As a respiratory therapist you educate your patient through pulmonary rehabilitation to best utilize the remaining lung function that they have. Pulmonary rehabilitation happens after the acute care hospital stay and will typically occur in a Rehabilitation/Transitional Care/Skilled Nursing facility.
As a respiratory therapist working in a Rehabilitation /Transitional Care/Skilled Nursing setting you will collaborate with a multidisciplinary team providing a structured set of services two or three times per week for six to twelve weeks. It involves exercise training under the supervision of a healthcare professional, education about self-management strategies, nutrition, teaching your patient to partner with his or her doctor, and how your patient can apply what they learn at home. Motivation is the key to success. The more your patient puts into it, the more they will get out of it. They need your constant encouragement and support.
The patient receives respiratory physical training from you, the respiratory therapist. You are the educator to the patient. The patient will learn much from you during their admission. You teach them about energy conservation and simple practices that will alleviate the respiratory distress they feel when they exert themselves during physical activity. Daily activities such as eating, bathing and dressing can be a struggle for someone with COPD (Chronic Obstructive Pulmonary Disease). They will learn how to safely manage their oxygen and you will educate them about all of their respiratory medications.
During this time your patient realizes that if they exercise a little bit and get short of breath, it’s not the end of the world. They learn to pace themselves and slow down until it goes away. You teach them breathing exercises such as pursed-lip breathing, diaphragmatic breathing and relaxation. Before long they are able to do more exercise without shortness of breath. And that may take away some of the dread or anxiety they feel about being physical active.
The goal is to get them into the best physical condition that they are capable of and, then to have them maintain that condition on their own. Pulmonary rehabilitation helps your patient by stopping and reversing some of the deconditioning related to COPD. This makes your patient feel stronger and able to do more with the lung function that they have remaining. It will take time for your patient to gain trust in you but over time you develop a professional relationship with them.
Weaning a formerly acutely ill patient from a ventilator and tracheostomy tube is another stage of pulmonary rehabilitation in the long-term acute care setting. The acuity of the patients in long-term acute acute care has increased. This means they need more skilled care than they would need if say they were in nursing home. As a respiratory therapist working in long-term acute care you will care for tracheostomy patients who may be on a ventilator.
Working collaboratively with the pulmonary physician, the patient is weaned from the ventilator and placed on a cool humidified oxygen. This process requires much monitoring and clinically assessing your patient. Weaning a respiratory patient with a long-standing tracheostomy tube can vary markedly. Depending how well they tolerate being off the ventilator you then determine how much respiratory muscle strength they have to breath without the tracheostomy tube in place. This is determined by measuring the pressure in and around the tube when they breath in and out through the tube. You constantly monitor their work of breathing and oxygen and carbon dioxide levels during these weaning clinical procedures.
As a respiratory therapist you collaboratively work as a team with other healthcare professionals towards personalized goals for the patient. Family education is on going to assure they understand the stages of weaning and recovery. When a patient returns home you want it to be a smooth process for everyone. The patient, the family and all home healthcare givers will understand the plan and expectations for the patient. A successful discharge involves a team approach. You will work together with discharge planners, case management, nurses and doctors to assure the patient has all the services they need at home.
As a respiratory therapist you help your patient stay motivated and give them one more reason for them to get up, get out of their room and do things. Always tell your patient it never too late to start!