Asked for male, 21years old from Navi Mumbai
Treatment methods are:
night time saturation records with pulse oximeter and bilevel positive airway pressure (bipap) may be indicated for the patients.
Physical therapy measures (chest percussion, breathing exercises, resistive inspiratory training) may be required to clear respiratory secretions to reduce the work of breathing.
Special weaning protocol to prevent over fatigue of respiratory muscles can be recommended for more severe patients with tracheostomy. Patients with cranial nerve involvement need extra monitoring as they are more prone to respiratory dysfunction.
Patients should be encouraged to cease smoking.
Posturally drain areas of lung tissues, 2-hourly turning into supine or side lying positions.
2-4 litre anaesthetic bag can be used to enhance chest expansion. Therefore, 2 people are necessary for this technique, one to squeeze the bag and another to apply chest manipulation.
Rib springing to stimulate cough
after the removal of a ventilator and adequate expansion, effective coughing must be taught to the patient
maintain normal range of movement
gentle passive movements through full rom at least three times a day especially at hip, shoulder, wrist, ankle, feet.
Orthoses use of light splints (eg. Using plastazote) may be required for the following purpose listed below: a) support the peripheral joints in comfortable and functional position during flaccid paralysis.
B) to prevent abnormal movements.
C) to stabilize patients using sandbags, pillows.
Prevention of pressure sores
2- hourly change in patients position from supine to side lying. If the sores have developed then uvr or ice cube massage to enhance healing.
Maintenance of circulation
a) passive movements b) effleurage massage to lower limbs.
Relief of pain:
a) transcutaneous electrical nerve stimulation
b) massage with passive rom c) patient can demonstrate increased sensitivity to light touch, a cradle can be used to keep the bed sheet away from the skin. Low-pressure wrapping or snug fitting garments can provide a way to avoid light touch.
D) reassurance and explanation of what to expect can help in alleviation of anxiety that could compound the pain.