References
Recumbent patients: is turning enough?
Abstract
Recumbency in patients can be challenging in veterinary practice, and further understanding of the care that these dependent patients require can be potentially further improved. Patients are seen for complex disease processes and the advances in veterinary medicine have allowed for impressive intensive care to be achieved, and the ability for gold standard nursing care which demands further research into this field. To enable care to be of the highest standard, and to ensure recumbent patients nursing care is maintained to the gold standard while hospitalised, informed, knowledgeable and trained registered veterinary nurses (RVNs) should be advised on the appropriate nursing interventions to be applied to promote quicker recovery from disease. Maintaining patent respiratory function is a necessity with recumbent patients to facilitate recovery from disease processes.
Recumbency, normally due to processes such as pulmonary disease or thoracic wall disease, rib fractures, ventilated patients, trauma or surgical intervention, does not allow the patient to carry out normal daily activities. One of the main concerns in recumbent patients is respiratory function, the ability to maintain a healthy airway and provide good oxygenation while recovering. With limited research in the veterinary field involving recumbency, this article reviews both veterinary and human literature.
The primary function and ability of the lung is to enable gaseous exchange, allowing air distribution within the lobes to match the perfusion of the body's tissues (Schilero et al, 2009). Altering body position of challenged patients with disease processes, alters biomechanical homeostasis (Vollman, 2004), subsequently requiring nursing interventions (NIs). Turning patients into variable positions and providing physical therapies are advised (Frownfelter and Dean, 2012). Clini and Ambrosino (2005) stated that early physiotherapy in human patients is cost effective, improves residual function, reduces the need for future admissions and improves quality of life. Physiotherapy is believed to restore respiratory function, ventilatory dependence, and reduce the risk of bed-rest complications. Therapy has been documented for strengthening the chest, lungs and stomach, initially by using deep breathing and postural exercises (Garrod and Lasserson, 2007). Change in posture is believed to decrease the incidence of further diseases developing, such as pneumonia, consolidation of lung lobes and atelectasis (Cook, 2003). Turning is a recognised technique, but current research into additional therapies has been controversial and spartan particularly in veterinary medicine, and postural exercises are difficult to replicate in veterinary patients.
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