On 4C the patient population consists predominantly of patients with kidney disease (stage 1-5). The general management of these patients can very from diet & lifestyle changes, to regular medication management, dialysis treatment or a kidney transplant.
As kidney disease can be caused by a wide range of chronic conditions including high blood pressure, diabetes, glomerulonephritis, it can lead to a wide range of health problems including frailty, bone weakness, malnutrition, anaemia, cardio-respiratory, vascular or neurological conditions
Conditions treated on ward include Acute kidney injuries, pulmonary oedema, hyperkalemia, peripheral joint amputation, haemodialysis tunnelled line infection:+/- sepsis, peripheral vascular neuropathies, calciphylaxis , vasculitis, amyloidosis, IgA nephropathy, multiple myelomas and kidney disease induced heart issues.
The role of the physiotherapist:
The physiotherapist will have a wide ranging role to play. Due to the various conditions these patients are susceptible to each patient will have an individualised physiotherapy assessment and treatment based on their needs and goals
Patients with frailty or muscular weakness post admission will be provided with an exercise rehabilitation programme, mobility assessments, home environment advice and supportive discharge planning.
Some patients could also have respiratory problems associated with their diagnosis. Following guidance from the patients consultant, the physiotherapist can provide the set up and management of oxygen devices, breathing and positioning techniques and advice and can help provide secretion clearance techniques when appropriate. As these patients become more medically stable the physiotherapist can also provide the same interventions as previously mentioned.
Finally this patient cohort could also be susceptible to MSK, neurological and vascular issues. The physiotherapist may provide walking aids, specific joint/ muscle exercise prescription, immobilising or mobilising supports depending on the patients specific needs.
As these patients can have several co-morbidities, a wide multi disciplinary role is needed. The physiotherapist will work closely with the OT, dietician, SALT, SW, nurses, doctors and the D/C co-ordinators to ensure a holistic plan that helps the patient progress safely.
Should the patient require further rehabilitation, the Physiotherapist can refer patients to the in-patient physiotherapy gym or onto the rehabilitation unit of St Finbarr's Hospital via a geriatrician review. If a renal patient is requiring regular dialysis and further rehabilitation, they will be treated via ward and Acute in-patient rehabilitation.
If the patient is medically fit and safe for discharge but may have some further rehabilitation that can be provided for at home or in a community setting, these patients can be referred for community physiotherapy intervention in a home environment setting or in an outpatient setting depending on the patient/ service needs.
Access to the service:
The patient is referred via their leading consultant or members of the leading team, anytime from day of admission.
If the patient requires physiotherapy input and are attending dialysis but are not in hospital as an inpatient, the renal team can still refer to the renal ward physiotherapist and the patient can be seen during their dialysis sessions. As this environment can be limiting due to the need of keeping the patient still for treatment, the patient can then be referred onto the primary care community services to see a physiotherapist for further assessment and treatment management.