Today was a busy day, I had the clinical tutor with me this morning while assessing a new patient. The patient had bipolar disorder in its depressive phase had been on lithium for depression and a cocktail of other drugs, it was interesting to note that the patients drug regime had resulted in Parkinsons type symptoms of bradykinesia and freezing although the patient did not have Parkinsons disease. I did a COVS assessment as part of the gerontology assessment form which I thought was a little disorganized, next time I will force myself to do it in a more sequential fashion. This is the second patient that I have followed from admission, I have a good idea now about the gerontology assessment form and discharge procedure and will do a better job with this patient.
The previous patient I followed from initial assessment is on an OT home visit tomorrow and is being discharged afterwards, tomorrow I will fill out a discharge list and a home exercise for the patient. I will see the patient again as they are coming back for day therapy to Swan Districts Hospital which is nice as I feel I have made a difference to this patient.
I attended a meeting today discussing the patients on the ward and their progress and their plans for discharge I felt part of the multidisciplinary team as I was able to contribute information about a particular patient I had been seeing, it was unfortunate that my supervisor was not present at the time to see me in action.
The meeting clarified the discharge plans of two patients for me and the situation of a patient who was desperate to go home and see his frail wife for a day, the patient had quizzed me about it previously and I had discussed it with my supervisor who had said it was unlikely to happen, the meeting clarified this point so I can now give the patient good reasons why they can not go home yet. I felt uncomfortable previously not being able to give the patient good enough reasons.
Wednesday, October 29, 2008
Monday, October 27, 2008
Week3 day1
Today I worked with an elderly man who had a hemiarthroplasty of the right hip. He had other issues such as Parkinsons which made his recovery more difficult. He was able to ambulate with a pulpit frame*2(A). As he had a (R)#NOF I was not able to lie him on the affected side and I could not lie him prone due to his stiff flexed posture due to Parkinsons. I had to assess the muscle strength of glutes of his affected side in sidelying and test his unaffected side by doing a one legged bridge and palpating glutes. I did some glute work in standing with the pulpit frame with his legs against the plinth and was able to ambulate him 6m with the help of student collegue Beck.
The intervention went well and the Pt was much happier as there has been a noticable improvement in his mobility in the last few days and a change of scenery from the gloomy surrounds of his room also made him feel better.
The patient asked me if he could go home and see his wife on the weekend, she lives 3 hours drive away, it was difficult acting as an advocate then having to tell him it was better if he stayed in hospital after consulting with my supervisor.
My clinical supervisor suggested that I look at impairments specifically in relation to parkinsons for my next treatment plan. I will do some reading and formulate a plan for tomorrow.
The intervention went well and the Pt was much happier as there has been a noticable improvement in his mobility in the last few days and a change of scenery from the gloomy surrounds of his room also made him feel better.
The patient asked me if he could go home and see his wife on the weekend, she lives 3 hours drive away, it was difficult acting as an advocate then having to tell him it was better if he stayed in hospital after consulting with my supervisor.
My clinical supervisor suggested that I look at impairments specifically in relation to parkinsons for my next treatment plan. I will do some reading and formulate a plan for tomorrow.
Week2 day3
Today I took an elderly lady to the gym, some of her issues were ankylosing spondylitis, RA, she was admitted due to loss of mobility and independence.
Her primary impairments were a decrease in balance and ambulation endurance and loss of spinal curves and trunk mobility. Her main goal was to remove her intention tremor which impacted on her socially as she was prone to spill food and drink.
I went through her exercises in the gym which concentrated on her quad strength, hip exstensors, abductors dorsi flexors and plantar flexors. I also did some shoulder external rotation exercises to improve her shoulder mobility and mini sit to stands. I did some trunk rotational exercises getting her to reach across her body and turning her head to improve her thoracic spine and cervical mobility. I also carried out some upper limb strengthening exercises. It was good to see how her mood improved with exercise. She is being discharged soon so I will have to create a home exercise program for her.
It is difficult to know what to tell the patient as she is clearly hopeful that the doctors can help her tremor, however this goal may be an unrealistic goal for her. Part of her problem may be nerve compression caused by her extreme cervical hyperextension, she has had an MRI scan of her cervical spine taken but the results have not yet arrived.
I was quite happy with my intervention, I have been told however that my clinical reasoning is not quite up to scratch so I will need to work on this.
Her primary impairments were a decrease in balance and ambulation endurance and loss of spinal curves and trunk mobility. Her main goal was to remove her intention tremor which impacted on her socially as she was prone to spill food and drink.
I went through her exercises in the gym which concentrated on her quad strength, hip exstensors, abductors dorsi flexors and plantar flexors. I also did some shoulder external rotation exercises to improve her shoulder mobility and mini sit to stands. I did some trunk rotational exercises getting her to reach across her body and turning her head to improve her thoracic spine and cervical mobility. I also carried out some upper limb strengthening exercises. It was good to see how her mood improved with exercise. She is being discharged soon so I will have to create a home exercise program for her.
It is difficult to know what to tell the patient as she is clearly hopeful that the doctors can help her tremor, however this goal may be an unrealistic goal for her. Part of her problem may be nerve compression caused by her extreme cervical hyperextension, she has had an MRI scan of her cervical spine taken but the results have not yet arrived.
I was quite happy with my intervention, I have been told however that my clinical reasoning is not quite up to scratch so I will need to work on this.
Sunday, October 26, 2008
Week2 day2
Today I completed some components of a geriatric assessment form this included sitting balance (COVS), AROM, sternal push and 6m walk test and coordination. I was told to estimate AROM rather than use a goniometer, I think I would have been more comfortable measuring the joint angles, I did the 6m walk test well but could have done the sternal push test better as I did not use enough force due to the frailty of the patient, I will have to repeat the test at a later date to obtain meaningful results. I have obtained a booklet on outcome measures that I will have a look at. I have developed a problem list for this patient based on what I have learned from the geriatic assessment form and will develop a plan. The patient is due to be discharged next week and will come back for day therapy so I will need to be given an exercise sheet.
Week2 day1
Today I treated a female outpatient with a sore knee and quads who had a stroke previously, I did some mobilizations on her patella and trigger points and massage on vastus lateralis and ITB as well as some stretching to her quads in sidelying. Her issue was mainly knee pain due to weak VMO and tight lateral structures and some pain in her quads on her unaffected side as she was overusing the unaffected side. I taped her knee to improve patella tracking, but was not happy with it and had a physio to check it for me. Apart from the taping I did the intervention well, the patient reported 6/10 pain before the intervention and nil pain afterwards which was very satisfying. It was more challenging to do an intervention on a larger individual with limited mobility. Tonight I will read up about various taping techniques not just in relation to the knee but also taping the shoulder to inhibit and facilitate muscles.
I went to take an inpatient to the physio gym to carry out an exercise program, as their obs had not been taken I took them myself and noted that the pulse rate was very low at 40 beats per minute. I informed the nurse and posponed the exercise program. It turned out that the beta blocker dosage was too high and their medications were modified accordingly.
I went to take an inpatient to the physio gym to carry out an exercise program, as their obs had not been taken I took them myself and noted that the pulse rate was very low at 40 beats per minute. I informed the nurse and posponed the exercise program. It turned out that the beta blocker dosage was too high and their medications were modified accordingly.
Sunday, October 19, 2008
Week1 Day5
Today I had the opportunity to follow a patient from admission. The patient was admitted to the restorative unit with an intention tremor, ankylosing spondylitis poor balance and Parkinsons ticked in the medical notes. The clinical supervisor supervisor suggested that the symptoms were more consistant with RA than ankylosing spondylitis. When seeing the patient I noted that they had a reasonable lumbar lordosis and distinct ulnar deviation consistant with RA. The patient also had no resting tremor which is indicitive of Parkinsons, the clinical supervisor confirmed that it was not likely Parkinsons and due to something else such as medications. It was interesting to note that these details were incorrect in the medical notes. I felt that my observations and reasoning were sound when seeing the patient. I began to fill out the Geriatric Assessment sheet, and began with a 6 minute walk test which I did well, although I forgot to measure gait speed. Later in the afternoon I took the patient to the physio gym and ran through some exercises to improve muscle strength and balance, on Monday I will create a gym exercise program for the patient and an exercise sheet so they can do some bed and chair exercises independantly. I will also complete the balance component of the Geriatric Assessment sheet. My clinical tutor suggested that it is a good idea to mix intervention with assessment each session rather that completing the assessment all at once. I learned quite a bit today about time managing patients and the referal and initial assessment process. I have also been writing up patients in the medical notes. I liaised with the doctor about my patient as she had been for a neck x-ray and I wanted to check prior to undertaking any trunk rotation exercises.
Tuesday, October 14, 2008
Week1 day2
Today I was given three patients and a patient list. The first patient I ran through his exercise program in the gym and then created a home exercise program on the computer as the patient was to be discharged that afternoon.
A patient with aponea I had seen earlier I revisited to do some passive physiological movements and stretches in bed, I noted that he was nolonger on 2l of oxygen and followed up with the nursing staff to determine if this was correct in light of the patients aponea. It was OK as the doctor had deemed it unessessary to continue with oxygen the previous afternoon.
One of my patients was unavailable for treatment as he was undergoing dialysis, I followed him up on his return and carried out some cardio exercise (pedalling), I was shown his fistula where the dialysis needle is inserted, temporary in his case.
Another patient was due for discharge in a few days and a family meeting was organised. I expressed an interest in attending one of these meetings in future, however today too many people were involved so it was inappropriate at the time.
I wrote a SOIER for a stroke patient I treated with pedalling, sit to stand, bed to chair transfers and shoulder flexion and IR exercises, I was to enter this into the patient notes however the notes were at the patients family meeting with the consultant, I will write in the patient notes first thing tomorrow.
The day went well - I learned about time management of patients, where to find the patient notes when they are not in the pigeon holes and where to find items such as theraband, and have been given a small case load.
Tomorrow a clinical tutor arrives.
A patient with aponea I had seen earlier I revisited to do some passive physiological movements and stretches in bed, I noted that he was nolonger on 2l of oxygen and followed up with the nursing staff to determine if this was correct in light of the patients aponea. It was OK as the doctor had deemed it unessessary to continue with oxygen the previous afternoon.
One of my patients was unavailable for treatment as he was undergoing dialysis, I followed him up on his return and carried out some cardio exercise (pedalling), I was shown his fistula where the dialysis needle is inserted, temporary in his case.
Another patient was due for discharge in a few days and a family meeting was organised. I expressed an interest in attending one of these meetings in future, however today too many people were involved so it was inappropriate at the time.
I wrote a SOIER for a stroke patient I treated with pedalling, sit to stand, bed to chair transfers and shoulder flexion and IR exercises, I was to enter this into the patient notes however the notes were at the patients family meeting with the consultant, I will write in the patient notes first thing tomorrow.
The day went well - I learned about time management of patients, where to find the patient notes when they are not in the pigeon holes and where to find items such as theraband, and have been given a small case load.
Tomorrow a clinical tutor arrives.
Week1 day1
Today I arrived early and was able to read through my induction folder. The folder was very useful outlining outcome measures used in detail and the structure of the hospital.
I observed a number of patients with stroke. I did a slide sheet transfer to reposition a heavy patient on the bed, this was done well and I recieved positive feedback from my supervisor, I also assisted the physio with suction to clear sputum as a result of pneumonia. This particular patient also had aponea and would stop breathing periodically, I observed a manual technique to facilitate this patient in taking a larger breath.
I supervised a patient in the physio gym with balance and strengthening exercises although this patient had reasonable balance and gait he had disphasia which was contollable if he took his time he had trouble finding words and constructing logical sentences. I undertook treatment of a stroke patient by undertaking passive shoulder flexion, abduction, external rotation and hip and knee flexion and extension noting spasicity in the flexors.
Another patient I assisted with sit to stand and learned how to avoid having the patient pushing onto his good side with assisted weight shift and having him reach to his bad side. I think that I could have been in a better position that would have required less effort.
I spoke to my supervisor regarding student progression over the five weeks, however there seems to be some confusion in relation to a full patient assessment that the university requires us to do - I will have to clarify this.
Generally I think the day went well and I have started to get a feel for the hospital.
I observed a number of patients with stroke. I did a slide sheet transfer to reposition a heavy patient on the bed, this was done well and I recieved positive feedback from my supervisor, I also assisted the physio with suction to clear sputum as a result of pneumonia. This particular patient also had aponea and would stop breathing periodically, I observed a manual technique to facilitate this patient in taking a larger breath.
I supervised a patient in the physio gym with balance and strengthening exercises although this patient had reasonable balance and gait he had disphasia which was contollable if he took his time he had trouble finding words and constructing logical sentences. I undertook treatment of a stroke patient by undertaking passive shoulder flexion, abduction, external rotation and hip and knee flexion and extension noting spasicity in the flexors.
Another patient I assisted with sit to stand and learned how to avoid having the patient pushing onto his good side with assisted weight shift and having him reach to his bad side. I think that I could have been in a better position that would have required less effort.
I spoke to my supervisor regarding student progression over the five weeks, however there seems to be some confusion in relation to a full patient assessment that the university requires us to do - I will have to clarify this.
Generally I think the day went well and I have started to get a feel for the hospital.
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