Good Case Study On Sepsis, Hcap, And Elevated Troponin
Sepsis is a health condition that is caused when infection-fighting chemicals that are released into the bloodstream triggers the inflammatory responses in the body. The state of inflammation is capable of causing organ system failure due to damage. Prolonged sepsis may lead to low blood pressure, which may eventually lead to death. Health care associated pneumonia is the institutions that tend to give attention to pneumonia people. Pneumonia is a health condition that affects the lungs and other respiratory organs.
Patients diagnosed with this condition have a difficult time in breathing; consistence coughing and at times they cough more often. Elevated Troponin, on the other hand, is an increased release of protein to the body muscles like that of cardiac muscles. Elevated Troponin is an indication of dead cardiac muscle cell in the human body. The multiple conditions that result in organs failure deteriorate the lungs, respiratory organs, and the cardiac muscles. The deterioration of the lungs, respiratory system, and the cardiac muscles leads weak breathing system and reduced morbidity. The intention of the case study is to investigate whether the physical therapy in the attempt to rehabilitate patients suffering from the multiple conditions mentioned above will get out of the bed and walk normal without the help of handrails and any support or supervision.
The study examined a patient who was first diagnosed with a pneumonia organism unspecified condition. The patient is a female aged 72 years and used to stay alone in her private residential home in Michigan. The patient had morbidity problem hence difficulties in getting into and out of the bed. The physical therapy process was an experiment for the patient to complete a 9-session exercise with a five frequency weekly for the duration of 8 weeks on a daily basis. The experiment grouped the 9 session into two variables where the first variable the patient had support and was under the supervision.
The other variable the patient was to try the experiment without help. To effect the experiment goals were set that need to be achieved. Goal setting is essential in physical therapy. Goals are set for either short-term or long-term purpose. For instance in our case study, both short-term and long-term goals were established in the process of administering the therapy. Under the short-term objectives, the patient engaged in simple bed mobility tasks with the help of side rails in order to get in and out of the bed. To increase the therapy participation, the patient performed functional mobility with the help of AD. As time progressed, the patient was engaged in more complex activities like that, of walking on the stairs 25 feet from the surface.
Finally, under short-term goals the patient was to ascend and descend four stairs within a minute by the help of the handrails. Long terms goals were the patient to perform the bed morbidity of getting out and into the bed without the help of side rails. The second long-term goal was for the patient to use modified side rails in the attempt to increase the participation. The patient was also supposed to ambulate on a level surface 50 feet but under the supervision. The patient was also supposed to ascend and descend a 15 stairs with supervision. Lastly, the patient was to perform transfer movement from the car as well as to the car with control. The patient had a goal of being able to walk and take care of herself. The potential for achieving the goals was good as first stated in the initial evaluation, but it was not efficient in the first therapy. From the past medical history, the patient would not get into or her bed. She needed physical therapy to help her gain her morbidity.
The essence of physical therapy is to help mentally, physically and any other disturbed patient to get back into their normal condition. However, from the previous medical result this was not the case. From the medical reports, the patient was referred to a higher medical institution. Reason for the referral was due to new onset of decreased morbidity, reduced strength, reduced ambulate and low tolerance to functional activities. From the previous test outcome, the patient lived alone before a lumbar surgery. This implied that she had no one to help her exercise. She had no one to set goals for to focus on and achieve them. As she moved to VA for the surgery, she was staying with her daughter who had a two-story house with the bedroom upstairs. The features of her daughter’s house were better considering her situation. It meant that on a daily period as long as she was staying with her daughter she had to go up and down on the stairs at least one times a day. Whether by help of the side rails or the help of her daughter, she had to go to her bedroom. The implication of her first live in Michigan had no positive impact on the physical therapy. However, her second place in VA had a positive effect on physical therapy. Additionally from the report, the patient intended to go back and stay alone in her private residence. However, she was recommended to stay with the family group in the process of full recovery.
The previous medical report indicated that the patient’s response to the therapy was inadequate. She had to be referred to VA for a lumber surgery. Upon her referral, she was diagnosed with sepsis, HCAP, and elevated troponin. The multiple conditions had resulted in organ system failure, which lead to the series of medical conditions of chronically dysfunction, lumbar spinal stenosis, lucrative colitis, and obesity. The diseases lead to decreased sensory functioning of the patient's muscles contributing to her current health conditions. As sepsis affects the inflammatory responses, there is reduced sensory functioning. Many body organs fail to function as their sensory receptors are affected. Elevated troponin as well is an increased protein production in the body, which has a negative impact on the body. Patients with this kind of condition have reduced cardiac muscle function, or the cardiac muscles stop to function because they are dead. Cardiac muscles in the body of a human are responsible for the right functioning of the heart. When the muscles die or when they cannot function well it means that the heart will not pump blood to various parts of the body. The correct and balanced pumping of blood is what determines the body morbidity of the patient.
As well, the patient in the case study was further diagnosed with increased troponin in addition to diagnosed pneumonia and sepsis this contributed to her reduced response to ambulate and reduced response to the physical therapy. Maybe if the patient was just suffering from pneumonia as early diagnosed she would have responded to the physical therapy to achieve the set goals. The goals set were short-term, long-term and the patient’s goal of being able to walk and support herself rather than being supported by people and side rails.
The medication offered to the patient was that of a surgery to relieve lumber spinal pain that, had been caused by nerve root pitching. The surgery entails removing a portion of the bone via nerve root from under the nerve root. The surgery helps to relieve pain of the pitching nerve to create room for the healing of the nerve cell. After the surgery, the recommendation was the patients to wear glasses for 24 hours. She was to continue in physical therapy to enable her recover fully from the morbidity condition. She was to engage in exercises of walking on elevated surfaces, but with time to increase her therapy participation. To was to engage cardiac muscles manually to make them start functioning well again. In her later treatment, the patient was recommended to engage in both lower and upper extreme muscle engagement. In lower extreme, she was to make the full range moves on gravity and avoid using plane at any given chance, as the planes would add some resistance to response to the medication and therapy at large. Under upper extreme, the patient was to move against gravity to put some pressure on the cardiac muscles. However, these kinds of moves should take minimum time with sudden withdrawal to impact the treatment. This is meant to test whether the muscles are responding to the treatment because due to surgery the patient is not supposed to feel the spinal pain. Removal of the affected part of the spinal bone is to reduce the muscle problem to enhance morbidity.
Interventions that, were provided prior the medication was that, of the early physical therapy. Reduced morbidity of the patient made her seek treatment assistance to enable her walk again probably. However, the first treatment was not effective as she was not able to achieve the set goals about the exercise. Further interventions were made as she was given a referral that would conduct a surgery on her to remove a paining portion of the bone in her lumbar spinal.
There is no applicable special consult provided in the medical report. We are not aware of whether the patient was put under any particular consult like that of keeping the diet, x-ray or any social work. However, she was recommended to continue her exercise to engage the cardiac muscles in the attempt of regaining her morbidity. From the report, the patient is not on the right track to achieving the goals. The initial goal set was the patient to improve her morbidity by first using the assistance of side rails as well as under supervision from the therapist. Then the long-term objective was to increase her participation in ambulate moves and to finally gain the ability of moving alone without the help of the therapist or the side rails. However, the reports indicate that the patient is at risk of decreased ability to gain her morbidity due to physical impairment and the associated functional deficit. From the reports is a clear indication that the patient is not on the right track to achieve the goals, as she might not be able to walk again, which is her goal to support herself. She still feels particular intensity pain both at rest and during movement. The sensory muscles are still impaired, and her bed morbidity is still minimal. She can barely make steps on the stairs meaning implying that the medication administered was not sufficient.
The patient's discharge plan was to continue her therapy exercises to find out whether she will respond to the medication. She is supposed to do it in small portions first, and if the positive changes are detected, she is required to increase her therapy participation.
My opinion on the effectiveness and appropriateness of the physical therapy was that the first therapy was effective in the setting of goals and was appropriate to prior diagnosed health status of the patient at that time. What failed the effectiveness of the treatment was the poor diagnosis of the patient? The patient was suffering from more severe conditions than that of pneumonia. Elevated troponin for instance hindered the effectiveness of the PT. From the case study, I have learned the need to set goals in the process of administering the physical therapy. This kind of objectives helps both the patient and the therapist to have objectives of what they aspire to achieve in a given period. I have also learned that sometimes the intended therapy might not turn effective if administered to the wrong health condition. Once detected that there is no positive response to the treatment I should not consider myself a failure but rather give a patient a referral as it may turn out that what a patient need is more than just a therapy.
Article review: The article of compassion fatigue
This article is a sample of evidence-based practice. EBP is a notion from the physicians where they agree with the scientific evidence that which need to be utilized to guide the physical decision. For instance in the article compassion fatigue, compassion fatigue has been defined as the physical spiritual and emotional depletion in providing care to the emotionally and stressed patients. Sometimes doctors who give care to the emotional and physical distressed patients get fatigued in the process of administering the therapy. This group of doctors needs supervision, seek mentorship or counseling from the other medical professionals to help them manage their fatigue. Most medicinal professionals get into the medical field with the intent of helping the patients manage their health conditions and leave a reasonable life. However, in the process these nurses’ falls the victims of fatigue due to continued stress to increased demand meet the needs of their patients. Compassion fatigue in return affects both the therapist and the workplace. Hence, the article reviews a nurse who did not seek further assistance in the process of administering her therapy.
The article uses an example of a nurse who specialized a career in cardiac nursing. The nurse’s mother suffers the condition of multiple cardiac events and most her life she has always been hospitalized. The mother started to experience the health condition early before the nurse was even a grown up person. The nurse became familiar with the medical attendants of her mother, and the condition of her mother motivates the nurse to pursue a course in cardiac nursing. After graduation, the nurse started working and was able to cope fast to her work conditions due to the experience. She attended to various patients suffering from multiple cardiac conditions. However, after sometimes, three of her patients died and this affected her balance of work greatly. She lost interest in the work and barely reported to work. Most of the time, she arrived at work late and would not attend to patients. The management observed her behaviors and decided to shift her to be working for 12 hours, but this did not work effectively.
It is evident from the article that, it is clear that even patients sometimes in attempt to give medical attention to the patient’s nurses may suffer compassion fatigue. This is accompanied when sometimes the patient fail to respond to the medication and therapies that are administered. Sometimes the professional fatigue may be due to several deaths of the nurse’s patients and then the nurse starts to think that he/she is a failure. In such scenarios nurses need to seek mentorship or counseling from other professionals. There is no need to fear that how can a professional seek mentorship but is very essential. From the article, I have learned that in the process of administering the therapy it might be an ambiguous process to the therapist especially when the patient is responding poorly. For instance, the responsible of my patient to the therapy is not promising. From the medical report, the ability of her gaining her morbidity is minimal. I will use the information from the article to refer the patient because failure of my attempt to make the therapy a success may lead to compassion fatigue. The information is useful to the future patients as it creates an avenue to gain more experience in dealing with cardiac completions. Future patients will get the perfect therapy from the gained experience.
Boissonnault, William G. Primary Care for the Physical Therapist: Examination and Triage. St. Louis, Mo: Elsevier/Saunders, 2011. Internet Resource
Guidelines for Pulmonary Rehabilitation Programs. Champaign, IL: Human Kinetics, 2011. Print