WEEK 1- FIRST ENTRY

Situation
On the third day of my placement ( 24/03/2010) my supervisor asked me to treat a 54 year old lady. This woman was 1 day post-operation from a laprascopy (a operation involving a large incision to the abdomen) that was performed to remove half of her colon (hemicolectomy) . Her past medical history included hypertension, hypercholesterolemia, and type 2 diabetes melinitus, she was also very obese.
This lady had only recently immigrated to Australia 2 years ago and she was of Polish decent. She could not speak English very well and her understanding of the language was very limited as well. This lady lived alone but was regularly visited by both her sons.

Task
My task was to treat this lady. This woman did not actually have any current problems with her chest, but I was treating her as more of a preventative measure to stop her contracting any post-operative complications such as chest infections or circulatory problems. I needed to asses her lungs and then treat any problems I saw.

Action
Firstly I assessed this lady. I auscultated her lungs and heard some crackling in both the lungs bi-basally. This could have indicated microatelactisis, which is very common after a long anaesthetic. I felt her chest expansion, which was good both sides and listened to her cough, which was weak, dry, non-productive and ineffective. I needed to improve her cough and possibly reverse her microatelactisis.
As a treatment I got her to take some deep breaths with an inspiratory hold at the end of them. I also showed her how to perform a supported cough (with a rolled up towel pressed against her incision site) to protect her incision site on her abdomen. As she was not feeling well enough to get out of bed I positioned her in high sitting in the bed and them attempted to educate her about the procedure, how important it was for her to keep taking deep breaths and that if she needed to cough up any mucous or flem she must attempt to cough while supporting her incision site.

Result
This woman then had post operative exercises that would help in preventing any lung or circularity problems that are sometimes associated with people who have operations that involve incisions on their abdomen and consequently long anasthetics.

Evaluation
I don’t think the treatment session was that successful. I did have some strengths with the treatment, they were:
1) I targeted the negative effects of anaesthetic on this woman’s lungs and I did prescribe her the appropriate exercises for preventing post operative complications to her lungs and circulation.
But I think I had a few more weaknesses, they were:
1) The fact that there was a lot of miscommunication occurring during the assessment and treatment session. I found it difficult to inform this lady that I was trying to prevent her from getting a chest infection. At one stage she thought she already had a chest infection and was getting quiet upset about it all.
2) I think I should have got this lady sitting on the edge of the bed, which would use more of her own muscle strength instead of letting her just sit up in bed. Sitting her out of bed would have been more beneficial in her rehabilitation from her operation (on the muscles of her abdomen).
3) I think I should have given her more exercises to target her circulation.

Strategies
My supervisor and I worked out a couple of strategies to help with communication when I come across this type of patient again:
1) Using simple short/direct words for a patient with a language barrier as well as trying to avoid complicated or long sentences. In this particular case instead of going through the whole spiel about post operative complications I should have told her the main points in a simplified way.
2) Drawing or writing down the exercises I give her so as to make sure she understands what I want her to do.
3) Using physical demonstrations to aid in teaching exercises
4) Getting the patient to repeat what you have asked them to do. I should say phrases like “So what are you going to do every hour?”. Their answer to this question would assure me of their understanding of the exercises that I have prescribed them to do.
5) Lastly get an interpreter to help out with communication.