I have thouroughly enjoyed this placement and now realise that although initially 'thrown in to the deep end', it made me become more confident in my own ablilities in the long run and develop much better skills in assessing and treating patients than if I had been only observing my supervisor.
I feel that I have improved my time management skills and ability to communicate my opinions and views with other members of the multidisciplinary team. My role in discharge planning has also made me far more aware of the team work that is required in planning when a patient can be discharged.
I learnt far more from this prac than I had imagined I would as in the rehab setting you are able to see a real variety of cases from orthopaedic to cardiorespiratory and musculoskeletal on top of the relevant gerontology issues.
Tuesday, September 1, 2009
Topic 3
Situation
The situation was such that I had a patient who was needing to be weaned off oxygen therapy in the rehab environment to assess whether or not he would be required to have oxygen therapy in his home following respiratory failure from AAA repair. The patient was 78yr old man who was previously completely independent in ADLs, ambulating without aids and still driving.
Task
The task was to measure his O2 saturation levels during physio sessions with decreased oxygen therapy (cont via NP) than prior to his rehab admission. As he was able to maintain his O2 sats above 90 during exertion the oxygen was to be removed.
Action
I completed a 6mwt with this patient initially, with him on 2L continuous O2 via NP, and after 3mins his saturation levels decreased to 88 so he was unable to continue walking the finally 3 minutes. A week later, after daily PT of ambulating, seated cycling and LL strength exercises, I re-assessed the 6mwt. The patient had been of O2 therapy during the day for the 3 days prior and off oxygen at night for 1 night.
Result
The result of this test was a much improved total distance at the conclusion of the test and on RA the patient's SpO2 levels remained between 92-93 on exertion. These were measured using pulse oximetry. He also had a lower maximum HR and a lower BORG rating of shortness of breath.
Evaluation
This reflects a positive outcome and suggests that my intervention of a PT program aiming to improve CR fitness and endurance assisted this patient in being able to maintain adequate O2 levels during physical exercise. However, this result can not simply be attributed to physio input but also nursing and medical management of the patient. During this process I realised the necessity of communication with nurses and doctors about the change in oxygen therapy the patient was to receive.
Strategies
Next time I feel that I may have been able to acheive the desired outcome earlier by using a gradual decline in O2 therapy rather than dropping the patient straight from 2L cont O2 throughout the day and on exertion to just RA. Perhaps it would have been more beneficial to the patient to have had periods during the day when he was at rest where the oxygen could have been removed, ensuring that SpO2 levels were regularly assessed.
The situation was such that I had a patient who was needing to be weaned off oxygen therapy in the rehab environment to assess whether or not he would be required to have oxygen therapy in his home following respiratory failure from AAA repair. The patient was 78yr old man who was previously completely independent in ADLs, ambulating without aids and still driving.
Task
The task was to measure his O2 saturation levels during physio sessions with decreased oxygen therapy (cont via NP) than prior to his rehab admission. As he was able to maintain his O2 sats above 90 during exertion the oxygen was to be removed.
Action
I completed a 6mwt with this patient initially, with him on 2L continuous O2 via NP, and after 3mins his saturation levels decreased to 88 so he was unable to continue walking the finally 3 minutes. A week later, after daily PT of ambulating, seated cycling and LL strength exercises, I re-assessed the 6mwt. The patient had been of O2 therapy during the day for the 3 days prior and off oxygen at night for 1 night.
Result
The result of this test was a much improved total distance at the conclusion of the test and on RA the patient's SpO2 levels remained between 92-93 on exertion. These were measured using pulse oximetry. He also had a lower maximum HR and a lower BORG rating of shortness of breath.
Evaluation
This reflects a positive outcome and suggests that my intervention of a PT program aiming to improve CR fitness and endurance assisted this patient in being able to maintain adequate O2 levels during physical exercise. However, this result can not simply be attributed to physio input but also nursing and medical management of the patient. During this process I realised the necessity of communication with nurses and doctors about the change in oxygen therapy the patient was to receive.
Strategies
Next time I feel that I may have been able to acheive the desired outcome earlier by using a gradual decline in O2 therapy rather than dropping the patient straight from 2L cont O2 throughout the day and on exertion to just RA. Perhaps it would have been more beneficial to the patient to have had periods during the day when he was at rest where the oxygen could have been removed, ensuring that SpO2 levels were regularly assessed.
Friday, August 14, 2009
Entry 2:
Situation:
I had a patient today who is a 97yr old man, admitted into the rehab unit 2 days ago after being in an acute ward following a postural collapse. He was mobilising with a wzf but at home was using a 4ww over a distance of 30m. His goal was to go back home and to do this he needed to be able to walk I with a 4ww over the required distance. His BBS was 33/56.
Task:
The task for me has been to improve his mobility so that he is ready for discharge when all other allied health and medical goals have been met. To achieve this I needed to make sure he was safe and independent on the wzf and then progress to a 4ww, ensuring that he was safe on that with stand-by assistance initially and then independently.
Action:
Day 1 treatment included assessing his ambulation on the wzf and also aiming to improve his dynamic balance reactions. Day 2, the patient was loaned a 4ww to ambulate with on the ward and reminded of extra safety precuations involved with having 4 wheels. Since the patient is so old it is expected his balance will improve sigificantly and the fact that the reason for his admission was not related to his poor balance, the main goal prior to discharge is to return the patient to his previous functional mobility level.
Communication was also another important aspect of this intervention as when a patients mobility status on the ward is changed it must be documented in the progress notes, changed on his bedside chart and the nurses need to be made aware of the change.
Result:
The result of my intervention has meant that the patient is now ready for discharge from a physio perspective and is mobilising at the level he was prior to his hospital admission.
Evaluation:
My actions in this situation were very effective and met the desired outcome of the patient being ok for discharge in terms of mobility. Ensuring good communication with the nursing staff is also essential and I made certain all the requirements of a mobility status change were met so all staff were aware.
Strategies:
I used the strategies of goal setting, communication with patient and staff and effective assessment and planning to ensure this patient was ready for discharge as soon as possible.
I had a patient today who is a 97yr old man, admitted into the rehab unit 2 days ago after being in an acute ward following a postural collapse. He was mobilising with a wzf but at home was using a 4ww over a distance of 30m. His goal was to go back home and to do this he needed to be able to walk I with a 4ww over the required distance. His BBS was 33/56.
Task:
The task for me has been to improve his mobility so that he is ready for discharge when all other allied health and medical goals have been met. To achieve this I needed to make sure he was safe and independent on the wzf and then progress to a 4ww, ensuring that he was safe on that with stand-by assistance initially and then independently.
Action:
Day 1 treatment included assessing his ambulation on the wzf and also aiming to improve his dynamic balance reactions. Day 2, the patient was loaned a 4ww to ambulate with on the ward and reminded of extra safety precuations involved with having 4 wheels. Since the patient is so old it is expected his balance will improve sigificantly and the fact that the reason for his admission was not related to his poor balance, the main goal prior to discharge is to return the patient to his previous functional mobility level.
Communication was also another important aspect of this intervention as when a patients mobility status on the ward is changed it must be documented in the progress notes, changed on his bedside chart and the nurses need to be made aware of the change.
Result:
The result of my intervention has meant that the patient is now ready for discharge from a physio perspective and is mobilising at the level he was prior to his hospital admission.
Evaluation:
My actions in this situation were very effective and met the desired outcome of the patient being ok for discharge in terms of mobility. Ensuring good communication with the nursing staff is also essential and I made certain all the requirements of a mobility status change were met so all staff were aware.
Strategies:
I used the strategies of goal setting, communication with patient and staff and effective assessment and planning to ensure this patient was ready for discharge as soon as possible.
Wednesday, July 29, 2009
Week 1 Entry: INTERVENTION
Today I had a great learning experience as a result of doing the wrong thing. We had done an initial assessment on an 82yr old lady who was recovering from pneumonia, was deconditioned and as well as had severe swelling of her lower limbs and especially around her left knee as a result of a fall. Our first treatment priority for the day was do decrease some of the swelling as it was severely affecting her mobility and comfort. However, as a result of a misunderstanding with our supervisor we performed RICE techniques and gentle massage to both lower limbs when we should have only been applying these treatments to the area around her knee injured in her fall. The error in this situation was that we didn't have a thorough understanding about what was causing the bilateral lower limb oedema and hadn't considered that this may be secondary to and infection or cardiac complications, in which case RICE and massage would be very inappropriate. I now am aware that is essential to be able to explain why you are doing a treatment before jumping in and doing it as well as the importance of liasing with the medical staff to discover if a sign is symptom is in fact caused be a medical imbalance and therefore not suitable for physiotherapy. That is, basic clinical reasoning about why you are doing something is vital before beginning any intervention.
Sunday, July 26, 2009
3rd Year Prac - Initial Entry
I am excited to start my placement at Hollywood hospital and am more relaxed about prac second time round as I have a better idea of what to expect. I am certain that this placement in neurology/gerontology will be a very different and im sure rewarding experience than my last placement in paeds. I am slightly apprehensive about being in a hospital for the first time but am looking forward to working as part of a larger multidisciplinary team. Working with the elderly is something very new to me but I'm sure that all my skills learnt at uni will assist me in adapting and being an active team member at Hollywood Hospital.
Thursday, November 13, 2008
Week 5: Entry 3
Today I met lovely little 11mth boy who is in the care of a foster mum as he waits to be placed for adoption. He is seen by many othe medical professionals and is waiting on an MRI to be confirmed with hyrocephallus. This is where there is too much fluid in his ventricles that is unable to move in or out of the brain causing compression from the inside out. He is most likely globally delayed and has great difficulty in planning movements. At 11mth he is functioning at a 7-8 month gross motor level and similar level in fine motor skills. It is also likely that his speech is delayed and he is waiting to be seen by an opthamologist because 0f a nystagmus query in one eye. For this baby as well as all the stresses of many different appointments and tests being done to him, his medical issues also have meant that an adoption that was lined up has fallen through.
I was given the task of an objective assessment with this boy in the session. This consisted of playing with toys in various positions and seeing how much he would tolerate. In prone he was pivoting and rolling but often found himself stuck in sidelying. In supine he would also roll but wasn't trying to play with his knees or feet and quickly moved into prone. He could sit well without support and was weight bearing on his legs. He was also low toned and probably on the borderline of being classed as hypotonic. He had significantly reduced strength and endurance in his trunk, upper limbs and lower limbs and was not showing any lateral head righting responses. I didn't have much structure to my examination but did feel that I covered most of the essential elements and was able to understand and transfer other knowledge.
I was given the task of an objective assessment with this boy in the session. This consisted of playing with toys in various positions and seeing how much he would tolerate. In prone he was pivoting and rolling but often found himself stuck in sidelying. In supine he would also roll but wasn't trying to play with his knees or feet and quickly moved into prone. He could sit well without support and was weight bearing on his legs. He was also low toned and probably on the borderline of being classed as hypotonic. He had significantly reduced strength and endurance in his trunk, upper limbs and lower limbs and was not showing any lateral head righting responses. I didn't have much structure to my examination but did feel that I covered most of the essential elements and was able to understand and transfer other knowledge.
Wednesday, November 12, 2008
Week 5: Entry 2
Yesterday I performed my first subjective assessment to a mother of a beautiful 19mth old little girl who had only just started to walk since being referred into the public system. i think it ran smoothly and I got all the information I required to write up the subjective aspect of her report. One area I think could have improved was my questioning about the birth history. I got enough essential information but could have included more questions just to clarify for my own understanding. This girl has just been diagnosed with benign joint hypermobility syndrome which is likely to be a significant factor in her gross motor delay. However, is now only a month behind for her age and fine motor skills are age appropriate so there were no major areas of concern. One thing I did find interesting was that the rheumatologist who diagnosed her hypermobility syndrome gave the mother a very worst case scanario prognosis saying she may never be able to write and will always struggle with gross and fine motor development. The mother said she was in hysterics after hearing this and it was only when she saw the physio who reassured her that she was doing well and making good progress that she didn't feel so concerned. From my perspective, I have seen many children who are far more delayed than this little girl and I think it was unecessary of the doctor to blow the situation out of proportion. Although it is important to ensure parents understand the condition and potential risks, I don't think this was the best way to help the family.
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