June 15, 2012
Vitals: BP: 110/70, Temp: 37.9, O2Sat: 95, HR: 67, RR: 26
HOMECARE ESSENTIALS 7 PROPER LUNG CARE
Even without doctors and xray results telling us, we knew, from the start, that Melit’s lungs will be one of the focal points of her recovery process.
For one, we knew her history of asthma and breathing problems.
Second, we know that when the body is always lying in bed, there will respiratory problems.
Third, she just recovered from a vicious pneumonia attack that was hospital-acquired.
Fourth, heck, she has a trache tube in her throat, that should be a daily reminder to be alert always.
Comatose patients do need assistance to breathe properly.
At home, we listed several ways to take care of her lungs:
- A sterile environment that prevents any inhalation of germs and bacteria
- A strict policy of not allowing anyone with coughs and colds to stay long inside the healing room, and for everyone to wear masks
- A concentrator and standby oxygen tank for her oxygenation needs
- A pulse oximeter that measures her oxygen saturation and a regular monitoring of her respiration rate
- A nebulizer with salbutamol and PNSS in case of labored breathing and asthma attacks
- A suction machine that clears her airways from fluids like phlegm
- A regular schedule of cleaning the trache tube and changing the inner cannula to prevent infection
- A regular schedule of changing her bed positions and degrees to allow movement and clearing of airways. Melit breathes better when lying on her right side with the bed at 80 degrees. That is the position we bring her to when she has asthma attacks.
- A daily dose of acetylcysteine , a mucolytic agent.
We even have developed a simple way of cleaning the inner cannula:
- Change the inner cannula every end of shift
- Place the old one under running water to remove phlegm and blood.
- Soak in a hydrogen peroxide solution for at least 5 hours.
- Transfer to distilled water to remove the hydrogen peroxide.
- Soak in PNSS for the final stage before using again.
THIS WE LEARN ALONG THE WAY
Today, we encountered one of the few dilemmas of medicine which must have confronted some doctors for a long period of time and which sends researches to the drawing table: choosing which part of the body to deal with.
Melit has a bloated stomach which means her water retention is high and her bowel is not moving very well. Aside from laxative, Doctor Sabal advised to limit her fluids to 1500 ml per day. This is a 1000 ml less than her usual intake. Within a day, her stomach was noticeably smaller, but she has signs of dehydration, her skin went dry and her cough drier, so dry that there was already blood in her phlegm.
So, we asked Dr. Sabal to prescribe the most logical thing, a rehydration solution called Glucolyte.