I really really enjoyed this placement!.
In my initial entry i was really worried and stressed about the responsibility of having my own patients, however this was a really big learning experience for me, we wern't just thrown into the deep end but they slowley eased us into having our own patients.
I also said in the initial entry that i was apprehensive about this being a neuro placement. Although we did see some neuro patients, we were always accompanied with a supervisor, so this wasn't as stressfull as i thought it would be. All my single patients were gerentology based.
I found each day i went to this placement i learnt so many new things. we contributed to team meatings, we discharged patients, we referred patients on. We saw a complete variety of patients aswell ranging from THR, to occipital strokes, temporal strokes, COPD patients, neurological compramise patients... the list was really broad. At times i was really stressed about my case load and often left late however i felt as though i was learning so much. i liked this placement alot better than my last!.
Monday, August 31, 2009
THIRD ENTRY- WEEK 5
S-i was asked to Ax and Rx a83 y.o F patient who had come in with a broken femur fixed with a femoral nail 2 weeks ago. She had a past medical history of parkinsons disease and hypertension. She had broken her hip when she fell over at a resturant.
T- my supervisor asked me to continue on with the Ax and Rx.
A-I began assessing her with the subjective questions and then the objective movements, i was however very wary about her ORIF , and restricted some of the Ax and Rx movements as i didn't want my patient to dislocate.
R-as a result i didn't get my patient to complete all the exercises necessary for hip rehabilitation.
E- i dont think this session went well with the patient. However she was very gracefull and next time i saw her i made amendments, ajusting her Rx programme and her exercises.
S-I think next time i am faced with a patient who has had replacement surgury or an ORIF put in i will read up on my orthopedics restrictions and be clear about what surgury requires restrictions. i learnt very quickly that ORIFS do not have any restrictions on them!. My supervisor mentioned that i need to take into consideration her other problems as well, in this case it was parkinsons disease. If her PD wasn't being effectivley managed with medication, then this could be the reason she is having the falls.
S-
T- my supervisor asked me to continue on with the Ax and Rx.
A-I began assessing her with the subjective questions and then the objective movements, i was however very wary about her ORIF , and restricted some of the Ax and Rx movements as i didn't want my patient to dislocate.
R-as a result i didn't get my patient to complete all the exercises necessary for hip rehabilitation.
E- i dont think this session went well with the patient. However she was very gracefull and next time i saw her i made amendments, ajusting her Rx programme and her exercises.
S-I think next time i am faced with a patient who has had replacement surgury or an ORIF put in i will read up on my orthopedics restrictions and be clear about what surgury requires restrictions. i learnt very quickly that ORIFS do not have any restrictions on them!. My supervisor mentioned that i need to take into consideration her other problems as well, in this case it was parkinsons disease. If her PD wasn't being effectivley managed with medication, then this could be the reason she is having the falls.
S-
Monday, August 24, 2009
SECOND ENTRY- WEEK 3
S- On placement, I was assigned one particular patient that had had a TKR. He was 84 y.o and had severe dementia. At times he appeared agitated and aggressive. Previous to admission this patient was independent in his ADL’s and living alone. He had the operation 2/52 ago and was admitted to the rehabilitation unit I was working in because he didn’t achieve the required degrees of knee flexion in order to be discharged.
T- I assessed this patient and begun treating him. He had approximately 52 degress of knee flexion, the hospital required at least 70 degrees of knee flexion for discharge. I knew from the orthopaedic handover that this patient was very distressed about using a pulley system to encourage knee flexion, and had the potential to get abusive.
A- I began increasing his knee flexion using Active Assisted movements. I used a sideboard with a towel under it so he could control the amount of knee flexion that was occurring himself. I then attached him to a CPM machine in the time he wasn’t at physio. I avoided completely the use of the pulley system. He seemed to like the systems I was using, however when the CPM machine pushed him a bit too far he called me some abusive names!.
R- the result wasn’t the best ;I did end up increasing his knee flexion to 59 degrees, however over the weekend my patient discharged himself. I suspect my patient would have had to have a MUA, because his knee would no longer be functional with the amount of knee flexion he had.
E-I though my methods of dealing with this patient were good considering his mental state. I think I have learnt from this situation that you have to be able to tailor your treatment to your patient and their needs. I would have loved to use all the pulleys and active assisted towel exercises for a patient with such poor knee flexion ROM however, his lack of understanding and mental state prevented me from allowing these treatments.
S-Maybe next time I should focus a lot more of my treatment time on education for the patient so they have a greater understanding of how the treatment can help their condition. Maybe next time I would try to get the family or loved ones to reason with a patient who had such a poor mental state. This could have prevented the patient from discharging himself.
T- I assessed this patient and begun treating him. He had approximately 52 degress of knee flexion, the hospital required at least 70 degrees of knee flexion for discharge. I knew from the orthopaedic handover that this patient was very distressed about using a pulley system to encourage knee flexion, and had the potential to get abusive.
A- I began increasing his knee flexion using Active Assisted movements. I used a sideboard with a towel under it so he could control the amount of knee flexion that was occurring himself. I then attached him to a CPM machine in the time he wasn’t at physio. I avoided completely the use of the pulley system. He seemed to like the systems I was using, however when the CPM machine pushed him a bit too far he called me some abusive names!.
R- the result wasn’t the best ;I did end up increasing his knee flexion to 59 degrees, however over the weekend my patient discharged himself. I suspect my patient would have had to have a MUA, because his knee would no longer be functional with the amount of knee flexion he had.
E-I though my methods of dealing with this patient were good considering his mental state. I think I have learnt from this situation that you have to be able to tailor your treatment to your patient and their needs. I would have loved to use all the pulleys and active assisted towel exercises for a patient with such poor knee flexion ROM however, his lack of understanding and mental state prevented me from allowing these treatments.
S-Maybe next time I should focus a lot more of my treatment time on education for the patient so they have a greater understanding of how the treatment can help their condition. Maybe next time I would try to get the family or loved ones to reason with a patient who had such a poor mental state. This could have prevented the patient from discharging himself.
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