Resp Care
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In order to train patients to carry out home pulmonary care adequately, we developed a hospital-based patient-education program we call Self-Administration of Medical Modalities (SAMM). This teaches patients about their pulmonary disease; about their medications' purposes, side effects and what to do if they occur, possible conflict with other medications, and the medication schedule; about use, care, and cleaning of aerosol inhalation devices and scheduling of aerosol medication treatments; and about chest physical therapy if it is indicated. Nurses, respiratory therapists, and physical therapists in the hospital teach and reinforce these concepts and evaluate the patient's progress in learning. ⋯ At Level III the patient's medications are kept at his bedside, he prepares and takes the medications himself, takes treatments himself, and he keeps written records. At this level the program simulates home conditions as much as possible. Patients have reported that they liked administering their own medications and treatments and that the SAMM Program was helpful in preparing them for self-care at home.
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Pulmonary rehabilitation can be a beneficial and cost-effective mode of therapy for patients with chronic obstructive pulmonary disease (COPD). At St Joseph's Hospital in Stockton, California, we established a multi-disciplinary, 10-week program combining outpatient education with aerobic exercise to promote both improved subjective well-being and increased exercise tolerance in patients with COPD. We studied 74 patients who had completed the program at least 1 year before the study began. ⋯ Of the 57 patients responding to the questionnaire, most felt that the program had improved the quality of their lives. After the program was completed, significant decreases were seen in oxygen consumption, minute ventilation, and heart rate during treadmill exercise. The number of days of hospitalization for the group decreased from 497 in the year before completing the program to 34 the year after.
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Discharge of the ventilator-dependent person from a hospital requires careful advance planning by hospital personnel and rehabilitation of the patient to assure maximal functional ability in the home. The patient and family should be taught the techniques necessary for both routine and emergency care in the home. ⋯ Trips of gradually longer duration out of the hospital allow the patient to gain confidence in his ability to care for himself. Responsibilities for follow-up in the home can be shared by respiratory home care companies, visiting nurses, and pulmonary physicians.
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The goals of the South Hills Health System Home Health Agency's program of home respiratory therapy for patients with chronic obstructive pulmonary disease are to support life; to improve physical, emotional, and social well-being and productivity; to promote patient and family self-sufficiency; to provide respiratory care of high quality; and to ensure the cost effectiveness of respiratory therapy services. In the patient's home, qualified respiratory therapists perform respiratory assessments, deliver and supervise respiratory therapy treatments and related procedures, and educate patients and their families. This program of home respiratory care has been shown to be a cost-effective solution to the care of homebound patients with chronic obstructive pulmonary disease.
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Pulmonary rehabilitation programs have resulted in improvements in quality of life, capacity for carrying out daily activities, and physical conditioning, as well as reduced hospitalization and cost of care. In our retrospective study, we reviewed the data of 75 patients who had participated in Loma Linda University Medical Center's pulmonary rehabilitation program--in order to determine its effect on survival, progression of disease, and quality of life for a selected group of patients with chronic obstructive pulmonary disease (COPD). A multidisciplinary rehabilitation team evaluated each patient and developed for him a plan of care that included a 2-week inpatient education program. ⋯ The mean FEV1 at the beginning of the program was 1.53 1 and the mean FVC was 2.87 1; the mean change in FEV1 was - 45 ml/yr, and in FVC, - 70 ml/yr. By use of a questionnaire, we also found that most of our responding patients felt that their quality of life had improved. Our findings compare favorably with other published data and suggest that it is possible to improve the survival of patients with COPD by early diagnosis, comprehensive treatment, continuing medical care, and home visitation.