I found this placement quiet challenging. I did enjoy the cardio-respiratory side to this placement, and I found that the practical side of cardio-respiratory is very similar to the theoretical side that we learn in university.
I found I became very exhausted over this placement, I found I got very little sleep trying to get too and from Fremantle Hospital in peak hour traffic and then coming home in the same traffic, I was spending over 2 hours a day driving. I did have my own caseload in this placement on some days, other days I would work with a partner, this was advantageous because; with some patients who had a number of “attachments” it was essential to have a second pair of hands.
I ended up working in the surgical ward for over 3 weeks and then I was able to work on the general medical ward for the last 2 weeks. This was really good because I was able to see a range of different chest presentations. I got to treat patients who were at the end stage COPD, and others with chronic bronchitis on the general medical ward, but on the surgical ward I was able to get exposure to all the chest complications that can be resultant from surgery and in addition to that all the attachments a patient can have . I entered ICU about 3 times during my placement. It was great to be able to have that exposure, because the runnings of ICU differed greatly from the running’s over the whole hospital.
I got to see one pulmonary rehabilitation class at the end of my placement. It was good to get exposure to this class, I wasn’t asked to run the class but it was good to observe how they conducted the session.
I think I learnt a lot about subjective questioning in this placement, I think I improved my auscultation skills greatly as well as my reading of chest X-rays, I learnt how to refine my communication skills with patients and how to articulate myself more precisely.
Sunday, April 25, 2010
WEEK 5-ENTRY 3
Situation
In the fifth week of my placement I was asked to give chest care advice to a 66 year old man who was 1 day post-op for a laparotomy ( upper abdominal surgery) to remove a section of his bowel that was cancerous . This man had a past medical history of type 2 diabetes melinitus, hypertension, peripheral vascular disease and a MI (2008). He lives with his wife, they have no stairs in their home and they receive no services. This man usually ambulates unaided and can walk up to 1 kilometre without needing a rest. This man was resting in bed but was in a lot of pain, scoring 7/10 at rest.
Task
I was asked to go treat this man who had undergone a laparotomy 1 day ago.
Action
I performed a subjective interview with this man and I found out a lot of the information mentioned above, I also found out that he was in a lot of pain. I then performed a objective examination and found his problem list to be 1) pain 2) decreased lung volumes 3) impaired gass exchange 4 ) reduced exercise tolerance.
I then tried to address his problems;
Intervention
This is what I did with this man:
- Taught supported cough with a rolled up towel.
- Educated him on sitting upright in bed.
- Active cycle of breathing techniques x 3 repetitions ( 5x thoracic expansion exercises)
- Gave him circulation exercises for his lower limbs (x 10 rep)
- Gave him post-operation chest education.
Result
I gave this man an effective way to clear his chest (by coughing) without increasing his levels of pain in his abdomen. And I optimised his lung function through positioning and deep breathing exercises, I also educated him on the effects of surgery on the chest.
Evaluation
I think the session went pretty averagely. I ended up saying all that I needed to tell the patient about his chest care; however I think there were a lot of improvements I could have made to the session.
The strengths in the session were; that I related well to the patient. I gave the patient all the appropriate advice they needed for correct physiotherapy chest care and he performed his exercises well under my direction.
However, there were a few weaknesses with my session as well, the structure of my advice was a bit haphazard, it needed to be more organised. At one point my patient became confused, and I needed to clarify a few of the things I was saying.
Another weakness that my supervisor pointed out; was the fact that I got a patient to do a activity and then explained the benefits after they did it, my supervisor said that it would be better to explain the benefits of something before you get a patient to perform the task. Lastly I should have made sure my patient had adequate pain relief ( checked if the nurse could give him some more pain relief) before talking to him, as his extremely high levels of pain could have affected his understanding of what I was explaining to him.
Strategies
I thought up a few good strategies that would help me when I have to perform post operational education on patients
- don’t use jargon, or medical terminology when explaining things to patients
- have a well thought out ‘post-operation’ spiel to tell patients who have undergone abdominal surgery, so they know the risks associated with surgery and the implications it has on the chest.
- Tell the patients the benefits of doing an exercise/treatment before actually getting them to perform it, as this well increase their motivation to perform a treatment and they will know the purpose of the treatment.
- Ask the patient if they have understood what your explaining to them
- Ask the patient if they have anymore questions associated with your treatment.
In the fifth week of my placement I was asked to give chest care advice to a 66 year old man who was 1 day post-op for a laparotomy ( upper abdominal surgery) to remove a section of his bowel that was cancerous . This man had a past medical history of type 2 diabetes melinitus, hypertension, peripheral vascular disease and a MI (2008). He lives with his wife, they have no stairs in their home and they receive no services. This man usually ambulates unaided and can walk up to 1 kilometre without needing a rest. This man was resting in bed but was in a lot of pain, scoring 7/10 at rest.
Task
I was asked to go treat this man who had undergone a laparotomy 1 day ago.
Action
I performed a subjective interview with this man and I found out a lot of the information mentioned above, I also found out that he was in a lot of pain. I then performed a objective examination and found his problem list to be 1) pain 2) decreased lung volumes 3) impaired gass exchange 4 ) reduced exercise tolerance.
I then tried to address his problems;
Intervention
This is what I did with this man:
- Taught supported cough with a rolled up towel.
- Educated him on sitting upright in bed.
- Active cycle of breathing techniques x 3 repetitions ( 5x thoracic expansion exercises)
- Gave him circulation exercises for his lower limbs (x 10 rep)
- Gave him post-operation chest education.
Result
I gave this man an effective way to clear his chest (by coughing) without increasing his levels of pain in his abdomen. And I optimised his lung function through positioning and deep breathing exercises, I also educated him on the effects of surgery on the chest.
Evaluation
I think the session went pretty averagely. I ended up saying all that I needed to tell the patient about his chest care; however I think there were a lot of improvements I could have made to the session.
The strengths in the session were; that I related well to the patient. I gave the patient all the appropriate advice they needed for correct physiotherapy chest care and he performed his exercises well under my direction.
However, there were a few weaknesses with my session as well, the structure of my advice was a bit haphazard, it needed to be more organised. At one point my patient became confused, and I needed to clarify a few of the things I was saying.
Another weakness that my supervisor pointed out; was the fact that I got a patient to do a activity and then explained the benefits after they did it, my supervisor said that it would be better to explain the benefits of something before you get a patient to perform the task. Lastly I should have made sure my patient had adequate pain relief ( checked if the nurse could give him some more pain relief) before talking to him, as his extremely high levels of pain could have affected his understanding of what I was explaining to him.
Strategies
I thought up a few good strategies that would help me when I have to perform post operational education on patients
- don’t use jargon, or medical terminology when explaining things to patients
- have a well thought out ‘post-operation’ spiel to tell patients who have undergone abdominal surgery, so they know the risks associated with surgery and the implications it has on the chest.
- Tell the patients the benefits of doing an exercise/treatment before actually getting them to perform it, as this well increase their motivation to perform a treatment and they will know the purpose of the treatment.
- Ask the patient if they have understood what your explaining to them
- Ask the patient if they have anymore questions associated with your treatment.
Sunday, April 11, 2010
WEEK 3
Situation
In the third week of my placement I was asked by my supervisor to assess and treat a 75 year old man, who had been taken in to Fremantle emergency department via ambulance.
The man had come in with respiratory arrest; he had had increased shortness of breath over the last two weeks and had gone to see a general practitioner three days ago. The man had a past medical history of ‘asthma’ (which was likely to be undiagnosed COPD) , high cholesterol, hypertension, peripheral vascular disease and a laperotomy in 2007 for a bowel obstruction. He was also very obese. This man also had a 40 year smoking history.
The gentleman lived alone and had no services helping him out, he used to walk approximately 500m in a day, without the help of any aids.
This man was admitted to Fremantle hospital on the 06/04/10 and I was asked to assess and treat him on the 07/04/10.
Task
I was asked to assess and treat this patient, trying to help with his respiratory problems, so he could return home to his previous level of function.
Action
I asked this patient a few questions regarding his shortness of breath, his flem production, dizziness and nausea, his pain levels and his home environment. I then performed an objective assessment, listening to his lungs with a stethoscope, listening to his cough, and feeling his chest expansion.
I then treated this patient. I gave his positions to ease his shortness of breath. I gave him techniques to clear flem/sputum from his lungs and I educated him about staying upright etc. I also gave him exercises to do hourly.
Result
The treatment session went well, the patient improved his shortness of breath and he also cleared out a fair bit of sputum/flem, the objective assessment also went well. However the subjective assessment didn’t go too well, it took along time and I had to keep rewording my questions so the patient understood.
Evaluation
I thought the session had both strengths and weaknesses in it. I thought my strengths were: 1) the treatment session addressed the patient’s main problems 2) I built a rapport very easily with the patient 3) I kept the session to a 30 minute time frame.
I thought I had some weaknesses in my session as well, I think my subjective assessment went poorly. I think I got nervous while asking the patient questions. I forgot to ask some pertinent questions and didn’t ask enough detail in other questions. In addition I wasn’t clear with some of my questions and I found I had to clarify a couple of times what I was asking the patient.
Strategies
I came up with a number of strategies to help improve my subjective assessment questioning. They were:
1) slow done, and take time asking questions
2) Use a notebook with questions written on it to help jog my memory so I don’t forget some pertinent questions when doing a subjective assessment.
3) Keep a neutral tone when talking to patients ( make sure it doesn’t sound condescending etc.)
4) Speak in a loud voice to make sure I am heard clearly and accurately. 5) Plan out what I want to ask a patient before entering the room so I know what questions are relevant to this patient before I even begin the subjective assessment
In the third week of my placement I was asked by my supervisor to assess and treat a 75 year old man, who had been taken in to Fremantle emergency department via ambulance.
The man had come in with respiratory arrest; he had had increased shortness of breath over the last two weeks and had gone to see a general practitioner three days ago. The man had a past medical history of ‘asthma’ (which was likely to be undiagnosed COPD) , high cholesterol, hypertension, peripheral vascular disease and a laperotomy in 2007 for a bowel obstruction. He was also very obese. This man also had a 40 year smoking history.
The gentleman lived alone and had no services helping him out, he used to walk approximately 500m in a day, without the help of any aids.
This man was admitted to Fremantle hospital on the 06/04/10 and I was asked to assess and treat him on the 07/04/10.
Task
I was asked to assess and treat this patient, trying to help with his respiratory problems, so he could return home to his previous level of function.
Action
I asked this patient a few questions regarding his shortness of breath, his flem production, dizziness and nausea, his pain levels and his home environment. I then performed an objective assessment, listening to his lungs with a stethoscope, listening to his cough, and feeling his chest expansion.
I then treated this patient. I gave his positions to ease his shortness of breath. I gave him techniques to clear flem/sputum from his lungs and I educated him about staying upright etc. I also gave him exercises to do hourly.
Result
The treatment session went well, the patient improved his shortness of breath and he also cleared out a fair bit of sputum/flem, the objective assessment also went well. However the subjective assessment didn’t go too well, it took along time and I had to keep rewording my questions so the patient understood.
Evaluation
I thought the session had both strengths and weaknesses in it. I thought my strengths were: 1) the treatment session addressed the patient’s main problems 2) I built a rapport very easily with the patient 3) I kept the session to a 30 minute time frame.
I thought I had some weaknesses in my session as well, I think my subjective assessment went poorly. I think I got nervous while asking the patient questions. I forgot to ask some pertinent questions and didn’t ask enough detail in other questions. In addition I wasn’t clear with some of my questions and I found I had to clarify a couple of times what I was asking the patient.
Strategies
I came up with a number of strategies to help improve my subjective assessment questioning. They were:
1) slow done, and take time asking questions
2) Use a notebook with questions written on it to help jog my memory so I don’t forget some pertinent questions when doing a subjective assessment.
3) Keep a neutral tone when talking to patients ( make sure it doesn’t sound condescending etc.)
4) Speak in a loud voice to make sure I am heard clearly and accurately. 5) Plan out what I want to ask a patient before entering the room so I know what questions are relevant to this patient before I even begin the subjective assessment
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