FIRST ENTRY- WEEK1

S-my collegues and i were assigned a 72 y.o. F, with a diagnosis of infected glands, dec. blood pressure ,ARF ( acutre renal failure), a R CVA 3 y. ago and a series of recent falls around the house. She presented with very swollen odetimus LL, the L knee bruised and even more swollen than the R ( this was due to a recent fall). She had a considerable reduction in all ROM of her LL and subsequent reduction in her balnce due to the swelling.
T- We decided to adress the, swollen limbs as she has dec. ROM in her LL and hence her balance was also very poor.
A- As a result we used , lymph massage, elevation icing and compression with tubigrip.
R- the result was terrible!. The tubigrip had pushed the swelling right up into her thighs, and although the compression bandage had retuned the shins back to a normal size, it had just directed the swelling into a higher another area, NOT the result we were hoping for.
E - Our supervising physiotherapist informed us that this was the wrong course of action as we as physio's cannot deal with this particular ladys swelling, as the CAUSE of the swelling could have been a number of things and it is best to leave this to the doctors field. She advised that we were better to look at strengthening type activities.
S-I have learnt that in a hospital situation you are faced with a patient who may have many problems going on at the same time, and as a physiotherapist you can only Rx those problems which relate to your field.
I have learnt that swelling in the LL can be attributed to heart failure, (AF or any pacemakers, as we have not completed our cardiorespiratory unit; we were not informed of this) , or ARF, incorrectly we assumed the oedema in the LL were attributed to an accumulation of lymph fluid.
Instead of following this form of Rx with this leady we decided to instead that adressing the following problems would be a better course of action:
Firstly treating the swelling in her L Knee that was actually created by the fall she had, using iceing every 20 min and elevation,
Secondly implementing a strengthenin programme, including exercises toadress weakness in her quadriceps and her glut. med
Thirdly looking at her transfers, teaching her new ways of transfering from chair- chair.
Lastly looking at her balance and implementing dynamic balance exercises. Also giving falls awareness and education.

Placement 2-Hollywood Hospital-Initial Entry

I have been placed in the Gerentology/Neurology section for Hollywood Hospital.
I'am excitied about experiencing a different section of physiotherapy, and being activley involved in the assessment and treatment process. I do enjoy working with older people so im glad that i will get the opportunity to deal with some of the elderly and hopefully help them with their problems. I'll be there 5 days a week from 8 in the morning till 4 in the afternoon, i think i could be a bit exhausted after the first week!.
However, I am a bit worried about being thrown in the deep end, i have been told some students are given their first patients day one and simply told to ""go ahead and treat them"". I'am hoping to eventually get my own patients but i would like a bit of direction to begin with.
I'am slightly apprehensive about going on this placement, as i havent had any physiotherapy experience in a hospital setting before. My last placement was in a private practice, and was a musculoskeletal placement, wich i feel is a bit more straight forward than a neurology placement.
I don't think Neurology is my strongest section of phsyiotherapy, however I'm determined to give it my best shot.
Tonight could be a late night, doing some last minuite study of Alisons' Nero tutorials!!.