I really enjoyed my placement at Sir Charles Gardiner Hospital (SCGH). I felt as though i really got extra experience in my cardiorespiratory skills.
It took me about an hour and a half to get to Sir Charles Gardiner in the morning as the traffic was terrible. The parking was bad aswell so i used to park about a 20 minuite walk away from the hospital and walk from there.
Because i was on the oncology ward i saw patients with end stage cancers. I saw all different types of cancer (oncology and haemotology) and patients with chest infections, respiratory distress , pneumonias and acute exaccerbations of COPD. I got to suction and i performed three induced sputums.
Most of my patients were older in age but i occasionally saw a younger patient as well. It was difficult to not get emotionally involved with the younger patients.
Aside from this i did see 3 surgical patients on my placement, this was fantastic to get experience in this area.
It was very interesting to learn about the effects of chemotherapy on a patients blood counts and therefore the limitations of what physiotherapy can provide as an intervention. I found somtimes my intervention was extreamly limited to very basic treatments.
I dealt with issues that I hadn't had to deal with in other placements. I dealt with the issue of death. About 5 of my paitents died while I was on placment. I found this very hard to deal with and somtiems questioned whether the intervention I gave could have been more effective and in that way prevented their death. However, my supervisor reassured me that I was providing the correct effective treatment and that most of these people were at the end stage of their disease.
I also dealt with the aspect of pallitive care on this placement. I found that when sometimes people recieve pallative care they wish for no more active treatment. This meant that if this person was to get a chest infection they would recieve no more active intervention ( including physiotherapy). Again this was dificutl to deal with as ethically I felt compelled to help them out.
I learnt so much under my supervisor and although this was sometimes a sad placment, I found the experience very rewarding and challenging.
Friday, October 8, 2010
Saturday, October 2, 2010
POST 1- SCGH
Situation
I have been placed on the oncology ward at Sir Charles Gardiner Hospital (SCGH).
On the 1st week of my placement I was asked to assess and treat a patient on a different ward than the one I had been assigned to.
This particular patient was a 66 year old man who was admitted to SCGH with diarrhoea and vomiting. It was later found he had a small bowel obstruction and a laparotomy was performed with a pancolectomy (he also had a small stoma and collection bag).
This patient had a few complications after his surgery which resulted in an infection, and he was currently being treated with IV antibiotics.
This man had a past medical history of GORD, diverticulitis, HTN and high cholesterol. He lived at home alone but has a very supportive son who lives in Margret River. He usually ambulated with no aids, and he had no services put in place at home.
This man was obese, and very anxious, his son had revealed to me that this patient became depressed easily and he had attempted to commit suicide on 3 different accounts.
This man was now 6 days post-laparotomy and due to his anxiety levels, fear of falling, infection status and pain management issues he was yet to be mobilised.
Task
I was asked to assess this mans chest and ambulate him.
Action
I went in to the patients room, performed a brief subjective assessment (as the patient seemed to be getting more anxious with each question I asked), and then got him from a supine position to sitting on the edge of the bed. I then assessed his chest and got him to get up and walk with a wheeled zimmer frame. I asked him to walk to a chair I had previously placed in the hallway approximately 15 meters away from his room.
Result
I ended up walking this patient to the chair 15 meters outside his room. I also assessed his chest and gave him some breathing exercises to help reduce his risk of a chest infection and help him re-expand his lungs. In addition I also gave him some advice to continue with the ambulation we started (with a nurse present) and continue with the breathing exercises I gave him every couple of hours.
Evaluation
I think there were some strengths in my session. I did effectively mobilise this patient, and in addition I did make him feel more secure (as he was afraid of falling) while mobilising by giving him a wheeled Zimmer frame to walk with. I also had a nurse follow with a commode behind us to make him feel even more safe.
However there were some areas where I believe I could have improved in. I don’t think I used very good manual handling skills. I felt myself straining as I helped my patient move from a supine position to sitting on the edge of the bed.
In addition to this I think for this particular patient who was very anxious I could have made my instructions more clear and direct. I felt him get a bit frustrated during the session with what I was asking him to do.
Strategies
I worked out some manual handling strategies that would help jog my memory when dealing with transferring patients.
1) Keep the load close to your body.
2) Use large muscle groups and your bodyweight to counteract the patients bodyweight
3) Use momentum to aid you when transporting large loads
I worked out some key points to remember wen mobilising very anxious patients
1) Keep instructions plain, clear and concise
2) Break up the task into steps and tell them exactly what you wish them to do.
3) Set a realistic goal that they achieve.
I have been placed on the oncology ward at Sir Charles Gardiner Hospital (SCGH).
On the 1st week of my placement I was asked to assess and treat a patient on a different ward than the one I had been assigned to.
This particular patient was a 66 year old man who was admitted to SCGH with diarrhoea and vomiting. It was later found he had a small bowel obstruction and a laparotomy was performed with a pancolectomy (he also had a small stoma and collection bag).
This patient had a few complications after his surgery which resulted in an infection, and he was currently being treated with IV antibiotics.
This man had a past medical history of GORD, diverticulitis, HTN and high cholesterol. He lived at home alone but has a very supportive son who lives in Margret River. He usually ambulated with no aids, and he had no services put in place at home.
This man was obese, and very anxious, his son had revealed to me that this patient became depressed easily and he had attempted to commit suicide on 3 different accounts.
This man was now 6 days post-laparotomy and due to his anxiety levels, fear of falling, infection status and pain management issues he was yet to be mobilised.
Task
I was asked to assess this mans chest and ambulate him.
Action
I went in to the patients room, performed a brief subjective assessment (as the patient seemed to be getting more anxious with each question I asked), and then got him from a supine position to sitting on the edge of the bed. I then assessed his chest and got him to get up and walk with a wheeled zimmer frame. I asked him to walk to a chair I had previously placed in the hallway approximately 15 meters away from his room.
Result
I ended up walking this patient to the chair 15 meters outside his room. I also assessed his chest and gave him some breathing exercises to help reduce his risk of a chest infection and help him re-expand his lungs. In addition I also gave him some advice to continue with the ambulation we started (with a nurse present) and continue with the breathing exercises I gave him every couple of hours.
Evaluation
I think there were some strengths in my session. I did effectively mobilise this patient, and in addition I did make him feel more secure (as he was afraid of falling) while mobilising by giving him a wheeled Zimmer frame to walk with. I also had a nurse follow with a commode behind us to make him feel even more safe.
However there were some areas where I believe I could have improved in. I don’t think I used very good manual handling skills. I felt myself straining as I helped my patient move from a supine position to sitting on the edge of the bed.
In addition to this I think for this particular patient who was very anxious I could have made my instructions more clear and direct. I felt him get a bit frustrated during the session with what I was asking him to do.
Strategies
I worked out some manual handling strategies that would help jog my memory when dealing with transferring patients.
1) Keep the load close to your body.
2) Use large muscle groups and your bodyweight to counteract the patients bodyweight
3) Use momentum to aid you when transporting large loads
I worked out some key points to remember wen mobilising very anxious patients
1) Keep instructions plain, clear and concise
2) Break up the task into steps and tell them exactly what you wish them to do.
3) Set a realistic goal that they achieve.
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