On my neuro placement, I had a patient who was about 4-5 days post R MCA. At this stage, the patient was still occasionally quite drowsy. Nevertheless, I took her to the gym for some rehabilitation. As it is still her early stages of recovery, the patient was quite fatigued by the end of the session.
From a physiotherapy point of view, we like out patients sitting out of bed whenever possible, as it is a much better position for there chest, and alignment. On discussion with the nursing staff, they suggested to put her back in bed as the patient was feeling tired. After my supervisor and I gave the nurse our justification for sitting out of bed (better for her chest, better for her trunk alignment etc) we decided on keeping the patient in the wheelchair for a little while.
I LEARNT THAT LIAISING WITH OTHER HEALTH PROFESSIONALS AND GIVING OUR JUSTIFICATION IS AN IMPORTANT FACTOR IN THE TREATMENT AND MANAGEMENT OF A PATIENT. I WILL CONTINUE TO GIVE MY RATIONALE FOR DIFFERENT ASPECTS OF MY MANAGEMENT NOT ONLY TO THE PATIENT, BUT TO OTHER ALLIED HEALTH STAFF, TO ALLOW A BETTER RECOVERY FOR THE PATIENTS.
Friday, November 21, 2008
Using different instructions
In my neuro placement, I was working on sitting balance with 2 different patients, both left hemis. My treatment mainly focused on promoting anterior pelvic tilt with these patients.
For one of these patients, i was using cues such as "grow tall", and that worked quite well with her. I tried to use the same cue for the other patient, and that wasn't so successful, as it did not encourage him to anteriorly tilt his pelvis. I found that using the cue "chest out" worked much better in promoting anterior pelvic tilt with this patient.
AFTER THIS INCIDENT, I LEARNT THAT DIFFERENT PATIENTS CAN REACT DIFFERENTLY TO DIFFERENT VERBAL INSTRUCTIONS, ESPECIALLY NEUROLOGICAL PATIENTS. IN THE FUTURE, I WILL DETERMINE WHICH INSTRUCTIONS SUIT THE PATIENT BEST, AND USE IT WHEN TREATING THE PATIENT.
For one of these patients, i was using cues such as "grow tall", and that worked quite well with her. I tried to use the same cue for the other patient, and that wasn't so successful, as it did not encourage him to anteriorly tilt his pelvis. I found that using the cue "chest out" worked much better in promoting anterior pelvic tilt with this patient.
AFTER THIS INCIDENT, I LEARNT THAT DIFFERENT PATIENTS CAN REACT DIFFERENTLY TO DIFFERENT VERBAL INSTRUCTIONS, ESPECIALLY NEUROLOGICAL PATIENTS. IN THE FUTURE, I WILL DETERMINE WHICH INSTRUCTIONS SUIT THE PATIENT BEST, AND USE IT WHEN TREATING THE PATIENT.
Monday, November 17, 2008
Pulse
On my rural placement I was treating orthopaedic inpatients. As most of you probably are aware by now, orthopaedic inpatients are very repetitive as it follows the post op routines as per each surgeon. Anyway, I was heading into a TKR patients room to walk him for the first time to the bathroom, and had seen him the day before in which he coped well at standing. The patient reported feeling well, nil complaints voiced. He was no longer on oxygen and all attachments removed. I checked his nursing charts which showed obs stable. I thought I should check them myself to get an immediate reading and for precaution. His oxygen and BP were normal, however his pulse rate was racing at 160 BPM!!! I was surprised, all other readings were fine, the patient was asymptomatic, and in fact the pt was quite cheerful. It was a little strange. I took his pulse manually, it was definitely high.
I decided not to walk him at this stage, and informed him why. I let his nurse know immediately. The patient was later taken to ED for a couple of hours, and his meds changed. He later returned to the ward, in which I was able to ambulate him to the bathroom when all his obs were stable.
This scenario highlighted to me the importance of checking stats prior to ambulating post op patients, even if the nursing obs are normal. Also, patients may be asymptomatic, therefore relying solely on pt responses is not adequate. I also feel that, with orthopaedic inpatients there is so much emphasis on checking Hb, Bp and oxygen that pulse rate gets a little ignored. In future I will take the extra 1 minute to take current obs of a patient that is post op as I have done in this scenario.
I decided not to walk him at this stage, and informed him why. I let his nurse know immediately. The patient was later taken to ED for a couple of hours, and his meds changed. He later returned to the ward, in which I was able to ambulate him to the bathroom when all his obs were stable.
This scenario highlighted to me the importance of checking stats prior to ambulating post op patients, even if the nursing obs are normal. Also, patients may be asymptomatic, therefore relying solely on pt responses is not adequate. I also feel that, with orthopaedic inpatients there is so much emphasis on checking Hb, Bp and oxygen that pulse rate gets a little ignored. In future I will take the extra 1 minute to take current obs of a patient that is post op as I have done in this scenario.
bad habbits
Whist on my rural placement I was treating a patient who had pneumonia. He had a 60 yr history of smoking and refused to quit while in hospital. Every day when I went to see him it would be a struggle to get him to complete any exercises and when he did he was quite negative towards the exercises and report that he just wanted to go home. I begun to develop an unenthusiastic mind set towards the patient and I found I would regularly tell him that he should consider quitting smoking and I was less motivational with my response towards treatment. I realised what was happening to y behaviour and decided to change my outlook towards the patient in a manner that I was required to educate him.
Everything I completed with him I educated him on the benefits of how he was going to return home sooner if he completed the exercises. In addition, I educated him on the negative effect s of smoking and the positive effects of quitting. We discussed options to help him quit and he begun to have a more positive approach towards quitting.
When the patient was D/C he still had not decided to quit smoking but was more aware of the options that are available to him.
I HAVE LEARNT THAT SOME HABITS ARE HARD TO BREAK AND EVEN IF THEY ARE HABITS THAT YOU CANNOT STAND, AS A PROFESSIONAL THE BEST YOU CAN DO IS EDUCATE THE PATIENT ON THE POSITIVES OF CEASING THAT HABBIT. IF I HAD ANOTHER PATIENT WHO WAS A LONG TERM SMOKER AND WAS NOT KEEN TO QUIT, I WILL ENSURE THAT I USE MY KNOWLEDGE TO GIVE THE CORRECT ADVICE, SUPPORT AND EDUCATION TO QUIT RATHER THAN DEVELOPING NEGATIVE BEHAVIOURS.
Everything I completed with him I educated him on the benefits of how he was going to return home sooner if he completed the exercises. In addition, I educated him on the negative effect s of smoking and the positive effects of quitting. We discussed options to help him quit and he begun to have a more positive approach towards quitting.
When the patient was D/C he still had not decided to quit smoking but was more aware of the options that are available to him.
I HAVE LEARNT THAT SOME HABITS ARE HARD TO BREAK AND EVEN IF THEY ARE HABITS THAT YOU CANNOT STAND, AS A PROFESSIONAL THE BEST YOU CAN DO IS EDUCATE THE PATIENT ON THE POSITIVES OF CEASING THAT HABBIT. IF I HAD ANOTHER PATIENT WHO WAS A LONG TERM SMOKER AND WAS NOT KEEN TO QUIT, I WILL ENSURE THAT I USE MY KNOWLEDGE TO GIVE THE CORRECT ADVICE, SUPPORT AND EDUCATION TO QUIT RATHER THAN DEVELOPING NEGATIVE BEHAVIOURS.
Team work
Whilst on my rural placement I was required to complete an initial assessment on a stroke patient. When I asked for a copy of particular stroke assessment the physiotherapist said that they did not have a copy of it. Being a regularly used stroke assessment I was surprised that they had not used it in the past and questioned their supply of resources to run a rehabilitation ward. I was able to access the university website and gain a copy of the assessment and complied a file of the assessment and other commonly used assessments.
At first I was taken aback by the lack of resources that the ward had and annoyed that I had to create a resource file. Although, I did not take into consideration that it was a rural hospital and it was a project to complete to benefit the other physiotherapists as well as the patients.
I BELIEVE THAT IT IS IMPORTANT TO BE ACTIVE IN CREATING AN EFFECTIVE AND WELL RESOURCED WORKING DEPARTMENT. IF WE ALL JUST SAID THAT WE COULD NOT BE ‘BOTHERED’ TO CREATE SUCH RESOURCES THEN THE DEVELOPMENT OF THE DEPARTMENT WOULD NOT EXIST. IF I HAD TO CREATE OR SERACH FOR ANOTHER RESOURCE AGAIN I WOULD HAPPILY DO SO KEEPING IN MIND THE ADVANTAGE OF TEAM COLABERTAION AND INPUT.
At first I was taken aback by the lack of resources that the ward had and annoyed that I had to create a resource file. Although, I did not take into consideration that it was a rural hospital and it was a project to complete to benefit the other physiotherapists as well as the patients.
I BELIEVE THAT IT IS IMPORTANT TO BE ACTIVE IN CREATING AN EFFECTIVE AND WELL RESOURCED WORKING DEPARTMENT. IF WE ALL JUST SAID THAT WE COULD NOT BE ‘BOTHERED’ TO CREATE SUCH RESOURCES THEN THE DEVELOPMENT OF THE DEPARTMENT WOULD NOT EXIST. IF I HAD TO CREATE OR SERACH FOR ANOTHER RESOURCE AGAIN I WOULD HAPPILY DO SO KEEPING IN MIND THE ADVANTAGE OF TEAM COLABERTAION AND INPUT.
Saturday, November 15, 2008
Full picture
Whilst on my paediatric placement I was treating a child with CF who was admitted quite frequently for tune ups, I had been told before I'd seen him that he was a bit of a difficult child and there were some social issues due to family problems.
On treating the patient I found that he had some behavioural problems but after developing a good rapport with him I found it quite easy to get the desired result from treatment.
This went on for several days and treatment session were going well, this was until an afternoon treatment session were I took the patient to the physio gym for some exercise. The exercise involved playing various games something which the patient usually enjoyed and was compliant with. On taking the patient to the gym I noticed that he wasn't his usual self he was a bit quitter than usual and just didn't seem as happy. Starting the gym session the patient was very difficult not wanting to play any of the games he had enjoyed previously. The session was completed and the desired outcome of the session had not been achieved, on reflecting about what had happened with my supervisor it had come to light that the patients mother hadn't visited or phoned the patient that morning, and that this may have been the cause for the misbehaviour during the treatment session.
FOLLOWING THIS INCIDENT IT MADE ME LEARN THAT I HAD TO LOOK AT THE PATIENTS MORE HOLISTICALLY PROBABLY MORE IMPORTANTLY IN A PAEDIATRIC SETTING AS THE ROLE AND INTERACTION OF FAMILIES WAS A LARGE PART IN HOW A CHILD WOULD BEHAVE.
On treating the patient I found that he had some behavioural problems but after developing a good rapport with him I found it quite easy to get the desired result from treatment.
This went on for several days and treatment session were going well, this was until an afternoon treatment session were I took the patient to the physio gym for some exercise. The exercise involved playing various games something which the patient usually enjoyed and was compliant with. On taking the patient to the gym I noticed that he wasn't his usual self he was a bit quitter than usual and just didn't seem as happy. Starting the gym session the patient was very difficult not wanting to play any of the games he had enjoyed previously. The session was completed and the desired outcome of the session had not been achieved, on reflecting about what had happened with my supervisor it had come to light that the patients mother hadn't visited or phoned the patient that morning, and that this may have been the cause for the misbehaviour during the treatment session.
FOLLOWING THIS INCIDENT IT MADE ME LEARN THAT I HAD TO LOOK AT THE PATIENTS MORE HOLISTICALLY PROBABLY MORE IMPORTANTLY IN A PAEDIATRIC SETTING AS THE ROLE AND INTERACTION OF FAMILIES WAS A LARGE PART IN HOW A CHILD WOULD BEHAVE.
Thursday, November 13, 2008
Getting out of the comfort zone,Make the most of every opportunity
Whilst on my rural prac I had the opportunity to do some after hours work this included a taping session for a local junior soccer team. Given the choice of whether or not to be involved I was more than happy to be a part of it and being a part of it then became me organizing the material for the presentation and running the presentation session.
At first I was a bit apprehensive about running the whole session as I was in a a different place a bit out of the comfort zone, however I persevered. I devised a plan of what to include in the session and this was basic information on first aid and whether taping was appropriate, basic taping methods and also warnings about taping. After spending a few days preparing the material I felt I had a pretty decent presentation on my hands now all I had to do was run the session.
The night of the presentation came around and I must say there were a few butterflies flying around. Once i began though everything ran smoothly I had prepared adequately and I had about a group of 30 or so teens hanging of my every word and interested in learning what I had to pass on. The night went off with out problem and I am very happy I put myself a out of my comfort zone.
I FOUND BY DOING THE TAPING SESSION AND DOING SOMETHING THAT WAS OUT OF MY COMFORT ZONE I REALLY LEARNT A LOT AND I DEFINITELY THINK IT HELPED MY PLANNING AND PRESENTATION SKILLS, IT ALSO LEFT ME WITH A GOOD FEELING AS THE PARTICIPANTS WERE REALLY INTERESTED IN THE KNOWLEDGE I HAD TO PASS OVER. IF I EVER GET THE CHANCE TO DO SOMETHING SIMILAR I WILL JUMP AT IT.
At first I was a bit apprehensive about running the whole session as I was in a a different place a bit out of the comfort zone, however I persevered. I devised a plan of what to include in the session and this was basic information on first aid and whether taping was appropriate, basic taping methods and also warnings about taping. After spending a few days preparing the material I felt I had a pretty decent presentation on my hands now all I had to do was run the session.
The night of the presentation came around and I must say there were a few butterflies flying around. Once i began though everything ran smoothly I had prepared adequately and I had about a group of 30 or so teens hanging of my every word and interested in learning what I had to pass on. The night went off with out problem and I am very happy I put myself a out of my comfort zone.
I FOUND BY DOING THE TAPING SESSION AND DOING SOMETHING THAT WAS OUT OF MY COMFORT ZONE I REALLY LEARNT A LOT AND I DEFINITELY THINK IT HELPED MY PLANNING AND PRESENTATION SKILLS, IT ALSO LEFT ME WITH A GOOD FEELING AS THE PARTICIPANTS WERE REALLY INTERESTED IN THE KNOWLEDGE I HAD TO PASS OVER. IF I EVER GET THE CHANCE TO DO SOMETHING SIMILAR I WILL JUMP AT IT.
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