Rehabilitation Nursing of Chinese and Western Medicine
Objective of Rehabilitation Nursing
The first objective is to improve patients’ life quality, prevent respiratory complications, improve respiratory function, and enhance mental health.
The second objective is to develop individualized nursing programs. It is essential to fully understand patients’ conditions in the formulation of a rehabilitation nursing plan. Teach step by step according to the different stages of the disease and publicize rehabilitation nursing knowledge to patients. Mobilize patients’ subjective initiative, actively cooperate with rehabilitation treatment and nursing, and let patients do progressive exercise to improve sports endurance.
The third objective is to use traditional Chinese medicine (TCM) nursing programs to improve fever, insomnia, gastrointestinal disorders, and other problems.
Rehabilitation Nursing Assessment
Based on the comprehensive collection of patients’ subjective and objective data, the following contents should be emphasized in patients’ nursing assessment with COVID-19.
Course of Onset and Treatment
8.2.2.1.1 Course of Illness
Understand the onset time, main symptoms, and concomitant symptoms, such as cough, sputum, dyspnea, hemoptysis, chest pain, etc., and their manifestations and characteristics; ask whether there is an inducement, symptom aggravation, and related factors or rules of mitigation.
8.2.2.1.2 Diagnostic and Therapeutic Process
Ask the patients what kind of tests they have had and the results, the names or types of drugs used, drug usage, the time of the last use, whether the drugs were used after the doctor prescribed, and the improvement of symptoms after the use.
8.2.2.1.3 Current Status
The disease impacts the patient’s daily life and self-care ability, for example, dyspnea can affect the patient’s daily eating, rest, and excretion, and can even decline self-care ability.
8.2.2.1.4 Releuant Medical History
Obtain patients’ history of diseases related to respiratory diseases, such as allergic diseases, measles, pertussis, and cardiovascular diseases.
Psychosocial Data
8.2.2.2.1 Knowledge about the Disease
Determine patients’ understanding of the occurrence, course, prognosis, and health care of the disease.
8.2.2.2.2 Psychological Status
Persistent cough, chest pain, dyspnea, and other symptoms may cause adverse emotional reactions.
8.2.2.2.3 Social Support Systems
Know necessary and basic information of patients, such as their family members, economic status, and educational background, etc. Ask the primary caregivers of patients about their understanding of the disease, the degrees of care, and their support for the patients.
Rehabilitation Nursing Measures
Patients with COVID-19 are at risk of respiratory dysfunction at all stages of the disease. In addition to monitoring patients’ vital signs and observing the blood oxygen saturation and rehabilitation routine care closely, nursing staff can effectively help patients relieve symptoms, restore function and improve life quality by using specialized rehabilitation nursing techniques, such as respiratory function guidance, cough training, posture drainage, muscle strength, and endurance training as well as psychological rehabilitation nursing guidance.
Nursing Guidance and Training Techniques for Respiratory Function
8.2.3.1.1 Definition
Respiratory function training refers to the training methods used to ensure the respiratory tract’s patency, improve respiratory muscle function, promote sputum excretion and drainage, improve blood metabolism of lung and bronchial tissues, and strengthen gas exchange efficiency.
- 8.2.3.1.2 Purpose
- 1) COVID-19 patients are prone to dyspnea during activities. Improve respiratory function through the control and regulation of respiratory movements to restore effective abdominal breathing as far as possible.
- 2) Increase the voluntary movements of respiratory muscles and respiratory capacity to improve oxygen inhalation and carbon dioxide emissions.
- 3) Improve the observance of the chest through active training and increase the abilities of patients’ cardiopulmonary function and physical activity.
- 8.2.3.1.3 Key Points of Operation
- 1) Half-closed lip respiration training
a. Position: Sit upright with hands on knees.
b. Lips shrink into a “whistling” shape. Allow gas to enter through the nostrils as inhale inhaling. Do not exhale in a hurry after each inhalation, but hold the breath for a while and then exhale through half-closed lips. When exhaling, retract the lips to be like a whistle, and gently blow air out of lungs through a narrow mouth. Each exhalation lasts 4-6 seconds. Inhale and exhale for a ratio of 1 to 2. Practice three to four times a day for 15-30 minutes each time.
2) Abdominal breath training: Diaphragmatic breathing is emphasized to improve abnormal breathing patterns, diaphragmatic contraction capacity, and contraction efficiency and change patients’ thoracic breathing into abdominal breathing. Abdominal breathing and halfclosed lip respiration can be used.
a. Position: Patients shall be placed in the supine position or sitting position (leaning forward position); or take a forward-leaning standing position. Let the patients breathe normally and relax as much as possible. First, close the mouth and inhale deeply through the nose. At this point, the abdomen will raise and lower the diaphragm as much as possible. Hold the breath for 2-3 seconds when patients can no longer breathe in (gradually increase to 5-10 seconds after practice); then use a half-closed lip to exhale slowly, meanwhile, recover the abdomen as much as possible, and blow slowly for 4-6 seconds. Simultaneously, gradually press hands on the abdomen to promote the upward movement of the diaphragm; also, place hands over the costal arch and, during exhalation, apply pressure to reduce the thoracic cavity and facilitate gas expulsion.
b. Take a deep and slow breath; The exhalation time must be two to three times of the inhalation time. The frequency of in-depth breathing training is 8-10 times per minute, lasting 3-5 minutes, and should be done several times a day. After proficiency, increase the number of times and length of time of the training.
3) Respiratory muscle training
a. Inspiratory resistance training: (a) Patients hold the handgrip resistance trainer to inhale. The trainer has tubes of various diameters. (b) Pipes with different diameters have different airflow resistance during suction. The narrower the pipe diameter is, the more excellent the airflow resistance will be. (c) On the premise that patients can accept, first select the pipe with a thick diameter for inspiratory training and start the training for 3-5 minutes per time. After training three to five times per day, the training duration can be gradually increased to 20-30 minutes per time.
b. Expiratory muscle training: (a) Abdominal muscle training requires patients to be placed in the supine position, with a 1-2 kg sandbag placed on the upper abdomen. Keep the shoulders and chest still while inhaling and try to hold out the abdomen while exhaling. Do lower limb flexion, hip flexion, and knee flexion while in the supine position and keep knees as close to the chest wall as possible to strengthen abdominal muscles, (b) For candle blowing training, place a lit candle 10 cm in front of the patients mouth, and blow out forcefully after inhalation to extinguish the flame. Rest for a few minutes after 3-5 minutes’ training each time, and then repeat, (c) Patients do expiratory training by holding a resistance trainer to improve the expiratory muscle capacity.
- 8.2.3.1.4 Cautions
- 1) Education and cooperation of patients
a. Examine and provide the patients with health education and explain the significance and purpose of respiratory function training before training. Try to avoid causing patients emotional tension during training by explaining well and obtaining their cooperation.
b. The training plan should vary from person to person, step by step in the training process, and encourage patients to persevere.
c. Evaluate patients and make specific training plans. The training is scheduled between meals.
d. Material preparation: Simple breathing trainer and candle.
2) Position exercise
a. Position selection: Choose a relaxed and comfortable position. Proper position can relax the auxiliary respiratory muscle group, reduce the oxygen consumption of respiratory muscles, relieve dyspnea symptoms, stabilize the mood, fix and relax the shoulder band muscle group, reduce the upper chest activity, and facilitate the diaphragm movement, etc.
b. Low head position and forward position: (a) Allows patients to lie on their back on a bed or flat bed that has been adjusted to tilt, with the foot of the bed raised (postural drainage in the same position), (b) Forward leaning refers to keeping the torso tilted 20°-45° when the patient is sitting. To maintain balance, the patient can support their knee with their elbow or on the table. When standing or walking, the patient can also take the forward-leaning position, or they can also use a walking stick or walk assisting car for support.
3) Precautions during respiratory function training
a. The frequency of abdominal breathing should not be too much each time, that is, after practicing two to three times, take a rest and then practice again. Let patients gradually get used to abdominal breathing in activities. Each training is generally 5-10 minutes to avoid fatigue.
b. Relax and exhale passively to avoid abdominal contraction. Place both hands on the patient’s abdominal muscles to determine whether the abdominal muscles have contracted.
c. Pay attention to the patient’s response. There should be no discomfort symptoms during training. The patient should feel normal when they get up the next morning. If they feel tired, weak, dizzy, and other discomforts, stop the training temporarily.
d. When the condition changes, the training program should be adjusted in time to avoid respiratory acidosis and respiratory failure induced in the training process.
e. Give oxygen appropriately during training. Doing activities while inhaling oxygen can enhance the patient’s activity confidence.
