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.