quantitative assessment will include the documented outcome of monitoring about patient’s situation as far as area of wound and other organs that can lead to bleeding are concerned. Qualitative evaluation will also take the form of physical examination of patient and engaging the patient in an interview where she gives personalised assessment of her condition. Wound infection or failure Why patient might be present with risk Polk and Naqvi (2005) attested to the fact that there are conditions that make postoperative wound infection or wound failure more prevailing. In Mrs. Seddon, she might be present with wound infection mainly because her surgical procedure has high risk of infection, which is contrary to a minimal risk of infection. Again, Mrs. Seddon, by the clinical features discussed about her makes her a high risk patient. Apart from her clinical features, there are some risk factors presented in her case that makes her high risk patient. Some of the risk factors include overweight, being a lifelong smoker, inability to stick to healthy diet, and high rate of stress from work. Meanwhile, Mosca et al. (2005) noted that such high risk patients have higher probability of experiencing wound failure or wound infection after cardiac surgery. Whatever the situation may be, Mrs. Seddon needs very immediate attention in ensuring that the issue of wound infection or wound failure does not take a better part of her. SMART goals Like with the problem of bleeding, postoperative wound infection could also have its long term and short term effects. As noted that Kreatsoulas et al. (2013), postoperative wound infection may be recorded within few hours after surgical procedures but may also be delayed till later time after the patient has been discharged from the hospital. In whatever case, the most important approach is to have the right management procedures. But to know the exact practices to pursue as part of management, it is always important to have clear cut goals that defines exactly what it is that must be achieved. The table below therefore gives an overview of the short term and long term goals that must be achieved as far as wound infection or wound failure is concerned. Short term Long term To avoid breach in a protective surface of the patient To maintain state of host resistance or particular characteristics of organisms that make them more likely to infest Control cases of abscess formation through procedural medical practice To limit degree of extensive local spread whether or not these may be made up of tissue death. To control and avoid distant spread of existing infection Educate patient on best practices with boy movement actions that does not risk surgical site infection Education patient on best diets that ensure quicker dying of wounds Appropriate management Just as was done in the case of postoperative bleeding, it will be extremely important and necessary to ensure that the management of patient against postoperative wound infection is done in the principle of shared responsibility. This principle is used with the rationale that it will help in defining the specific roles that ought to be played by all other members of the multi-disciplinary team. From the list of short term and long term goals given, it is very clear that the management of the postoperative wound infection will not be done by the physiotherapist alone. Based on this understanding, the following management or treatment plan will be implemented. Reassurance of patient: Patient might have already seen wounds getting infected right after surgical procedure or after being discharged from the hospital. Such instances will put the patient in a lot of suspense position and may even trigger fear and anxiety. In such a situation, Tamura et al. (2013) advised on the need to give patients reassurance about the fact that it is possible to bring their situations under control. Wound debridement: To ensure that the postoperative wound infection that may be developing is given the most immediate management intervention that prevents further spread of wound, McSweeney et al. (2003) recommends the need to engage in debridement. This is to be done as the removal of unhealthy tissue that is identified with or within the wound. Depending on the extent of the infection, debridement may be done through such procedures as surgery, mechanical, autolytic or chemical (Tamura et al. (2013). Vacuum-assisted closure treatment: In very rare cases when infection continues even after wound debridement, it will be most ideal to engage in the use of vacuum-assisted closure treatment. Though a simple technique, vacuum-assisted closure may be very effective in treating postoperative wound infection. The procedure may be done by inserting foam that has an open-cell structure into the wound. This is followed by laying wound drain that has lateral perforation on top of the wound (McKenzie, 2002). Support with mobility: Mobility can be a major contributing factor with wound infection and so it is very important to ensure that the physiotherapist gives the necessary assistance, support and training on how to engage in regular daily activity without compromising the injury Dietary education: A nutritionist must be present to give education on best meals that guarantee the achievement early wound treatment. Evaluation method In this instance also, using both qualitative and quantitative evaluation in the same manner as explained earlier will be recommended. Conclusion To conclude, it will be reiterated that the need for effective mobility functionality in a person is not something that can be achieved as an event or in isolation. Rather, physiotherapy must be seen as both a process and a shared responsibility. By saying that physiotherapy must be a process, what this means is that intervening for such physical health conditions as what Mrs. Seddon experienced must be carried out in a systematic and gradual manner, which entails the careful diagnosis of problem, identification of situation remedies, application of remedies, as well as the evaluation of remedies. All of these are what the current treatment plan that has been prepared sought to achieve. Again, by saying that physiotherapy must be a shared responsibility, what this means is that the role of other members of the multi-disciplinary team must be clearly defined and incorporated in the whole intervention process. In this paper, this was done by clearly outlining how nutrition and counseling for example are very important in ensuring that Mrs. Seddon attains the kind of health status she requires. As the approach to treating Mrs. Seddon has been carried out both as a process and a shared responsibility, it is expected that the remedy she will experience in the long run will be one that guarantees holistic physical health recovery. References Bakewell S. (1997). Illustrations from the Wellcome Institute Library: Medical Gymnastics and the Cyriax Collection, Medical History 41 (17), 487–495. Bialosky JE, Simon CB, Bishop MD and George SZ (2012). "Basis for spinal manipulative therapy: A physical therapist perspective". 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