Respiratory therapists work with many different kinds of patients and a variety of conditions. The therapists’ task was to assess the patient’s airways and maintain them to provide adequate oxygenation and ventilation. During the process, they would keep monitoring the patient’s condition until we were satisfied with their condition, though we would check on them regularly afterward. The methods used generally succeeded in clearing up the patients’ airways and reducing the buildup of fluids. The registered nurses handled the routine tasks, such as starting an IV and giving the patients their medication. If necessary, we would also insert catheters to collect samples from the patient’s lungs for further analysis and conduct other necessary procedures.
The primary method the therapists used to determine a patient’s issues was the ABG test. Depending on its results, they would prescribe one or several of a wide array of other, more specific procedures if necessary. Some examples included spirometry, respiratory muscle function testing, and airway resistance tests. They help ascertain the specifics of the patient’s issues and prescribe an adequate treatment.
However, the initial ABG results typically featured strongly in the final diagnosis, highlighting the versatility of the test. We primarily used nebulizers, both small-volume and high-flow, alongside BiPAP and ventilators. There are other treatments, such as pulmonary drainage and cardiopulmonary resuscitation, but we did not perform them during our time at the facility. However, I encountered an unusual and noteworthy case that required a particular methodology, namely a patient who had cystic fibrosis.
During my rotation, my focus patient was a 3-year-old boy. Upon admission, the patient’s vital signs were as follows: temperature – 100,76; heart rate – 132 beats/m; oxygen saturation – 89%. He had a very high body temperature, mucopurulent discharge from the nose, cough, frequent (5 times a day) stool. From the medical history, it turned out that unstable fetid greasy stools have been bothering him since birth. Respiratory problems appeared in the first month when staphylococcal pneumonia was clinically and radiologically diagnosed. After this, there was a constant low-productive cough, 2-3 times a year, bronchitis, pneumonia. In all cases, the disease was prolonged. Up to 8 months of age, two times, there was rectal prolapse. He lags behind his peers in physical development. Both parents are healthy.
Upon initial testing, we discovered some signs that enabled us to make an accurate diagnosis. The first was the patient’s age, combined with his history of various issues. According to Farrell (2017), cystic fibrosis is a genetic condition that occurs in newborns and affects the respiratory system along with several other organs. It is characterized by a lesion of the exocrine glands with the formation of a high-viscosity secretion that obstructs the excretory ducts.
Another feature is the development of secondary progressive changes (functional insufficiency, fibrosis) of organs, primarily the lungs, pancreas, liver, and intestines. “No other lung disease is known to induce such an early, sustained and intense inflammatory process as seen in the CF airway.” (Cantin, Hartl, Konstan & Chmiel, 2015, p. 420). Combined with the results of several follow-up tests, this information enabled the team to make a confident nursing diagnosis and proceed to treatment.
After the diagnosis of cystic fibrosis, we used several respiratory tract purification methods. They include postural drainage, chest percussion, and hand vibration along the chest wall. During this rotation, I was taught how to perform chest physical therapy, and I did it daily. The patient should receive all the usual vaccinations, especially against infections such as those caused by Haemophilus Bacillus, flu, measles, whooping cough, pneumococcus, and chickenpox, which cause respiratory diseases.
Nurses’ other duties included giving injections, providing the patient with necessary medicine, helping him to maintain a nutritious diet, and encouraging him to do some physical activities. The damage that the patient’s non-respiratory organs receive cannot be ignored, and an adjustment in nutrition is required to compensate for it and guarantee proper growth for the child.
The patient’s condition improved substantially after the implementation of the treatment. His temperature dropped to 97 degrees, his heart rate dropped to a more acceptable level, and the oxygen saturation in his blood increased to 96%. His stools became less frequent and greasy than before, and the amounts of nasal discharge were reduced. Overall, the treatment succeeded in relieving his immediate issues, and he could leave the ER. However, CF is an incurable condition, and the symptoms would return if it were not appropriately managed. To that end, the patient’s parents were educated in the practices used to address the issue. The patient will also be returning to the hospital for regular check-ups to monitor his condition and respond to any issues that emerge.
The medical care I was able to provide this patient with is part of everyday service for a respiratory therapist. During this rotation, I realized how much psychological and social support children with cystic fibrosis need, as they often cannot interact freely with other children and feel lonely. The main burden of treating a child with cystic fibrosis falls on the shoulders of parents, who must receive enough information, training, and support so that they can understand the disease and the rationale for its treatment. Through practice, I have managed to improve and to acquire several crucial skills. I had an excellent opportunity to apply my theoretical knowledge in real-life situations.
References
Cantin, A. M., Hartl, D., Konstan, M. W., & Chmiel, J. F. (2015). Inflammation in cystic fibrosis lung disease: pathogenesis and therapy. Journal of Cystic Fibrosis, 14(4), 419-430.
Farrell, P. M., White, T. B., Ren, C. L., Hempstead, S. E., Accurso, F., Derichs, N.,… & Sermet-Gaudelus, I. (2017). Diagnosis of cystic fibrosis: consensus guidelines from the Cystic Fibrosis Foundation. The Journal of Pediatrics, 181, 4-15.