Sunday, March 27, 2011
Initial Entry
My second rotation in the neurosurgery ward. My initial thoughts are a bit apprehensive and nervous about this placement as it is a large hospital as well as the fact that neuro requires a lot of theoretical knowledge. I’m unsure as to my role as a 4th year in a neurosurgery setting. I have gathered from feedback that the caseload will be around 5 or 6 patients a day. However, I’m not sure about the level of independence we will have as neuro is quite a complex area and I would think there would be an adequate level of supervision. My major concerns about the placement will be identifying impairments and treatment strategies individual to the patient as I will need to be able to respond quickly to the patient particularly if there are any behavioural or cognitive issues involved. I also think that this placement will be quite confronting as I have not had much exposure to neurosurgery patients in particular. I think that I will have an extended time with patients as opposed to my last placement which was quite quick as there were numerous patients to be seen. I think that my assessment skills and treatment skills will be refined and challenged as each patient will react differently depending on the level of injury. I am hoping that this placement will be a good learning curve, interesting as well as challenging but at a manageable level for my capability as a student.
Sunday, March 20, 2011
Final Entry
After 5 weeks in a rural acute hospital setting, I feel I have gained a vast experience in a variety of presenting conditions. I initially focused on studying orthopaedic cases, however I soon realised that an acute ward, particularly in a rural area contains a variety of cases.
I was able to gain experience clinically on the ward with a combined case load including cardio, neuro and orthopaedic patients. I also gained some experience in musculoskeletal in an outpatient setting.
By the end of the placement, I was able to run the ward and delegate the patient load and plans for the day. This became challenging towards the end of the week as the case load almost tripled with new admissions, theatre admissions, and current patients. I was able to further develop my skills in prioritisation of a case load and time management skills.
Throughout the placement, I developed the confidence to approach multi-disciplinary team members and provide opinions from a physiotherapy perspective and aid in discharge planning. This is something that I found difficult in my previous placement and I was able to overcome this challenge. I also developed some musculoskeletal outpatient skills but I did not have a lot of time allocated to this area and this will need to be consolidated in my musculoskeletal focused placement.
Overall, this placement was the most beneficial I’ve had to date as it allowed me to be in an acute hospital setting, see a variety of presentations, enabled me to work closely with multidisciplinary team members and become more confident and independent with applying my skills. Although I am still not confident with particular presentations such as ICU, I feel this placement has prepared me well for the next three this year and has provided a foundation as to the field of work I may eventually end up in the near future.
I was able to gain experience clinically on the ward with a combined case load including cardio, neuro and orthopaedic patients. I also gained some experience in musculoskeletal in an outpatient setting.
By the end of the placement, I was able to run the ward and delegate the patient load and plans for the day. This became challenging towards the end of the week as the case load almost tripled with new admissions, theatre admissions, and current patients. I was able to further develop my skills in prioritisation of a case load and time management skills.
Throughout the placement, I developed the confidence to approach multi-disciplinary team members and provide opinions from a physiotherapy perspective and aid in discharge planning. This is something that I found difficult in my previous placement and I was able to overcome this challenge. I also developed some musculoskeletal outpatient skills but I did not have a lot of time allocated to this area and this will need to be consolidated in my musculoskeletal focused placement.
Overall, this placement was the most beneficial I’ve had to date as it allowed me to be in an acute hospital setting, see a variety of presentations, enabled me to work closely with multidisciplinary team members and become more confident and independent with applying my skills. Although I am still not confident with particular presentations such as ICU, I feel this placement has prepared me well for the next three this year and has provided a foundation as to the field of work I may eventually end up in the near future.
Week 5
S: 88-year-old male who suffered an AMI 3/52 ago and did not seek medical attention. The patient then collapsed twice since the infarct and was admitted. Patient cares for his elderly wife and received services to assist with her care. Patient is NFR and had been in bed 2/7 since admission.
T: To perform a subjective and mobility assessment on the patient, mobilise the patient and determine any other relevant requirements the patient may have needed such as walking aids and additional services.
A: I initially performed a subjective assessment. On assessment, I discovered the SpO2 levels had not been obtained. The patient was unable to provide a full subjective history secondary to drowsiness. I did not perform a mobility assessment.
R: I was able to obtain some subjective information from the patient. However, I did not perform a mobility assessment or attempt to mobilise the patient, as I was uncomfortable with the medical stability of the patient.
E: Although I was unable to gain the information, I required for the patient, I feel I made the right decision in choosing not to mobilise the patient. Without knowing the O2 saturation levels and lowered level of alertness of the patient, I did not feel it was safe to attempt to mobilise the patient particularly as the patient was NFR.
S: Strategies I used was to seek advice from my supervisor after the subjective history and presenting the situation and my action to not perform the assessment. I liaised with the medical team regarding my concerns for the patient and this was acknowledged.
T: To perform a subjective and mobility assessment on the patient, mobilise the patient and determine any other relevant requirements the patient may have needed such as walking aids and additional services.
A: I initially performed a subjective assessment. On assessment, I discovered the SpO2 levels had not been obtained. The patient was unable to provide a full subjective history secondary to drowsiness. I did not perform a mobility assessment.
R: I was able to obtain some subjective information from the patient. However, I did not perform a mobility assessment or attempt to mobilise the patient, as I was uncomfortable with the medical stability of the patient.
E: Although I was unable to gain the information, I required for the patient, I feel I made the right decision in choosing not to mobilise the patient. Without knowing the O2 saturation levels and lowered level of alertness of the patient, I did not feel it was safe to attempt to mobilise the patient particularly as the patient was NFR.
S: Strategies I used was to seek advice from my supervisor after the subjective history and presenting the situation and my action to not perform the assessment. I liaised with the medical team regarding my concerns for the patient and this was acknowledged.
Monday, March 7, 2011
Week Three
S: 52-year-old male inpatient referred for physio due to desaturation of oxygen following abdominal surgery. The patient had been a smoker for 20 years and recently quit. The patient’s current saturation levels were 95% on 3L of oxygen.
T: Assess the patient’s cardio respiratory function including a subjective history and perform the relevant treatment for the findings.
A: I performed a routine subjective history particularly relating to the patient’s cardio respiratory function. I asked questions about cough, sputum production, smoking history, and what was normal for the patient. I ausculatated and took the patients room air sats. I then taught the patient breathing exercises and a supportive cough.
R: The patient had decreased breath sounds but no evidence of crackles or wheeze. The patient’s saturation levels on room air were 93%. After ambulation, this dropped to 89% but was relieved with deep breathing and a cough and soon returned to 95%. The patient reported feeling better after ambulating.
E: I think my overall assessment and treatment for the patient was done reasonably well. I was a bit worried about the drop in saturation levels after ambulation, however they increased with intervention, which I was relieved about.
S: I did not seek any advice from my supervisor however; next time I could have employed a walking exercise programme for the patient to do with monitoring of sats to determine any levels of improvement in saturation levels with ambulation. This could have been then carried over into a home exercise programme for the patient.
T: Assess the patient’s cardio respiratory function including a subjective history and perform the relevant treatment for the findings.
A: I performed a routine subjective history particularly relating to the patient’s cardio respiratory function. I asked questions about cough, sputum production, smoking history, and what was normal for the patient. I ausculatated and took the patients room air sats. I then taught the patient breathing exercises and a supportive cough.
R: The patient had decreased breath sounds but no evidence of crackles or wheeze. The patient’s saturation levels on room air were 93%. After ambulation, this dropped to 89% but was relieved with deep breathing and a cough and soon returned to 95%. The patient reported feeling better after ambulating.
E: I think my overall assessment and treatment for the patient was done reasonably well. I was a bit worried about the drop in saturation levels after ambulation, however they increased with intervention, which I was relieved about.
S: I did not seek any advice from my supervisor however; next time I could have employed a walking exercise programme for the patient to do with monitoring of sats to determine any levels of improvement in saturation levels with ambulation. This could have been then carried over into a home exercise programme for the patient.
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