Energy saving techniques are methods to reduce the level of fatigue by redesigning activities of daily living after assessing the case. Energy saving techniques are used to help patients improve respiratory efficiency and reduce additional skeletal muscle work. Activities of daily living are further divided into basic activities of daily living and instrumental activities of daily living. The basic activities of daily living intervention, within 4 weeks after discharge, focuses on improving the ability to perform basic activities of daily living. For critically ill and critically ill patients who are limited in basic activities of daily living due to respiratory distress, they can be instructed to learn the following methods to reduce oxygen consumption: firstly, activities of daily living such as transferring, grooming, toileting and bathing can be assessed, and the assessment focuses on understanding, when performing these The focus of the assessment is to understand whether there is difficulty in breathing, pain, weakness and other factors that cause impairment in activities of daily living when performing these activities of daily living, and then give appropriate technical support after the problem points are clearly identified. For patients with severe or critical illnesses, they may have joint contracture, muscle atrophy, limb pain, etc. due to long-term bed rest, so they should be treated with medication, physiotherapy, bracing and stretching training to perform comprehensive activities of daily living intervention. For the impairment of activities of daily living due to respiratory difficulty, it is necessary to consider the patient’s respiratory function, aerobic activity capacity, limb strength and other factors, and then instruct the patient to learn to master energy-saving techniques, or use assistive devices, and intervene in a compensatory manner, as follows: 1. First, including turning, sitting up and standing up. (1) Turn over, instruct the patient to bend both knees to 90°, then turn the head to the side you want to turn over, stretch your hands forward, hold your hands, and tilt your upper and lower limbs to the head-turning side at the same time, pay attention to the abdominal muscles during this process to try not to exert force, prevent holding your breath, cooperate with exhalation, and finish turning over, using axial turning can well avoid abdominal force and achieve the purpose of energy saving, keep even breathing during turning over, and do not hold your breath. (2) Sit up, ask the patient to keep the posture of turning over, place the legs under the bed, raise the head to the oblique top, and support the bed with both hands in turn with exhalation to complete sitting up. Use the cooperation of limb strength to disperse the burden of the core muscles of the waist and abdomen, so that sitting up becomes easy and feasible (Note: in the process of sitting up to maintain even breathing, do not hold your breath.) (3) stand up, when sitting on the bed, feet apart and shoulder width, heels slide back so that the knees fall in front of the toes, torso lean forward until the hips leave the support surface, exhale and extend the knees to complete standing, sitting in a chair can also follow this method to stand. For patients with weakness or balance dysfunction, a walking frame can be used to help complete standing. Adjust the walking frame to the same height as the greater trochanter, with the upper arm at an angle of 150° to the forearm, ask the patient to hold the handrails at both ends with both hands, separate the feet shoulder-width apart, slide the heels backward so that the knees fall in front of the toes, torso lean forward until the hips leave the support surface, and exhale with simultaneous force of the upper and lower limbs to complete standing. The use of walking frames can make good use of the strength of the upper limbs to help complete the stand, but it is important to remember that the feet should not move during the stand, so that the stand becomes more secure. In the process of standing up to maintain even breathing, do not hold your breath, if the symptoms do not ease or have aggravated during training, please seek medical attention; 2, walking: in the walking process, in order to maintain balance and maintain stability, it requires a lot of muscle involvement in contraction to complete, which will increase the oxygen consumption of the body, you can use appropriate walking aids to make walking smooth and easy, the appropriate walking aids can help increase the support surface The appropriate walker can help to increase the area of the support surface, and can also use the support of the upper limb strength to reduce oxygen consumption. During the walking process, the respiratory ratio should be maintained at 2:1 to keep the blood oxygen within the appropriate range, and the respiratory rhythm should be controlled to prevent the heart rate from accelerating and the blood oxygen from dropping due to the disturbance of the respiratory ratio; 3, dressing: for patients who have respiratory difficulties and need oxygen, it is more recommended to wear cardigan clothes to prevent the wheezing under the oxygen separation when wearing a pullover, and pay attention to the hand but not the shoulder during the dressing process, such as having to wear a If you have to wear a pullover, you should put the clothing on your forearm in advance, and organize the oxygen inhalation line, take off the oxygen, and quickly put it on at once. After completing the casing action, wear the oxygen absorption tube first and then organize the clothes to reduce the time away from oxygen; 4. Putting on shoes: For patients with respiratory distress, bending over to put on shoes should be avoided because the abdominal contents will restrict the diaphragm movement, so it is recommended to use the long shoe puller under the sitting position, and the patient putting on shoes should sit on a firm and stable support surface slightly higher than 10 cm above the calf and finish putting on shoes with the long shoe puller, if the symptoms are not relieved during training or If the symptoms are not relieved or aggravated during the training, please seek medical attention promptly; 5. face washing: for patients with respiratory distress, bending over to wash the face should be avoided because the abdominal cavity contents will restrict the diaphragm movement, so it is recommended to take a sitting position, and to reduce oxygen consumption, both upper limbs can be supported on the table, and face wiping can be used instead of face washing to avoid leaving oxygen, and do not hold your breath during this process; 6. tooth brushing: it is recommended to stand as much as possible when brushing the teeth, looking forward, avoiding bending over and lowering the head because the abdominal cavity The contents of the abdominal cavity will restrict diaphragmatic movement and affect breathing, those who cannot stand can brush their teeth in a sitting position and support their upper limbs on the sink to reduce oxygen consumption, two cups can be used for rinsing, one for receiving water and one for spitting water, alternating quickly to reduce the time of breath holding; 7, eating: if the patient can sit alone, take a sitting position to eat, those who cannot sit alone can use a semi-sitting position to eat, those who cannot eat alone, the caregiver can use a 30-degree position to eat. If the patient is unable to eat alone, the caregiver can adopt a 30° reclining position for feeding. During the feeding process, try to ensure that one entrance of food does not exceed 10 ml (about half a spoonful at a time), finish swallowing at the end of inspiration, and swallow with a low head instead of tilting the head to avoid choking and coughing; 8.Bathing: a non-slip shower stool, a non-slip mat, and a long-handled shower brush and shower cap should be chosen to help in bathing. A shower stool allows showering in a seated position, which can play a good role in reducing physical exertion for patients who cannot stand, or who do not have the means to maintain standing for a certain period of time. Anti-slip mats can increase safety, and the long-handled shower brush can accommodate patients with a smaller range of motion, enabling them to reach further distances, reducing energy consumption and saving physical energy. When the water flows down from above, it will cover the face and affect breathing, which can lead to choking and coughing if you are not careful. This time the shower cap can block the water into the eyes, nose and ears, playing a good role in the protection, to ensure smooth breathing. It should be noted that: (1) oxygen if needed, you can use a long oxygen tube from the bottom of the door to pass in. (2) excessive humidity will cause breathing difficulties, it is recommended to maintain good ventilation. (3) For patients who can stand up to take a bath, handrails should be installed to prevent slipping or falling when standing on one leg. Content source: Dr. You Lai