Topic 3

Situation
The situation was such that I had a patient who was needing to be weaned off oxygen therapy in the rehab environment to assess whether or not he would be required to have oxygen therapy in his home following respiratory failure from AAA repair. The patient was 78yr old man who was previously completely independent in ADLs, ambulating without aids and still driving.

Task
The task was to measure his O2 saturation levels during physio sessions with decreased oxygen therapy (cont via NP) than prior to his rehab admission. As he was able to maintain his O2 sats above 90 during exertion the oxygen was to be removed.

Action
I completed a 6mwt with this patient initially, with him on 2L continuous O2 via NP, and after 3mins his saturation levels decreased to 88 so he was unable to continue walking the finally 3 minutes. A week later, after daily PT of ambulating, seated cycling and LL strength exercises, I re-assessed the 6mwt. The patient had been of O2 therapy during the day for the 3 days prior and off oxygen at night for 1 night.

Result
The result of this test was a much improved total distance at the conclusion of the test and on RA the patient's SpO2 levels remained between 92-93 on exertion. These were measured using pulse oximetry. He also had a lower maximum HR and a lower BORG rating of shortness of breath.

Evaluation
This reflects a positive outcome and suggests that my intervention of a PT program aiming to improve CR fitness and endurance assisted this patient in being able to maintain adequate O2 levels during physical exercise. However, this result can not simply be attributed to physio input but also nursing and medical management of the patient. During this process I realised the necessity of communication with nurses and doctors about the change in oxygen therapy the patient was to receive.


Strategies
Next time I feel that I may have been able to acheive the desired outcome earlier by using a gradual decline in O2 therapy rather than dropping the patient straight from 2L cont O2 throughout the day and on exertion to just RA. Perhaps it would have been more beneficial to the patient to have had periods during the day when he was at rest where the oxygen could have been removed, ensuring that SpO2 levels were regularly assessed.