Hi All,
I am on my Cardio placement and on Wednesday, I had experienced hard time from one of my new patients.
Mr.NT is 65 years old male after CABGx5 with pulmonary complication. I checked the patient’s X- ray and blood results. I found that the patient has ¯Hb (below 90).When I came to perform cardiopulmonary subjective and objective assessment and gather missing SHx information I could felt that patient is not in “good mood” however; the patient let me do assessment. I found some very “interesting information” such for example patient was using puffer (Ventolin) 2 puffs every 2 hours. I went to my clinical supervisor to present my findings and discuss my treatment plan( DBExs, supported huff ect). Additionally, I was going to provide some information to the patient about Ventolin and reviewed his technique. When I came back, the patient was standing at doorframe and he stated that either I take him outside or I can go away. I did not wanted be bossy and tell that I in charge so first, I tried to explain to the patient what is treatment plan and why. I mentioned as well that I would like to have a look how he is using his puffer. Automatically, patient commented this that I am saying he is using wrongly his puffer. I kept trying to clarified and explained, however in vain. Finally, I decided to clarify whether the patient refusing treatment. The answer was yes. I went to my clinical supervisor and I reported this situation and documented in patient’s notes.
My supervisor was supportive and said I should treat this as a good experience and do not take personally. Later afternoon my supervisor asked me again if I am OK and added that this patient was grumpy to other medical staff too. He refused blood transfusion and was unpleasant to nursing staff. He said that not all patients are compliant.
It is hard especially at the beginning do not take this sort of situation personally but it was good lesson. I am glad I had this lesson now.
Sunday, March 16, 2008
Sunday, March 9, 2008
Open Heart Surgery outcomes
I am currently on my cardio placement. I am treating the patients who have undergone cardiothoracic surgery such as CABG as well as I have opportunity to conduct pulmonary rehabilitation classes. That is great experience to observe how patients attitudes toward lifestyle are changing.
Hi Guys,
I has treated patient that had CABGx3 performed 2 weeks ago. The patient had presented in ED with chest pain and SOB. PMHx included Ca throat, IHD, high cholesterol, DM, #jaw, ETOH abused. When I asked the patient about smoking history, the patient reported that he had been smoking for 50 years about 40 cigarettes per day before admission. He did not quit smoking after diagnosis of throat Ca but this time the patient said he had his lesson. The patient reported he has not been participated in any regular physical activities or structured exercises. However, because of education about his disease and effects of physical activity, the patient was more than happy to take part in Cardiac Rehabilitation after being discharge.
It is great to treat this very compliant patient with very good outcomes, immediate release of symptoms, good posture, full UL ROM, ability to walk independently and frequently including 2 flights of stairs.
Thanks
Hi Guys,
I has treated patient that had CABGx3 performed 2 weeks ago. The patient had presented in ED with chest pain and SOB. PMHx included Ca throat, IHD, high cholesterol, DM, #jaw, ETOH abused. When I asked the patient about smoking history, the patient reported that he had been smoking for 50 years about 40 cigarettes per day before admission. He did not quit smoking after diagnosis of throat Ca but this time the patient said he had his lesson. The patient reported he has not been participated in any regular physical activities or structured exercises. However, because of education about his disease and effects of physical activity, the patient was more than happy to take part in Cardiac Rehabilitation after being discharge.
It is great to treat this very compliant patient with very good outcomes, immediate release of symptoms, good posture, full UL ROM, ability to walk independently and frequently including 2 flights of stairs.
Thanks
Monday, February 4, 2008
Communication/Interpretation
Hi All,
During my neuro placement I have learnt how important is communication both verbal as well as written. There are many reasons for this such as benefit of patient, from the legal point of view, better team work and relations with other health professionals.
One of my patients is after PCI with severely impaired posterior circulation presents with very ataxic gait. This patient balance varies sigificantly from day to day or even during the same day, for example one day patient can maintain his static standing balance with eyes open then closed for 60 seconds, another day can not perform these tasks at all. I have noticed that patient's balance and functional level were generally worse after weekend as patient hasn't have chance to "experiance"/practice his balance and walking. Other factors that influence on patient's balance are mediacations, especially sedative ones that patient receives if he is restless and "significantly impaired memory"(assessment performed by OT).
The patient that I mentioned above is at a hospital ward therefore nursing staff rely on information regarding functional level of each patient provided by physio. Functional level assessment is assessed/reviewed on daily basis and has to be documented in the notes and on functional chart in a patient's room. Then any changes have to be handovered to nurse who looks after patient as well as to co-ordinator nurse. When I have assessed my ataxic patient functional level and I found his balance deteriorated a lot that I wasn't able to walk him on my own (for mine and my patient safety) I asked another physio student to give me hand. After session I have reported my concern about patient's balance to medical staff.I documented in notes my assessment, findings and changes in functional level then I changed information on functional chart in patient's room ( ambulation: 2 A max). I was very suprised when I showed/informed coordinator nurse and I found that her interpretation was different to what I meant. When I have written "ambulation: 2 A max" (this is commonly used abbrivation used on this ward) I meant that patient can ambulate with maximun assistance from two staff members. The nurse understood that patient needs assistance maximum two staff members ( can be less than two but not more than two). It was good lesson!
During my neuro placement I have learnt how important is communication both verbal as well as written. There are many reasons for this such as benefit of patient, from the legal point of view, better team work and relations with other health professionals.
One of my patients is after PCI with severely impaired posterior circulation presents with very ataxic gait. This patient balance varies sigificantly from day to day or even during the same day, for example one day patient can maintain his static standing balance with eyes open then closed for 60 seconds, another day can not perform these tasks at all. I have noticed that patient's balance and functional level were generally worse after weekend as patient hasn't have chance to "experiance"/practice his balance and walking. Other factors that influence on patient's balance are mediacations, especially sedative ones that patient receives if he is restless and "significantly impaired memory"(assessment performed by OT).
The patient that I mentioned above is at a hospital ward therefore nursing staff rely on information regarding functional level of each patient provided by physio. Functional level assessment is assessed/reviewed on daily basis and has to be documented in the notes and on functional chart in a patient's room. Then any changes have to be handovered to nurse who looks after patient as well as to co-ordinator nurse. When I have assessed my ataxic patient functional level and I found his balance deteriorated a lot that I wasn't able to walk him on my own (for mine and my patient safety) I asked another physio student to give me hand. After session I have reported my concern about patient's balance to medical staff.I documented in notes my assessment, findings and changes in functional level then I changed information on functional chart in patient's room ( ambulation: 2 A max). I was very suprised when I showed/informed coordinator nurse and I found that her interpretation was different to what I meant. When I have written "ambulation: 2 A max" (this is commonly used abbrivation used on this ward) I meant that patient can ambulate with maximun assistance from two staff members. The nurse understood that patient needs assistance maximum two staff members ( can be less than two but not more than two). It was good lesson!
Sunday, January 27, 2008
Treatment for weakness vs altered muscle activation pattern...
Hi all,
I am currently on my neuroplacement at SCGH. One of my patient is 65 year old male who had PCI. Patient's gait is ataxic and his balance vary significantly from day to day or even between morning and afternoon of same day. Patient showing lack of insight and often overestimates his abilities.He is really compliant with physio treatment and wants to work hard to improve his functional level however, he is stubborn personality and very inpatient and attempts to do things before full explaination/demo is finished. It is my third week of placement and last two monday's morning I find very upsetting as patient had 2 falls when he was trying to get to toilet on his own even though his "mobility chart" says "ambulation 1 A - close supervision".I was trying to explain to the patient that he needs to call for help, that he could fracture his leg ect. My clinical supervisor said it is qiute common problem that patient is trying to experience his abilities.Hoverever it does not make me feel better. My treatment first consisted of: balance exercises ( static,dynamic with all possible variables), walk, protective responses training and exercises to decrease ataxia AI's and RS's. I've noticed that balance even vary improved whereas I was not satisfied with patient's gait especially his trunk moving forward and backward with preference for backward (the patient tends to fall backward). So after consultation with my supervisor I added more abdominals exercises and moved toward building endurance in walking by increasing distance. Additionally, I noticed some weakness (not significant) in LL and decrease the ability to produce fractionated movements in LL (L>R). Can anyone give me some suggestions what sort of treatment can be used to improve ability to fractionate movements.
Thanks,
Daria
I am currently on my neuroplacement at SCGH. One of my patient is 65 year old male who had PCI. Patient's gait is ataxic and his balance vary significantly from day to day or even between morning and afternoon of same day. Patient showing lack of insight and often overestimates his abilities.He is really compliant with physio treatment and wants to work hard to improve his functional level however, he is stubborn personality and very inpatient and attempts to do things before full explaination/demo is finished. It is my third week of placement and last two monday's morning I find very upsetting as patient had 2 falls when he was trying to get to toilet on his own even though his "mobility chart" says "ambulation 1 A - close supervision".I was trying to explain to the patient that he needs to call for help, that he could fracture his leg ect. My clinical supervisor said it is qiute common problem that patient is trying to experience his abilities.Hoverever it does not make me feel better. My treatment first consisted of: balance exercises ( static,dynamic with all possible variables), walk, protective responses training and exercises to decrease ataxia AI's and RS's. I've noticed that balance even vary improved whereas I was not satisfied with patient's gait especially his trunk moving forward and backward with preference for backward (the patient tends to fall backward). So after consultation with my supervisor I added more abdominals exercises and moved toward building endurance in walking by increasing distance. Additionally, I noticed some weakness (not significant) in LL and decrease the ability to produce fractionated movements in LL (L>R). Can anyone give me some suggestions what sort of treatment can be used to improve ability to fractionate movements.
Thanks,
Daria
Sunday, January 20, 2008
"Likely MS" diagnosis
Hi all,
I am currently on my neuro placement in SCGH. Last week I treated a patient with "likely MS" diagnosis.
This patient presented at the beginning of last week with neurological symptoms such as altered sensation (R) face, double vision lasting for more than 1 hour, decreased hearing (R) with tinnitus, numbness (R) arm plus (R) leg. Everything started suddenly in November 2007 with loss of balance.
I found really hard to treat this very nice and cooperative patient and I had to constantly think about wards I am using and how I communicate with this particular patient. During the treatment I was trying not to use the words that would indicate that patient has definite MS even mentioned earlier neuro symptoms plus fatigue, depression, headaches seem to match MS very well.
The patient has asked one of her friends to find out on internet about MS, another friend who is nurse was helping in interpretation. The doctors were doing extra investigations to confirm/exclude MS diagnosis. I knew that it is very hard time for this patient like wanting for a sentence. On the one hand patient wanted to know as much as possible but on the other hand probably wanted to find out that doctors are wrong. To be honest I wanted to believe that it is not MS, too.
In addition, this patient (female) is only 4 years older than me. She has loving husband, beautiful daughter, good job and suddenly everything may have to change. At the end of week this patient sensation, balance have improved a lot, gait has become more stable but still slow on top of this patient finds balance exercises very tirying and has to concenetrate o lot.
To sum up, I think that treating patients with degenerative disease can be very rewarding but depressing,too
I am currently on my neuro placement in SCGH. Last week I treated a patient with "likely MS" diagnosis.
This patient presented at the beginning of last week with neurological symptoms such as altered sensation (R) face, double vision lasting for more than 1 hour, decreased hearing (R) with tinnitus, numbness (R) arm plus (R) leg. Everything started suddenly in November 2007 with loss of balance.
I found really hard to treat this very nice and cooperative patient and I had to constantly think about wards I am using and how I communicate with this particular patient. During the treatment I was trying not to use the words that would indicate that patient has definite MS even mentioned earlier neuro symptoms plus fatigue, depression, headaches seem to match MS very well.
The patient has asked one of her friends to find out on internet about MS, another friend who is nurse was helping in interpretation. The doctors were doing extra investigations to confirm/exclude MS diagnosis. I knew that it is very hard time for this patient like wanting for a sentence. On the one hand patient wanted to know as much as possible but on the other hand probably wanted to find out that doctors are wrong. To be honest I wanted to believe that it is not MS, too.
In addition, this patient (female) is only 4 years older than me. She has loving husband, beautiful daughter, good job and suddenly everything may have to change. At the end of week this patient sensation, balance have improved a lot, gait has become more stable but still slow on top of this patient finds balance exercises very tirying and has to concenetrate o lot.
To sum up, I think that treating patients with degenerative disease can be very rewarding but depressing,too
Sunday, January 13, 2008
What is patient’s priority?
I finished 1st week of my neuro placement at SCGH. One of my patients case seems to be very interesting when I analyzed his social history, past medical history, his attitudes toward his health. The patient had PCI before that he had 2 episodes of vertigo, blurred vision, slurred speech and couple falls. However, he ignored these signs. He is 65-year-old male with history of HTN, CABGx3 who smokes 25g tabbaco per week and drinks 1 L wine per day. As the patient has own business and lives alone his social circumstances absorbing him more than his health state. Patient verbalized couple times he wants go home even after doctor has educated him about his condition which deteriorated, necessity of further investigation and rest in bed ( head flat to 30°) in order to improve blood supply to his brain. At that stage, it was interesting to see how results of investigation match with signs (↓ level of consciousness). Now I understand what Anne meant by person appears to be sleepy.
I find this case difficult as well as challenging. On the one hand, the patient is very compliant/ cooperative during physio treatment on the other hand he shows unawareness of his state and even ignorance and I know that sorting out his social issue ( own business) is his priority.
I finished 1st week of my neuro placement at SCGH. One of my patients case seems to be very interesting when I analyzed his social history, past medical history, his attitudes toward his health. The patient had PCI before that he had 2 episodes of vertigo, blurred vision, slurred speech and couple falls. However, he ignored these signs. He is 65-year-old male with history of HTN, CABGx3 who smokes 25g tabbaco per week and drinks 1 L wine per day. As the patient has own business and lives alone his social circumstances absorbing him more than his health state. Patient verbalized couple times he wants go home even after doctor has educated him about his condition which deteriorated, necessity of further investigation and rest in bed ( head flat to 30°) in order to improve blood supply to his brain. At that stage, it was interesting to see how results of investigation match with signs (↓ level of consciousness). Now I understand what Anne meant by person appears to be sleepy.
I find this case difficult as well as challenging. On the one hand, the patient is very compliant/ cooperative during physio treatment on the other hand he shows unawareness of his state and even ignorance and I know that sorting out his social issue ( own business) is his priority.
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