Today, we were referred to see at 91 yr old lady for chest physio. We read the file and it stated that she was a paraplegic from T7 down. So this was going to be interesting!
We found her sitting in the chair and coughing a very moist and effective cough.
We auscultated her and found that she had decreased breathe sounds in the lower zones of her lungs.
We tried to do some deep breathing to help get the sputum up, but found that her diaphragm excertion wasn't great, and she was using her accessory muscle and hitching her shoulders when trying to take a deep breath.
My supervisor concluded the lack of diaphragmatic excertion due to her paraplegia with secondary weakness to the muscles of respiration, so she thought she might use the bird machine.
I found this a really interesting machine. It forces the air down to the lower airways when you breathe in causing a postive pressure and allows for the sputum to be moved easily. It stops blowing air into your lungs when you take a breath out. Coupling this with vibes on exhalation, the IPPB was a very effective treatment for this lady as after a cycle, we got her to cough and she was productive of a light yellow runny sputum, which she was previously having trouble getting up.
After been shown how to use the machine it is very easy, because the patient controls it with their breathing.
If i was to do this treatment again, i think i would get the lady to huff instead of cough, as it did make her very SOB and she was having to use a lot of force behind that cough to get up the sputum, and the huff might have been a bit less exerting for her.
Friday, October 31, 2008
Thursday, October 30, 2008
Week 3 # 2 -Language barrier
Today i had a challenging situation with a patient.
He was an Italian man, that didn't understand much english, admitted with and infective exacerbation of COPD. Physios were referred to him to complete a 6mwt with and without oxygen to see if he may need home oxygen. I was to explain the test to him and do it with him. I read out the protocol that must be read out to each patient, execpt I kept it very basic and simple, knowing about his limited english. I asked him if he understood and had any question, which he responded that he understood. So we began the test.
We took the baseline assessment and he gave a RPE score of 4 which is common for people with COPD. We began the walking and at the first minute i asked him to give a number to equal his breathlessness, and he just moved his finger around and said 'I'll just choose this one.' which was 7, and i could tell that he didnt understand the numbering system as he was able to communicate (even though told not to) and his RR was staying at 18/minute. On the sheet he used to see what number corresponds to how breathless they felt, instead of asking for a number i asked him to point to a word, (slight, mod, severe). But with this he was still pointing at numbers.
I began to feel very frustrated, cause no matter how i tried to reword the concept, he just wasnt understanding it. I could tell he was also frustrated cause at the next minute my supervisor tried to get it out of him and he just said 'I dont understand!' At that point my supervisor decided it was best if we just left the RPE out of the assessment. This then jepordises the measurement as the RPE gives the evaluator an insight into how the pt feels they are coping with their exertion compared to how their body is reacting, ie. RR, SaO2, HR.
Considering how frustrating the situation was, i believe i stayed calm and tried my best at trying different ways to explain the RPE to the patient.
If i was to be in that situation again, I probably wouldn't mention the numbers for scaling of the RPE and get then to chose a word and then i would see what number it equates to.
He was an Italian man, that didn't understand much english, admitted with and infective exacerbation of COPD. Physios were referred to him to complete a 6mwt with and without oxygen to see if he may need home oxygen. I was to explain the test to him and do it with him. I read out the protocol that must be read out to each patient, execpt I kept it very basic and simple, knowing about his limited english. I asked him if he understood and had any question, which he responded that he understood. So we began the test.
We took the baseline assessment and he gave a RPE score of 4 which is common for people with COPD. We began the walking and at the first minute i asked him to give a number to equal his breathlessness, and he just moved his finger around and said 'I'll just choose this one.' which was 7, and i could tell that he didnt understand the numbering system as he was able to communicate (even though told not to) and his RR was staying at 18/minute. On the sheet he used to see what number corresponds to how breathless they felt, instead of asking for a number i asked him to point to a word, (slight, mod, severe). But with this he was still pointing at numbers.
I began to feel very frustrated, cause no matter how i tried to reword the concept, he just wasnt understanding it. I could tell he was also frustrated cause at the next minute my supervisor tried to get it out of him and he just said 'I dont understand!' At that point my supervisor decided it was best if we just left the RPE out of the assessment. This then jepordises the measurement as the RPE gives the evaluator an insight into how the pt feels they are coping with their exertion compared to how their body is reacting, ie. RR, SaO2, HR.
Considering how frustrating the situation was, i believe i stayed calm and tried my best at trying different ways to explain the RPE to the patient.
If i was to be in that situation again, I probably wouldn't mention the numbers for scaling of the RPE and get then to chose a word and then i would see what number it equates to.
Tuesday, October 28, 2008
Week 3 #1 - Pallative Care
Today I saw a pt for the first time who had just been transferred for pallative care but was referred to physio for a mobility Ax prior to t/f to the pallative care unit, to see what he could manage mobility wise, so as to see as whether there would be a chance that he could end up at home, in the end stages instead of a nursing home.
I found this quite confronting as this man has decided to give up. This is also the reason why my supervisor and I had some difficulty getting him to do the assessment. If a man had given up on recieving treatment, what would make him do a mobility assessment.
We went in an introduced ourself. The first barrier we crossed was that he was from italy, and only knew the basics of English. The second barrier was that he was very drowsy and you could tell he just wanted to be left alone in peace.
After we had introduced ourself we asked for consent to look at his muscle strength and the extent of his mobility. He said he understood, but it took a little of encouragement to try to get him to agree to do the assessment.
He performmed the muscle strength assessment well, but was not alert during it, and even began to fall asleep. I began to feel quite sympathetic for him, as I couldn't understand why the Dr would refer him to us, if all he wanted to do was rest and be left alone, but i guess from the Drs perspected he could see that he still had a lot of function left and wanted to utilise it, it was just trying to make the patient see that too.
We then tried to get him to do some walking, and we found this quite a challenge to do. Although he had adequate strength in his lower limbs, he was just not motivated enough to stand up without anyhelp. We did manage to get him standing but after around 10 seconds he just flopped down and didn't want to do anymore, he really just wasn't motivated.
I found this a really hard referral.
I wondered why the Dr would bother referring us to a man who has been put on pallative care, if he didn't want any help. I do realise the Dr was just trying to make sure the pt had the best QoL in the terminal stages, but the pt was clearly not motivated and just wanted to be left alone.
If I am to see the patient again, I think i would try to motivate him to help with the assessment by saying that if he doesn't try or put them effort into maintain his mobility then he is just going to have to be hoisted all the time, and that means spending the rest of his life in a nursing home, which I think wouldn't be the best option, if he could maitain is mobility and be discharged back to his home so that his ability level is enough so no to be stenuous on care staff.
I found this quite confronting as this man has decided to give up. This is also the reason why my supervisor and I had some difficulty getting him to do the assessment. If a man had given up on recieving treatment, what would make him do a mobility assessment.
We went in an introduced ourself. The first barrier we crossed was that he was from italy, and only knew the basics of English. The second barrier was that he was very drowsy and you could tell he just wanted to be left alone in peace.
After we had introduced ourself we asked for consent to look at his muscle strength and the extent of his mobility. He said he understood, but it took a little of encouragement to try to get him to agree to do the assessment.
He performmed the muscle strength assessment well, but was not alert during it, and even began to fall asleep. I began to feel quite sympathetic for him, as I couldn't understand why the Dr would refer him to us, if all he wanted to do was rest and be left alone, but i guess from the Drs perspected he could see that he still had a lot of function left and wanted to utilise it, it was just trying to make the patient see that too.
We then tried to get him to do some walking, and we found this quite a challenge to do. Although he had adequate strength in his lower limbs, he was just not motivated enough to stand up without anyhelp. We did manage to get him standing but after around 10 seconds he just flopped down and didn't want to do anymore, he really just wasn't motivated.
I found this a really hard referral.
I wondered why the Dr would bother referring us to a man who has been put on pallative care, if he didn't want any help. I do realise the Dr was just trying to make sure the pt had the best QoL in the terminal stages, but the pt was clearly not motivated and just wanted to be left alone.
If I am to see the patient again, I think i would try to motivate him to help with the assessment by saying that if he doesn't try or put them effort into maintain his mobility then he is just going to have to be hoisted all the time, and that means spending the rest of his life in a nursing home, which I think wouldn't be the best option, if he could maitain is mobility and be discharged back to his home so that his ability level is enough so no to be stenuous on care staff.
Thursday, October 23, 2008
Wk 2 # 3 - ICU ward
Today was SO interesting! One of the PTs told me i would be going with her after lunch to the intesive care unit. I was really quite nervous cause I didn't want anyone to die on me! So we went to the ICU unit and it was all high tech with heaps of machines around the parient monitoring, more like the hospital rooms you see in the TV shows.
My patient was a male that was day 1 post-op for a right TKA. I was really excited as I really like orthopaedics and it was something i could apply my full knowledge to (a bit different to the respiratory ward, where i'm mainly being taught things because we havent finished our learning from Shane).
Our aim with this patient was to run through the immediate post op exercise and to get him up standing so that we could get him on to his ward bed and up to the rehab ward. So we gowned up for infection control and got to it.
We explained everything to him and asked him his pain level out of 10. His was 7! I felt so bad, cause the ROM exercises were probably going to make him a 10. So we told him to press his PCA so that we could get an idea of his ROM. He could get about 20-30 degrees AROM, and 40 degrees with active assisted. It was then my job to teach him some breathing and LL bed Xs.
I found this quite challenging because I felt so bad about the amount of pain he was in, and because everytime he used his PCA he was getting drowsier and drowsier and wasn't concentrating on the Xs. However he managed to do all of them efficiently.
It was then our task to get him standing. This was also going to be a challenge as he was quite a heavy man, plus a little drowsy so we thought he would rely on us and we would have to try to stand him against his dead weight.
We detached all the attachments that weren't needed, leaving the drips and drains and got him a WZF them it was time to start.
He was very co-operative and the whole process of switching beds and keeping him standing was actually quick and easy.
I was to help him bring his legs to the egde and over, mainly supporting the affected leg, while the PT was behind him to help him to sit up. Once he was sitting on the edge of bed, I had to slowly lower his leg, so the blood didn't rush down the leg, advicing him to do some foot pumps to get the blood pumping. It was then time to stand, so the pt pushed his PCA and he stood up and then used the frame to help him balance, but mostly putting his weight through both legs, as after a TKA they are FWB unless a surgeon specifies differently.
The beds were changed and he was then able to sit back down on his ward bed. The transfer went really well, as I had hardly had to bear any of his weight.
It was really good to go down to the ICU and see an acute post op pt. I found it really interesting down there, compared to the same case of COPD and respiratory pts i see everyday! Nothing like a change!
Hopefully i get to do that again cause i really enjoyed it! To be able to do the exercises on someone that has actually had a TKA/ surgery, you get an understanding on the time needed to spend with them, because of the pain, they can't just go through the Xs quickly.
My patient was a male that was day 1 post-op for a right TKA. I was really excited as I really like orthopaedics and it was something i could apply my full knowledge to (a bit different to the respiratory ward, where i'm mainly being taught things because we havent finished our learning from Shane).
Our aim with this patient was to run through the immediate post op exercise and to get him up standing so that we could get him on to his ward bed and up to the rehab ward. So we gowned up for infection control and got to it.
We explained everything to him and asked him his pain level out of 10. His was 7! I felt so bad, cause the ROM exercises were probably going to make him a 10. So we told him to press his PCA so that we could get an idea of his ROM. He could get about 20-30 degrees AROM, and 40 degrees with active assisted. It was then my job to teach him some breathing and LL bed Xs.
I found this quite challenging because I felt so bad about the amount of pain he was in, and because everytime he used his PCA he was getting drowsier and drowsier and wasn't concentrating on the Xs. However he managed to do all of them efficiently.
It was then our task to get him standing. This was also going to be a challenge as he was quite a heavy man, plus a little drowsy so we thought he would rely on us and we would have to try to stand him against his dead weight.
We detached all the attachments that weren't needed, leaving the drips and drains and got him a WZF them it was time to start.
He was very co-operative and the whole process of switching beds and keeping him standing was actually quick and easy.
I was to help him bring his legs to the egde and over, mainly supporting the affected leg, while the PT was behind him to help him to sit up. Once he was sitting on the edge of bed, I had to slowly lower his leg, so the blood didn't rush down the leg, advicing him to do some foot pumps to get the blood pumping. It was then time to stand, so the pt pushed his PCA and he stood up and then used the frame to help him balance, but mostly putting his weight through both legs, as after a TKA they are FWB unless a surgeon specifies differently.
The beds were changed and he was then able to sit back down on his ward bed. The transfer went really well, as I had hardly had to bear any of his weight.
It was really good to go down to the ICU and see an acute post op pt. I found it really interesting down there, compared to the same case of COPD and respiratory pts i see everyday! Nothing like a change!
Hopefully i get to do that again cause i really enjoyed it! To be able to do the exercises on someone that has actually had a TKA/ surgery, you get an understanding on the time needed to spend with them, because of the pain, they can't just go through the Xs quickly.
Wednesday, October 22, 2008
Weeks 2 #2 - confrontation
Today, I had an interesting encounter with a patient.
I went to review the exercises i had given him the previous week and wanted to teach him some more leg strengthening Xs as he had requested some. However he wasn't feeling up to doing them, as he was SOB after he had been walking. I decided to make a compromise with him so that it was a win-win situation. I said we didn't have to do the leg exercises but if he could to do the UL Xs i had given him, so that i could see that he was doing them correctly, and go for a walk with me tomorrow that i will leave him for the rest of the day. Considering physios seem to be the most hated profession on the ward, he was happy to do it so i would go away.
I went and got his theraband, and he stated that he thought the theraband was the reason why he was getting his itchy hands. I had a look at his hands, noticing they were a little red, and asked him why he thought the theraband was making them itchy. He then said it was he is allergic to latex.
He said that he really liked using the theraband as he found it versatile and was able to do his own Xs and wondered if there were any latex free gloves he could have so as to continue to use the theraband. I then went to find my supervisor to tell her the situation, and if she knew he was allergic to latex and ask whether the theraband does actually contain latex. She said she had no idea he was allergic and doesn't rememerber it being documented in his notes, and told me to go check if I could find the documentation anywhere.
After checking the pt's bed file and current medical history folder, there was no evidence of my pt being allergic to latex. It was only when we looked through the 'old medical notes' that it stated he was allergic to latex, which the theraband contained.
So i was left to break the news to him that he was no longer allowed to use the theraband and I gave him the option of using .5 or 1 kg weights. WOW he was not a happy man! I told him that we had found in his old notes that it said he was allergic to latex, and i legally had to take the theraband of him (to save my butt!!!). And didn't he cause a storm! 'I'm not doing my exercises unless i have the theraband!'
I believe i handled the situation well. I waited until he finished having his rant and calmly stated the reason i had to take the latex of him, and until we could find appropriate gloves, he could not use it but he may use the weights that I had and showed him in my hands. He didn't talk to me for a while, turning his head away, but i waited. I then asked him which weights he would like, and after a while he stated he wanted the 1 kg ones even though he 'wouldn't use them anyway'
i then apologise for all the inconvience, but he contiued to ignore me, so i thought i would leave him alone and leave. So i said bye and that i will see him in a couple of days.
I went and reported back to my supervisor about his attitude and the overall outcome when a nurse found me and said my pt asked to see my supervisor and was apparently throwing his socks around saying 'i'll use these as gloves just give me back the theraband.' My supervisor tried to calm him down, and restated what i had said, which i thought was good of her, so as to not contradict the things i had told him.
Overall, I thought i handled the situation well. I'm not usually a patient person but i believe I was very pateint in this situation as i would have usually probably given up a lot quicker and just left the room, but instead i tried to reason & compromise with him, because i know he must be frustrated with his health deterioration, or the attitude may have been because of some of the medication he is using.
If i was to improve anything in that situation, it would have been my communication. I felt as though i didn't really know what to say to him, to make him understand that he was allowed to use the theraband and to calm him down. I guess thats something that comes with exprience with dealing with grumpy patients!
Hopefully he will speak to me the next time i see him and allow me to treat him!
I went to review the exercises i had given him the previous week and wanted to teach him some more leg strengthening Xs as he had requested some. However he wasn't feeling up to doing them, as he was SOB after he had been walking. I decided to make a compromise with him so that it was a win-win situation. I said we didn't have to do the leg exercises but if he could to do the UL Xs i had given him, so that i could see that he was doing them correctly, and go for a walk with me tomorrow that i will leave him for the rest of the day. Considering physios seem to be the most hated profession on the ward, he was happy to do it so i would go away.
I went and got his theraband, and he stated that he thought the theraband was the reason why he was getting his itchy hands. I had a look at his hands, noticing they were a little red, and asked him why he thought the theraband was making them itchy. He then said it was he is allergic to latex.
He said that he really liked using the theraband as he found it versatile and was able to do his own Xs and wondered if there were any latex free gloves he could have so as to continue to use the theraband. I then went to find my supervisor to tell her the situation, and if she knew he was allergic to latex and ask whether the theraband does actually contain latex. She said she had no idea he was allergic and doesn't rememerber it being documented in his notes, and told me to go check if I could find the documentation anywhere.
After checking the pt's bed file and current medical history folder, there was no evidence of my pt being allergic to latex. It was only when we looked through the 'old medical notes' that it stated he was allergic to latex, which the theraband contained.
So i was left to break the news to him that he was no longer allowed to use the theraband and I gave him the option of using .5 or 1 kg weights. WOW he was not a happy man! I told him that we had found in his old notes that it said he was allergic to latex, and i legally had to take the theraband of him (to save my butt!!!). And didn't he cause a storm! 'I'm not doing my exercises unless i have the theraband!'
I believe i handled the situation well. I waited until he finished having his rant and calmly stated the reason i had to take the latex of him, and until we could find appropriate gloves, he could not use it but he may use the weights that I had and showed him in my hands. He didn't talk to me for a while, turning his head away, but i waited. I then asked him which weights he would like, and after a while he stated he wanted the 1 kg ones even though he 'wouldn't use them anyway'
i then apologise for all the inconvience, but he contiued to ignore me, so i thought i would leave him alone and leave. So i said bye and that i will see him in a couple of days.
I went and reported back to my supervisor about his attitude and the overall outcome when a nurse found me and said my pt asked to see my supervisor and was apparently throwing his socks around saying 'i'll use these as gloves just give me back the theraband.' My supervisor tried to calm him down, and restated what i had said, which i thought was good of her, so as to not contradict the things i had told him.
Overall, I thought i handled the situation well. I'm not usually a patient person but i believe I was very pateint in this situation as i would have usually probably given up a lot quicker and just left the room, but instead i tried to reason & compromise with him, because i know he must be frustrated with his health deterioration, or the attitude may have been because of some of the medication he is using.
If i was to improve anything in that situation, it would have been my communication. I felt as though i didn't really know what to say to him, to make him understand that he was allowed to use the theraband and to calm him down. I guess thats something that comes with exprience with dealing with grumpy patients!
Hopefully he will speak to me the next time i see him and allow me to treat him!
Tuesday, October 21, 2008
Beginning of week 2
Week 2 is so much better than week 1. I find that i feel like i've got my bearings and have gotten used to the hospital system, reading and writing in patient notes, and talking and building rapport with patients just comes that little bit easier, and hopefully will continue to with more practise.
On monday Jesse and I were together with my supervisor, this was good as we both got to see how much we had learnt. Jesse's supervisor had also taught him to do vibes, so today my supervisor taught me how to do them which was really great!
I got to see more patients by myself on monday, which helps build my confidence as my supervisor believes that i can do it. I mainly just ran through the exercises I had previously given patients and ambulated them, which i found i did well. Most of my patients are making good recoveries, with 3 to be discharged over the next couple of days.
On monday I also got to run through a 6mwt with jesse and my supervisor stood by and watched. This was really helpful as it allowed me to practice incase we get this in the gero prac!!
Today I also completed 2 subjective and objective Ax of patients. This was interesting, as both these patients were what i would consider difficult patients.
One of the patients was very confused, and we think it was because of his UTI. He was okay to perform a subjective Ax on him, but he did say things that were a bit weird. So my supervisor asked me to call his next of kin just to get an accurate history. I found this very daunting, but thankfully the next of kin was very helpful and i was able to saught a few things out. Usually i'm really bad on the phone, but thought i stepped up to the ocassion! The pt was okay to perform an objective Ax on, but when Ax his ambulation, he was very confused, thinking his relatives had redone the house and put all these beds in, thinkin the hosiptal was his house. My supervisor just kept agreeing with him rarely stating theres your bed in the hospital with emphasis on hospital, but didn't persist with trying to correct him to where he was, which i found was weird but i discussed it with her after. She said she sometimes just mostly agrees with the patient if she thinks they can become agitated, distressed or very angry if you're disagreeing with what their brain is telling them is right. Interesting, think i will have to get better at ready people to make the right decision in that situation! My supervisor also thought that the confusion was due to the UTI and therefore should pass, another reason why she didn't want to risk him getting upset, and why she didn't think it was necessary to do a MMSE, but will if he continues like this.
I personally think my subjective Ax is getting much better as my questions are more grouped together and not so jumbled with different topics, and they ran well, even though i did them on some difficult patients. In that situation I think I would tried to get him to understand where he was, as he seemed a little distressed in the environment, as he thought his house had been changed.
On monday Jesse and I were together with my supervisor, this was good as we both got to see how much we had learnt. Jesse's supervisor had also taught him to do vibes, so today my supervisor taught me how to do them which was really great!
I got to see more patients by myself on monday, which helps build my confidence as my supervisor believes that i can do it. I mainly just ran through the exercises I had previously given patients and ambulated them, which i found i did well. Most of my patients are making good recoveries, with 3 to be discharged over the next couple of days.
On monday I also got to run through a 6mwt with jesse and my supervisor stood by and watched. This was really helpful as it allowed me to practice incase we get this in the gero prac!!
Today I also completed 2 subjective and objective Ax of patients. This was interesting, as both these patients were what i would consider difficult patients.
One of the patients was very confused, and we think it was because of his UTI. He was okay to perform a subjective Ax on him, but he did say things that were a bit weird. So my supervisor asked me to call his next of kin just to get an accurate history. I found this very daunting, but thankfully the next of kin was very helpful and i was able to saught a few things out. Usually i'm really bad on the phone, but thought i stepped up to the ocassion! The pt was okay to perform an objective Ax on, but when Ax his ambulation, he was very confused, thinking his relatives had redone the house and put all these beds in, thinkin the hosiptal was his house. My supervisor just kept agreeing with him rarely stating theres your bed in the hospital with emphasis on hospital, but didn't persist with trying to correct him to where he was, which i found was weird but i discussed it with her after. She said she sometimes just mostly agrees with the patient if she thinks they can become agitated, distressed or very angry if you're disagreeing with what their brain is telling them is right. Interesting, think i will have to get better at ready people to make the right decision in that situation! My supervisor also thought that the confusion was due to the UTI and therefore should pass, another reason why she didn't want to risk him getting upset, and why she didn't think it was necessary to do a MMSE, but will if he continues like this.
I personally think my subjective Ax is getting much better as my questions are more grouped together and not so jumbled with different topics, and they ran well, even though i did them on some difficult patients. In that situation I think I would tried to get him to understand where he was, as he seemed a little distressed in the environment, as he thought his house had been changed.
Friday, October 17, 2008
First week of prac
Wow! first week of prac is already over! 4 more to go.
I really enjoyed my first week at Hollywood. I really like my suprvisor which is a bonus and im doing a lot of interesting stuff!
I'm leanring so much more about respiratory, so I'll have one up on you guys for next semester!
My supervisor taught me how to do percussion and i got to do that on some patients which is good. I'm still getting used to it, but the more i'm doing it the less my wrists hurt from afterwards, I'll get the technique right one day!
We found out today that they are not sending my stroke patient to rehab which is a bummer! But the hostel said that they have a spare high care bed that they are saving for her, which is good, so all we need is a new ACAT to say she is appropriate for it and then she can go there, where they have a PT 3 days a week and a PTA 5 days a week that can treat her.
I'm getting quite an exercise on the respiraotry ward as we try to walk all our patients, which means i spend most of my day going up and down the ward corridor with the pateints. Its 56m so i end up walking over a kilometer just going up and down the corridor.
Its also interesting to see how a hospital works behind the scenes! I swear, all the nurses at hollywood are british, scotish, or irish. They all have accents! They are so friendly too!
A funny thing happened today. My supervisor decided we were going to walk a patient, so she went out of the room to get portable oxygen and a oxymeter, and i stayed there and got her WZF and her hudson mask organised for her to walk. Anyway i hadn't said a word to her because she was trying to catch her breathe from when she sat up, and i was by the oxygen flow meter at the wall attaching the hudson mask when here my pt say "She's a bosy one this one." I didn't know who she walks talking to or about so i turn around and shes pointing at me and saying it as my supervisor is walking through the door!! So i said "I wasn't even talking to you Mrs X" so that i let my supervisor know i haven't been abusing the pts when shes out of the room, and my supervisor starts laughing.
Anyway, my point is my pt thinks I'm the devil, but thankfully my supervisor has had Mrs X call her mean things when she hasn't done anything, so she doesn't think I'm a bad student.
After this all happened one of the cleaning/ meals ladies called us physioterrorits, so today was me and my supervisor being slandered by everyone!!!
I really enjoyed my first week at Hollywood. I really like my suprvisor which is a bonus and im doing a lot of interesting stuff!
I'm leanring so much more about respiratory, so I'll have one up on you guys for next semester!
My supervisor taught me how to do percussion and i got to do that on some patients which is good. I'm still getting used to it, but the more i'm doing it the less my wrists hurt from afterwards, I'll get the technique right one day!
We found out today that they are not sending my stroke patient to rehab which is a bummer! But the hostel said that they have a spare high care bed that they are saving for her, which is good, so all we need is a new ACAT to say she is appropriate for it and then she can go there, where they have a PT 3 days a week and a PTA 5 days a week that can treat her.
I'm getting quite an exercise on the respiraotry ward as we try to walk all our patients, which means i spend most of my day going up and down the ward corridor with the pateints. Its 56m so i end up walking over a kilometer just going up and down the corridor.
Its also interesting to see how a hospital works behind the scenes! I swear, all the nurses at hollywood are british, scotish, or irish. They all have accents! They are so friendly too!
A funny thing happened today. My supervisor decided we were going to walk a patient, so she went out of the room to get portable oxygen and a oxymeter, and i stayed there and got her WZF and her hudson mask organised for her to walk. Anyway i hadn't said a word to her because she was trying to catch her breathe from when she sat up, and i was by the oxygen flow meter at the wall attaching the hudson mask when here my pt say "She's a bosy one this one." I didn't know who she walks talking to or about so i turn around and shes pointing at me and saying it as my supervisor is walking through the door!! So i said "I wasn't even talking to you Mrs X" so that i let my supervisor know i haven't been abusing the pts when shes out of the room, and my supervisor starts laughing.
Anyway, my point is my pt thinks I'm the devil, but thankfully my supervisor has had Mrs X call her mean things when she hasn't done anything, so she doesn't think I'm a bad student.
After this all happened one of the cleaning/ meals ladies called us physioterrorits, so today was me and my supervisor being slandered by everyone!!!
Tuesday, October 14, 2008
Thoughts and Queries
I was on the stroke ward today(thursday) and i never really thought much about nero physio but i found today to be so rewarding!!
It was amazing to see the recovery and the happiness on the patient's face when they are able to move their affected arm or leg.
Sometimes it's not always to command and may just be a reflexive action, but when you ask them to squeeze your hand and they actually do, their face lights up, especially the ones with communication problems from their stroke.
Sometimes it's not always to command and may just be a reflexive action, but when you ask them to squeeze your hand and they actually do, their face lights up, especially the ones with communication problems from their stroke.
I have one patient that is making such an amazing recovery as my supervisor informed me last week she wasn't moving her at all, but the doctors don't want to send her to rehab! It's quite frustrating as she came from a hostel, and she has the capacity to recover to the ability requirements of a hostel if put in rehab, but they just want to send her to a nursing home, where she will become social isolated as she won't get the PT, OT and speech pathology she needs!
My supervisor has a team meeting with her doctor, so hopefully she can persuade them to reconsider her for a t/f to rehab!
I was also asked to start seeing patients by myself yesterday, which is exciting. I went on computer and made up exercise programs for my patients. The program i used was called Exercise Pro, it's seriously cool!! You just click the boxes on different body areas, the type of movement (AROM, resisted, isometric) then the direcion of movement and if you went to use any devices like weights, and it searches them for you and brings up pictures with instructions which you can edit to make it pt specific. Its an amazing program!
First days of prac!
Thank god my first day is over! I was really nervous but now i'm really excited!
My supervisor is really nice and she is teaching me so much stuff, and allowing me to do a lot to! I'm based on 3 wards, a stroke ward, a cancer ward and a respiratory ward which is where i spend most of the time. My patients are all older people which is good so that i can put my gerontolgy skills to work, considering the exam was the hardest!
Already on the respiratory ward one of the patients we were seeing has passed away which was a bit of a shock considering she was alert and talking to us on monday.
I've got to put a lot of my knowledge to work. I've made bubble PEPs and taught patients how to use them, auscultated a few patients which is good considering I haven't heard a disease lung before! I've also been able to do a couple of 6mwt which is good to practice.
I've written quick SOIERs in patients files which is good considering i'm not ver good at them so it's good practice.
Tomorrow i'll be using the computer to make an exercise program for a lady with COPD, so hopefully i choose appropriate exercises!
Hope everyone's placement is going well and they are liking it!!
My supervisor is really nice and she is teaching me so much stuff, and allowing me to do a lot to! I'm based on 3 wards, a stroke ward, a cancer ward and a respiratory ward which is where i spend most of the time. My patients are all older people which is good so that i can put my gerontolgy skills to work, considering the exam was the hardest!
Already on the respiratory ward one of the patients we were seeing has passed away which was a bit of a shock considering she was alert and talking to us on monday.
I've got to put a lot of my knowledge to work. I've made bubble PEPs and taught patients how to use them, auscultated a few patients which is good considering I haven't heard a disease lung before! I've also been able to do a couple of 6mwt which is good to practice.
I've written quick SOIERs in patients files which is good considering i'm not ver good at them so it's good practice.
Tomorrow i'll be using the computer to make an exercise program for a lady with COPD, so hopefully i choose appropriate exercises!
Hope everyone's placement is going well and they are liking it!!
Sunday, October 12, 2008
Pre- prac
I'm really quite nervous!! I'm not sure what to expect, but i have a feeling i'll be doing a lot of chest physio and getting patients up out of bed for the first time. This kind of scares me as i really don't know what Hb level or BP you don't get a patient up at. I'm so glad that i'll have Dixon there with me!
Come to think of it I dont even know where to show up on the first day, I'll have to go check that out now!
I hope the first day is just getting showed around so we can get our ground!
Hope its good!
Good luck to everyone else!
Come to think of it I dont even know where to show up on the first day, I'll have to go check that out now!
I hope the first day is just getting showed around so we can get our ground!
Hope its good!
Good luck to everyone else!
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