Facet Joint Injection guideline

Facet joint injection procedure guide 

Facet Joint injection procedure

Bismillahirahmanirahim , today the sharing info I would like to share is one of the treatment are advice by Dr to manage a back pain called Facet Joint injection, what can we understand about this procedure , I have discussed with my Spine surgeon to make me understand about this procedure and it keep me to prepare how to give a plan of treatment for the patient after post of injection under physiotherapy management .This information aims to give you a better understanding of these procedures. All procedures are a means to an end that is to improve function. Your average pain score should decrease by 4 on a 0 to 10 scale.1The duration of pain relief will depend on whether it is diagnostic or therapeutic (hours to weeks and months). There are differences in the way that these procedures are performed depending on the individual patient, the institution and the doctor. Therefore, not all of this information may apply to you. Please discuss your individual circumstances and concerns with your doctor or specialist.

Why am I having this procedure and what is facet joint injection ?

Facet joints in other terms also called zygapophyseal joints there are small joints of the spine that provide stability and help guide motion. They are found in the neck (cervical), upper back (thoracic) and lower back(lumbar). They can become painful as a result of arthritis, injury or mechanical stress. However, this is not necessarily the sole cause of long term back pain.

For your understanding there will be a 2 nerves called “medial branches” that is supply each facet joint. These  function and job duty of this nerves are to carry pain signals to the spinal cord and these signals will eventually reach the brain.

Picture of facet joint

What are the Dr will do when their apply this procedure to you ?

When this procedure is  carried out by the DR the facet joints and/or medial branch nerves can be injected with a local anaesthetic and/or steroid.

There are two reasons for doing this base on medical condition are

• Diagnosis: If the local anaesthetic in the injection relieves your pain then it suggests that the

facet joints are a source of your pain. Repeating the procedure a second time improves

accuracy of the diagnosis. This can guide future treatment such as "radio frequency

lesioning" of medial branch nerves. There is strong scientific evidence to support this.

• Therapy: The steroid in the injection can reduce inflammation, reduce medial branch nerve

sensitivity and provide long lasting pain relief. The duration of pain relief may vary from weeks

to months. There is limited to moderate scientific evidence to support this.

   

   

How the patient need to prepare of this procedure ?

The most important thing is communication between you and healthcare staff and Please advise staff if you are:

• Taking blood thinners (especially warfarin and clopidogrel)

• Have a history of Diabetic

• have in Pregnant (or any chance of you being pregnant).

• show and history of Allergic to iodine, betadine, shellfish, local anaesthetics, or steroids.

• Feeling Unwell (especially if you have an infection).

In our routine the medical Staff may advise you to:

• Fasting before the procedure

• Take your usual medications (apart from those mentioned above)

• Arrange for someone to accompany you home after DC from hospital.

What is the procedure is doing?

After arriving and completing the necessary paperwork and assessment

• You will be asked to change into a hospital gown

• A small cannula may be inserted into one of your veins.

• You may be given a mild sedative, but you will usually be awake throughout the procedure.

• Your heart rate and blood pressure are usually monitored throughout the procedure.

• You will lie face down on an x-ray table, the skin over the area to be injected is cleaned with

an antiseptic solution, and sterile drapes applied

• A local anaesthetic is injected into your skin

• An x-ray machine is used to guide a small needle into the facet joint and/or onto the medial

branch nerve. An x-ray dye (contrast) may be used to confirm the position of the needle.

• The local anaesthetic and/or steroid solution is injected.

• Multiple injections may be required.

What is post procedure will be happen?

You will be monitored in a recovery area until you are ready to go home (usually 20-60

minutes).

• It is preferable to have someone take you home and stay with you for the next 24 hours.

• If you have received any sedation during your procedure, the effects of these medications may

last for up to 24 hours. You may not remember some of the information given during the

procedure. This is a normal side effect of the medication. For the next 24 hours you should

not drive a vehicle, drink alcohol, operate machinery, make important decisions, sign legal

documents or travel unaccompanied

• You will be given a pain relief chart to fill out. Please bring this to show the doctor at your next

consultation.

• Please remove the dressing the day after the procedure, when you next wash.

• The pain may return when the local anaesthetic wears off. Some people experience an initial

increase in pain and stiffness that may continue for several days. If necessary, an ice pack

can be applied to the area, 20 minutes at a time, for 1-2 days following the procedure.

• If steroids are injected then it may take several days for the benefits to be noticed.

Additionally, you may feel flushed in the face and/or notice a change in your mood for a few

days. Diabetic patients may notice a rise in their blood sugar levels.

• After the procedure, care must be taken to avoid a rapid increase in your activities. Gradually

increase your daily activities as tolerated. Discuss this with your doctor.

• If you notice any swelling or bleeding from the site or have any other concerns, please contact

your General Practitioner, the Pain Management Unit, or the Emergency Department of your

local hospital.

·   Some of the pain management , the physiotherapist will be refer by the Dr and guide you about home management and to control the pain in physio procedure.

What are the risks of the procedure of this injection ?

All invasive procedures carry the risk of complications. In general the risk is low, but includes:

• Discomfort at the site of the injection

• Worsening of your pain (probably a temporary “pressure effect” from the injection).

• Infection

• Bleeding

• Allergic reaction to the medications.

• Fainting

• Nerve damage (due to direct trauma, the medication, infection or bleeding).

• Steroid-related side effects such as transient flushing, mood swings, high blood sugar levels

(especially in diabetic patients). The manufacturer did not specifically design most steroid

solutions for this procedure. Despite this, these medications have been widely used, over

many years, for this procedure without significant complications.

• Risks of sedation, if used (see separate document)

This info will be guide and give you some of the info about this procedure and it will be different approach by the Dr and the hospital management . Wallahuaklam..

Virus Zika di Malaysia

Nyamuk Aedes dan Zika 

Bimillahirahmanirahim , sukar betul malam nie saya nak lelapkan mata sedangkan esok nak bangun pagi insha allah, disebabkan mata nie degil tak nak tidur maka datanglah idea saya nak menaip tentang  antara topic yang paling hangat dibincangkan di media kesihatan ialah tentang penularan wabak virus zika ini , sudah bersediakah kita sebagai rakyat Malaysia menerima dan juga memerangi wabak bencana ini.

Sebelum itu saya nak Tanya diri saya sendiri kenapa pekara ini berlaku dan mengapa ianya terjadi , pucuk pangkalnya ianya merupakan mesej daripada  Allah swt ,ianya memberikan kita peringatan bahawa kebersihan mencerminkan keperibadian , sebelum ini kita tahu nyamuk Aedes akan menyebabkan denggi dan juga boleh membawa maut , tetapi kali ini nyamuk aedes mengupgradekan virus bawaan di dalam badanya dan ianya boleh menular keseluruh ummat manusia sekarang nyamuk aedes bukan sahaja membawa denggi tetapi juga membawa Zika.

Sebagai Negara yang mempunyai nyamuk yang sama jenis dengan amerika latin kebarangkalian ianya juga mampu menyebarkan virus ini , ini kerana Malaysia mrupakan Negara yang terletak sebaris dengan iklim Khatulistiwa yang semestinya menjadi tempat kegemaran pembiakkan nyamuk ini.

Apakah yang kita ketahui tentang Virus Zika Ini ?

Untuk pengetahuan umum virus zika  mula ditemui  pada darah seekor monyet di Uganda pada tahun 1947. Nama virus ini diambil sempena nama dari hutan Zika iaitu diaman tempat pertama kalinya virus jenis ini ditemui. Adalah diketahui bahawa virus zika ini tidak mematikan penghidapnya tetapi akan mengakibatkan  kecacat ginetik kepada bayi yang dikandung, antara lainya virus ini sama muncul seperti gejala demam denggi dan juga demam kuning atau demam berdarah. Pada tahun 1968 virus ini dicatatkan pertama kali menyerang manusia dan Negara yang terlibat pada waktu itu ialah Nigeria.

Bagaimanakah Virus zika ini tersebar ?

Kajian terbaru dan membuktikan bahawa penyakit Zika ini boleh disebarkan dengan gigitan nyamuk , dan nyamuk pembawa virus ini dikenali Nyamuk Aedes Aegypti ,yang kita kenali di Malaysia sebagai punca terjadinya demam denggi dan juga denggi berdarah . Dunia kajian perubatan pernah mencatatkan bahawa penularan virus ini juga boleh terjadi melalui dengan hubungan intim oleh pasangan yang dijangkiti  (Negara yang dicatatkan ialah Tahiti) tetapi ianya tidak mempunyai bukti yang kukuh.

Apakah Gejala Jangkitan virus Zika ini ?

Para pengkaji sains menyatakan , pesakit yang dijangkiti virus zika ini tidaklah terus jatuh sakit , ada ketiak pesakit yang menghadapi penyakit zika ini Cuma mengalami gejala gejala ringan seperti Demam dan ruam , mata menjadi merah dan mengalami kelesuan otot. Ada waktunya gejala penyakit  ini akan hilang dengan sendiri tanpa diketahui bahawa virus itu berada di dalam pembawanya.Untuk pengetahuan masih tiada lagi vaksin untuk melawan virus ini yang pernah dihasilkan.

  

Apakah kecacatan ginetik yang dihasilkan oleh virus zika?

Saya tahu ini yang paling merunsingkan para ibu bapa terutama bagi ibu yang mengandung. Jangkitan virus zika boleh mendatangkan kemudaratan kepada ibu yang mengandung ini kerana kajian terbaru menunjukkan virus zika yang dihidapi oleh para ibu yang hamil akan menyebabkan berlakunya kematian kepada janin dan juga akan mengakibatkan kecacatan genetic pada bayi yang dikandungkan . Laporan WHO menyatakan ribuan bayi yang dilahirkan di bahagian amerika selatan seperti brazil dan Colombia mencatatkan kelahiran  kecacatan genetic yang tinggi .Selalunya bayi ini dilahirkan dengan ukuran saiz kepala yang lebih kecil dari normal.

Adakah Malaysia berisiko mengalami virus ini?

Dari bahan bacaan dan juga mengikut perkembangan semasa , Negara kita juga berisiko untuk menghadapi bawaan virus ini , ini kerana sepsis nyamuk aedes ini merupakan sepsis yang sama membawa virus ini kepada manusia , Di Negara Jiran kita iaitu Indonesia Dr Ari F Syam menyatakan bahawa virus zika ini pernah dicatatkan muncul di negaraitu , dan beliau menyatakan sejumlah warga Australia yang pernah dijangkiti virus tersebut didapati pernah melawat Negara itupada tahun 1981 dan 2013 ,tetapi apa yang membimbangkan kita penularan wabak ini sedang hebat berlaku di Negara amerika selatan.

Apakah pencegahan yang perlu diambil ?

Seperti yang disarankan oleh kementerian kesihatan Malaysia , mencegah virus zika ini merupakan tanggung jawab bersama yang ianya memerlukan kerjasama erat antara semua lapisan masyarakat.Ini kerana penyebaran virus zika ini boleh kita lakukan dengan membasmi tempat pembiakkan nyamuk Aedes yang juga kita ketahui merupakan salah satu punca terjadinya demam denggi berdarah , lakuakan saranan dan garis panduan yang dikeluarkan oleh jabatan kesihatan.

Ketahuilah bahawa mencegah itu lebih baik dari menyembuh , kerana apabila menularnya wabak ini ianya merupakan satu pekara yang perlu dipandang serius dari semua pihak

Wallahuaklam..

Meniscus Injuries treatment

Meniscus injuries rehabilitation simple Tips

Anatomy of meniscus 
Bismillahirahmanirahim , quite early for me to go for sleep so it give me some idea to write and share about asimple tips of meniscus repair care.

For our understanding each knee joint has two crescent-shaped cartilage menisci. These lie on the

medial (inside of knee) and lateral (outside of knee) of the upper surface of the

tibia (shin) bone. They are essential components of the knee, acting as shock

absorbers as well as allowing for the proper interaction and weight

distribution between the tibia and the femur (thigh bone). The meniscus is a piece of cartilage that provides a cushion between your thighbone (femur) and shinbone (tibia). There are two menisci in each knee joint. They can be damaged or torn during activities that put pressure on or rotate the knee joint.

Meniscus Repair Tips 

What can we understand a rehabilitation of meniscal repair?

I always explain to the patient and guide them to be understand that this rehabilitation protocol was developed for patients who have isolated meniscal repairs. Meniscal repairs located in the vascular zones of the periphery or outer third of the meniscus are progressed more rapidly than those repairs that are more complex and located in that avascular zone of the meniscus it will be dependent upon the location of the repair, weight bearing status post-operatively as well as the intensity and time frame of initiation of functional activities will vary. 

What is the Goal of meniscal repair after surgery ?

Most of my orthopedic surgeon have setup their own goal and here i compile all the overall goals of the repair and rehabilitation are to:

• Control pain, swelling, and hemarthrosis

• Regain normal knee range of motion

• Regain a normal gait pattern and neuromuscular stability for ambulation

• Regain normal lower extremity strength 

• Regain normal proprioception, balance, and coordination for daily activities

• Achieve the level of function based on the orthopedic and patient goals

When can physiotherapy can be start?

In our practice the physiotherapy should be initiated within 3 to 5 days post-op. It is extremely important for the supervised rehabilitation to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility, it will guide the patient to be more aware about their recovery process.

What are Important post-op signs to monitor?

I always tell to my patient this is the type of sign their need to monitor after the surgeries 

 • Swelling of the knee or surrounding soft tissue

• Abnormal pain response, hypersensitive

• Abnormal gait pattern, with or without assistive device

• Limited range of motion

• Weakness in the lower extremity musculature (quadriceps, hamstring)

• Insufficient lower extremity flexibility

What are the suitable time to return back to activity ?

This is one of the hot question ask by my patient , some of them think after surgery their can start their sport and work immediately but to understand return to activity requires both time and clinic evaluation. To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Isokinetic testing and functional evaluation are both methods of evaluating a patient’s readiness to return to activity. Return to intense activities such as impact loading, jogging, deep knee flexion, or pivoting and shifting early post-operatively may increase the overall chance of a repeat meniscal tear and symptoms of pain, swelling, or instability should be closely monitored by the patient .wallahuaklam.

Hip Bursitis stretches and exercise treatment

Hip Bursitis

Bismillahirahmanirahim , for today entry I would like to share one of the condition that can be happen in your hip call hip bursitis

What can we understand regarding of this problem ?

here the explanation will give your idea ,Your hip bursitis is caused by inflammation of your bursa, a jelly-like sac that contains fluid.

What will happen when you have this problem ?

Inflammation of your bursa can cause stiffness and pain, making it difficult to sit, walk, stand,

or sleep.

What you need to do?

Maintaining strength and flexibility in the hip muscles can help reduce the friction that

causes the inflammation and pain. Your physician or physical therapist will recommend when to start and how often to do your hip bursitis exercises. The general recommendation is to do the stretches 2 to3 times a day and the exercises 1 to 2 times a day as tolerated. A floor mat can be useful and you will need a cushion or pillow. Start each exercise slowly, and ease off the exercise if you start having pain.

The exercise that can help you to manage a pain and stiff cause by bursitis are

Hip Rotator Stretch

1. Lie on your back with both knees bent and your feet flat on the floor.

2. Place the ankle of your affected leg on the opposite thigh near your knee.

3. Use your hand to slowly push your knee away from your body until you feel a gentle

stretch at the front of your hip.

4. Hold the stretch for 15 to 30 seconds.

5. Repeat 2 to 4 times.

 Part 2.

1. Repeat steps 1 through 5 except this time, during step 3, slowly pull your knee towards

your opposite shoulder until you feel a strech at the back of your hip.

Iliotibial Band (IT band) Stretch

1. Stand with your affected hip against a wall. For extra

support you can use a chair or counter.

2. Put your weight on your affected hip and cross the other

leg in front of it.

3. Raise your arm, on the same side as your affected hip,

above your head.

4. Lean away from the wall, letting your affected hip press

against it, until you feel a gentle stretch on the outside of

your hip.

4. Hold the stretch for 15 to 30 seconds.

5. Repeat 2 to 4 times.

Straight-leg Raises (Side Lying)

1. Lie on your side, with your affected hip on top. Support your head and stablize yourself as necessary.

2. Tighten the muscles in your affected leg to keep your knee straight.

3. Lift your top leg until your foot is about 12 inches off the floor. Be sure to keep your hip and leg in line with

the rest of your body and make sure you don’t roll towards your back.

4. Hold your leg in the raised postion for 6 seconds and slowly lower your leg.

5. Repeat 8 to 12 times.

Clamshell

1. Lie on your side with your affected hip on top.

Support your head with a pillow and stablize

yourself as necessary.

2. Keep your legs together and bend both knees.

3. Keep your feet together and lift your top knee

until your knees are about 8 to 10 inches apart.

Be sure your top hip does not roll back.

4. Hold your leg in the raised postion for 6 seconds

and slowly lower your knee each time.

5. Rest for 10 seconds.

6. Repeat 8 to 12 times.

This exercise is one of the alternative of the treatment , because with the exercise it will help you to manage your pain and stiffness in a safest way ,wallahuaklam.

Setting good Office workstation

WORKSTATION ADVICE TO PREVENT PAIN

   Bismillahirahmanirahim , today just want to share a simple ergonomic awareness in office setup ,from this method it will prevent you develop a postural pain problem. Sitting incorrectly for prolonged period puts a great strain on your back, neck and arms. It can cause postural pains such as low back pain, stiffness up from sitting, shoulder and neck ache and “tennis” elbow pain. The symptoms come on gradually over weeks, months or years.

Therefore, it is important that your work station is set up correctly to encourage good posture and keep the strain on your body to a minimum. This will help to PREVENT posture related problems.

The most common causes of postural pain are:

§   Sitting in a slumped position

§   Poking your head forward to read the screen

§   Stretching your arms too far to reach equipment on your desk such as the mouse

§   Twisting to one side repeatedly

§   Staying in the same position for long periods of time

The following tips will help you set up you work station for your maximum comfort.

1. Adjust your chair so your thighs are just above your knees
2. Your arms should be by your side with elbows bent to 90 degrees. Your fingers should then rest comfortably on the middle row of the keyboard with your mouse within easy reach to the side of it.
3. Your back rest should be set at approximately 100 degrees, so you’re not bolt upright. Get your bottom right to the back of the chair so that it supports your lower back in a neutral posture 
4. Your feet should be in contact with the floor once you have correctly positioned yourself. If not you may need a footrest.
5. Make sure your chair is brought in close to the desk to avoid over stretching. If you have arms on your chair which prevent this then you may need to adjust them or change your chair.
6. If you have to twist to the side of your computer to do paperwork, swivel on your chair do NOT twist from the spine.
7. Desk height: With your elbows flexed to 90 degrees your forearms should rest comfortably on your desk top.
8. Place other frequently used equipment and objects within functional easy reach so you avoid repetitive twisting movement,
9. Organize your desk so that you have enough space to comfortably carry out the various tasks in a day.
10. Use a document holder placed next to the screen when copying from a document or using it for reference. This will minimize awkward neck movements.

Other simple tips to prevent postural problems

1. Get out of your chair regularly every 20 minutes, and walk around.
2. Perform simple exercise while sitting such as, rolling your shoulders, arching your back and rotating your head from side to side.
3. Try to vary the tasks you do to avoid repetitive activities. If aches and pains persist, contact your physiotherapist to seek advice as to whether treatment will benefit you .Wallahuaklam..

Don't do this at your office

Purse Lip Breathing exercise for chronic obstructive pulmonary disease (COPD)

Purse Lip Breathing Technique 

 Bismillahirahmanirahim This simple steps of exercise is one of the practice can easily to learn and use especially for patient who had a Chronic Obstructive Pulmonary Disease (COPD), and other lung diseases can cause airways to collapse when you breathe out (exhale), trapping staleair. This leaves less room in your lungs for fresh air to enter. When this happens you are likely to feel short of breath.

(sign and symptom of COPD)

 

·         Pursed-lip breathing keeps airways open longer during exhalation. This

helps release trapped air from your lungs and allow fresh air to come in.

·         Practice pursed-lip breathing while you are resting so you can use this

technique when you are feeling short of breath.

1.      Breathe in or inhale through your nose at a normal rate and depth. Feel your lungs fill with air.

2.      Purse your lips together as if you going to whistle or play a flute or like blow a candle for birthday

3.      Breathe out or exhale slowly and gently through your mouth, keeping your lips pursed. The time it takes to exhale should be 2 to 4 times longer than the time you inhale.

4.      Do not force air out and Adjust your breathing rhythm and the amount you purse your lips to increase your comfort.

5.      Use this technique during exercise or activities that cause you to be short of

breath.

Your lips will be like this when you practice this exercise

However, this technique also may be used at anytime, with this practice it will help you to deal a situation when you have a panicking attack because hard to breath , as my old man says practice will make it perfect and easy.

Danger of Pneumonia infection

Pneumonia

Bismillahirahmanirahim , in physio this is one of the disease that have a one goal for us to setting for the patient ,is to make sure their lungs is clear .Pneumonia is one of the common problem happen in kids and elder people, here I want to share the info regarding the cause and how we need to understand this disease.

What are we understand about pneumonia ?

Pneumonia is an inflammatory process of the lung parenchyma that is commonly caused by infectious agents.

Classification of pneumonia

According to causes

·         Bacterial (the most common cause of pneumonia)

·         Viral pneumonia

·         Fungal pneumonia

·         Chemical pneumonia (ingestion of kerosene or inhalation of irritating substance)

·         Inhalation pneumonia (aspiration pneumonia)

According to areas involved

·         Lobar pneumonia; if one or more lobe is involved

·         Broncho-pneumonia; the pneumonic process has originated in one or more bronchi and extends to the surrounding lung tissue.

How the pneumonia can be transmitted ?

In the study its shown some of the result the ways you can get pneumonia include:

·         Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.

·         You may breathe some of these germs directly into your lungs (droplets infection).

·         You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia).

Predisposing factor to get pneumonia is

·         Immuno-suppresed patients

·         Cigarette smoking

·         Difficult swallowing (due to stroke, dementia,parkinsons disease, or other neurological conditions)

·         Impaired consciousness ( loss of brain function due to dementia, stroke, or other neurological conditions)

·         Chronic lung disease (COPD, bronchostasis)

·         Frequent suction (Non sterile technique)

·         Other serious illness such as heart disease, liver cirrhosis, and DM

·         Recent cold, laryngitis or flu

What can we understand about pathophysiology of pneumonia ?

·         It can be a a factor like The streptococci reach the alveoli and lead to inflammation and pouring of an exudates into the air spaces.

·         WBCs(white blood cells) migrates to alveoli, the alveoli become more thick due to its filling consolidation, involved areas by inflammation are not adequately ventilated, due to secretion and edema. This will lead to partial occlusion of alveoli and bronchi causing a decrease in alveolar oxygen content.

·         Venous blood that goes to affected areas without being oxygenated and returns to the heart. This will lead to arterial hypoxemia and even death due to interference with ventilation

The symptom and clinical sign people get pneumonia is

·         Shaking chills

·         Rapidly rising fever ( 39.5 to 40.5 degree)

·         Stabbing chest pain aggravated by respiration and coughing

·         Tachypnea, nasal flaring

·         Patient is very ill and lies on the affected side to decrease pain

·         Use of accessory muscles of respiration e.g. abdomen and intercostals muscles

·         Cough with purulent, blood tinged, rusty sputum

·         Shortness of breath

·         Flushed cheeks

·         Loss of appetite, low energy, and fatigue

·         Cyanosed lips and nail beds

What is the test the Dr will given to the  pneumonia patient ?

·         History taking

·         Physical examination

·         Chest x-ray

·         Blood test

·         Sputum culture

Chest X-ray shown a pneumonia

What is medical management for pneumonia ?

·         Antibiotic, depending on sputum and blood culture

·         Oxygen therapy

·         Chest physiotherapy (Breathing Exercise , Postural Drainage and effective cough )

What is the complication of the pneumonia if not treated early ?

·         Acute respiratory distress syndrome (ARDS)

·         Pleural effusion

·         Lung abscesses

·         Respiratory failure (which requires mechanical ventilator)

·         Sepsis, which may lead to organ failure

What is Physiotherapy and Nurse can help and manage the pneumonia ?

·         Maintain a patent airway and adequate oxygenation.

·         Obtain sputum specimens as needed.

·         Use suction in cleaning technique if the patient can’t produce a specimen.

·         perform chest physiotherapy.

·         Provide a high calorie, high protein diet of soft foods.

·         To prevent aspiration during nasogastric tube feedings, check the position of tube, and administer feedings slowly.

·         To control the spread of infection, dispose secretions properly.

·         Provide a quiet, calm environment, with frequent rest periods.

·         Monitor the patient’s ABG levels, especially if he’s hypoxic.

·         Assess the patient’s respiratory status. Auscultate breath sounds at least every 4 hours.

·         Monitor fluid intake and output.

·         Evaluate the effectiveness of administered medications.

·         Explain all procedures to the patient and family.

·         Frequent turning of bed ridden patients and early ambulation as much as possible.

·         Coughing and breathing techniques.

·         Sterilization of respiratory therapy equipment

·         Suctioning of secretion in the unconscious who have poor cough and swallowing reflexes, to prevent aspiration of secretions and its accumulation.

Close Suctioning is one of the best prevention to get nosocomial infection that can lead to pneumonia 

How can we understand about the prognosis of pneumonia ?

With treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment.So the most important to treat early when the symptom is appear and always follow the guideline prescribe by the physician and the therapist 

wallahuaklam..