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