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Comprehensive Rehabilitation in Patient Care during Ventilator weaning process
CPTE-Chest Th 25th June 2015 13:00-13:45
Bangkok Rehabilitation Center Team
นพ.พิพัฒน์ ชุมเกษียร
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Care and Share Topic
• Healthcare Global Streams 2015
• Why Comprehensive Rehabilitation and Team ?
• The Patient we care, need Person-Centered care
• Ventilator weaning care : Pathway or Journey (work shop) • Quality and Safety : monitoring and precaution
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Comprehensive Rehabilitation in Patient Care during Ventilator weaning process
CPTE-Chest by Bangkok Rehabilitation Center Team
Quality and Safety In Healthcare, London 2015
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Comprehensive Rehabilitation in Patient Care during Ventilator weaning process
CPTE-Chest by Bangkok Rehabilitation Center Team
Why Comprehensive Rehabilitation ? Co-Creating Team, Transdisciplinary Team Team= Healthcare staff+ Patient&Family Identify Person-need, What matter to you? Participatory Goal setting Program management
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Healthcare staffs Attending physician Intensivist, Medicine ,Surgeon Consulting physician Anesthesist, Nutritionist, Pulmonologist , Cardiologist, Nephrologist, Neurologist, CVT, .. , Psychiatrist Physical Medicine and Rehabilitation Paramedic : Nurse, Pharmacist, Dietitian, Physiotherapist, Occupational Therapist
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Patient and Family : who we care? • Respiratory insufficiency/failure - Pneumonia, Asthma, COPD, Atelectasis, Bronchiectasis,.. - Intrinsic lung disease: Pulmonary fibrosis, CA lung - Traumatic Chest contusion, Fracture ribs, Pneumo-Hemothorax - Post surgery : Thoracotomy, Sternotomy, InterCostal Drainage,.. - Spinal defect: Scoliosis, Ankylosing Spondylitis,.. • Cardiac failure, Myocardial infarction • Stroke, Seizure, TBI, SCI, Neuropathy , GBS, Myopathy • Kidney failure • Liver failure • Critical illness Multi-Organ Failure
Comprehensive Rehabilitation in Patient Care during Ventilator weaning process
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Care and Share Topic
• Healthcare Global Streams 2015
• Why Comprehensive Rehabilitation and Team ?
• The Patient we care, need Person-Centered care
• Ventilator weaning care : Pathway or Journey(work shop) • Quality and Safety : monitoring and precaution
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Person’s need-Centered Care
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Comprehensive Rehabilitation in Patient Care during Ventilator weaning process
CPTE-Chest by Bangkok Rehabilitation Center Team
Problem list Person need
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Care and Share Topic
• Healthcare Global Streams 2015
• Why Comprehensive Rehabilitation and Team ?
• The Patient we care, need Person-Centered care
• Ventilator weaning care : Pathway or Journey(work shop)
• Quality and Safety : monitoring and precaution
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Comprehensive Rehabilitation in Patient Care during Ventilator weaning process
CPTE-Chest by Bangkok Rehabilitation Center Team
Ventilator weaning care : Pathway or Journey(work shop)
Clinical Assessment + Diagnosis ( PathoPhysiological Diagnosis) Problem list Patient needs Participatory Goal Setting with Patient and Family Program management as a Jouney
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CPTE-Chest by Bangkok Rehabilitation Center Team
Ventilator weaning care : Pathway or Journey(work shop)
Clinical Assessment + Diagnosis ( PathoPhysiological Diagnosis) Day 1 1.Aspiration pneumonia RLL , RLL atelectasis with Respiratory failure, on CMV mode Sputum culture : Staph Aureous,+ve MRSA 2.Acute Stroke:Right Hemiplegia, Left MCA infarction, Aphasia, Dysphagia 3.Paroxysmal AF with Rapid VR 4.DM 5.Smoker 1pack/day
Problem list : Ineffective cough,Atelectasis RLL,Aspiration,..
Patient needs: go home
Participatory Goal Setting with Patient and Family: independent ADL and ambulation, attend his son wedding next month
Program management: ( Dynamic synergy to clinical conditions) PT chest + Fluimucil Nebulizer ( BID), Vibration, Head tilt 30*
RLL segmental expansion, cough assisted machine, gentle suction PT neuro (Daily) : Neurofacilitation and progressive upright activities OT(Daily) swallowing test and safety swallowing training Monitor: Gastric residual content< 50ml., SaO2>95%, AF with VR 60-100/min. SBP 120-160 torr., Neurological change
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CPTE-Chest by Bangkok Rehabilitation Center Team
Ventilator weaning care : Pathway or Journey(work shop)
Clinical Assessment + Diagnosis ( PathoPhysiological Diagnosis) Day3 1.Aspiration pneumonia RLL , RLL atelectasis with Respiratory failure, on SIMV mode Sputum culture : Staph Aureous,+ve MRSA 2.Acute Stroke:Right Hemiplegia, Left MCA infarction, Aphasia, Dysphagia 3.Paroxysmal AF with Rapid VR 4.DM 5.Smoker 1pack/day
Problem list : Ineffective cough,Atelectasis RLL, aspiration water
Patient needs: go home
Participatory Goal Setting with Patient and Family: independent ADL and ambulation, attend his son wedding next month
Program management: ( Dynamic synergy to clinical conditions) PT chest + Fluimucil Nebulizer ( BID), Vibration, Head tilt 30*
RLL segmental expansion, cough assisted machine technique, gentle suction PT neuro (BID) : Neurofacilitation and progressive upright and Transfer activities OT(Daily) swallowing training with food texture titration Monitor: Gastric residual content< 50ml., SaO2>95%, AF with VR 60-100/min. SBP 120-160 torr., Neurological change