S: The patient is a 61 year old male admitted to the ward following a coronary artery bypass graft surgery. The patient has an extensive smoking history of 20 cigarettes a day for 50 years. The patient is from the country and lives with a work colleague. The patient was previously independent with all mobility and domestic duties. He is a self employed brick layer.
T: Perform an assessment and treatment for the patient
A: I checked the patient’s chest, and then re-educated the patient on deep breathing exercises and a supported cough. I then monitored the patient’s oxygen saturation levels with and without the use of oxygen. I took the patient for a short walk without the use of oxygen but took a portable oxygen trolley just in case it was needed.
R: The patient managed the walk however his oxygen saturation levels decreased to 86% off the oxygen. I then asked the patient to rest and take deep breaths in an attempt to increase the oxygen levels. The oxygen level only improved to 91% so I then placed the patient on oxygen and returned the patient to the room where I continued to do deep breathing exercises with the patient.
E: I think I managed the situation appropriately. I was able to determine when it was appropriate to place the patient back on oxygen and cease the session. It was challenging as the patient was not showing any signs of respiratory distress but I took the necessary precautions to make sure my session was safe.
S: I asked my supervisor when it would be appropriate to place the patient back on the oxygen even if they were asymptomatic. I also liaised with the med team regarding the levels of oxygen they were happy with for the patient to be off the oxygen.
Sunday, May 22, 2011
Sunday, May 15, 2011
Initial Entry
It is the third rotation for fourth year placement and the area in focus is cardio. I feel a bit nervous about this placement, however as I have had some experience in cardio in my previous placements I do not feel as nervous as I was at the beginning of the year. I think the placement will allow me to gain further skills as well as consolidate my previous knowledge in the area. I hope that I will be able to be more confident during this placement and have more initiative with liaising with other multidisciplinary team members.
I think my role as a 4th year student will be to manage a caseload independently. I think that initially I will have supervision and help from the supervisor, which will allow me to gauge an idea of how the facility runs. I will need to ask many questions regarding discharge planning, average length of stay and the style of note writing the facility prefer.
My major concern about the placement initially is what types of patients I will be treating as I am unsure what particular ward I will be on. This is making me a bit nervous, as I don’t feel as well prepared as I would if I knew what the specific area was going to be. Nonetheless, I am hoping I will have enough knowledge as a 4th year to be able to apply to any type of setting and I will then research any uncertainties I have.
Overall, I am looking forward to furthering my knowledge and skills during this placement in order to become a more experienced and confident physiotherapist.
I think my role as a 4th year student will be to manage a caseload independently. I think that initially I will have supervision and help from the supervisor, which will allow me to gauge an idea of how the facility runs. I will need to ask many questions regarding discharge planning, average length of stay and the style of note writing the facility prefer.
My major concern about the placement initially is what types of patients I will be treating as I am unsure what particular ward I will be on. This is making me a bit nervous, as I don’t feel as well prepared as I would if I knew what the specific area was going to be. Nonetheless, I am hoping I will have enough knowledge as a 4th year to be able to apply to any type of setting and I will then research any uncertainties I have.
Overall, I am looking forward to furthering my knowledge and skills during this placement in order to become a more experienced and confident physiotherapist.
Sunday, May 1, 2011
Final entry
The last five weeks of placement have been very challenging and educational. I was very overwhelmed within the first few weeks of placement as it was neurosurgery. I found the first week to be very confronting witnessing the types of behaviours associated with head injured patients. I also found it difficult to treat a patient that did not open their eyes or respond to me as I was used to dealing with quite well and mobile patients.
As the weeks progressed and I was given more of a role as a physio with patients, I struggled with keeping the flow of sessions as I felt flustered when I wasn't able to perform the planned treatment or assessment due to the behavioural issues.
By the end of the placement and having input from the uni supervisor as well as another well experienced physio, I was able to broaden my treatment ideas and carry out more effective treatment sessions as I felt more confident. I was able to redirect sessions when patients became distracted or agitated and I was also able to carry out sessions when the patients did not participate due to being in a stuperosed state.
Overall, after this placement I feel more confident within my skills as a physio being communication particularly as well as types of treatment techniques for head injured patients which can also be transferred to stroke as the presentation can be quite similar physically. I felt more confident by the end of the placement and feel I would be able to manage a case load for the neurosurgery population effectively.
As the weeks progressed and I was given more of a role as a physio with patients, I struggled with keeping the flow of sessions as I felt flustered when I wasn't able to perform the planned treatment or assessment due to the behavioural issues.
By the end of the placement and having input from the uni supervisor as well as another well experienced physio, I was able to broaden my treatment ideas and carry out more effective treatment sessions as I felt more confident. I was able to redirect sessions when patients became distracted or agitated and I was also able to carry out sessions when the patients did not participate due to being in a stuperosed state.
Overall, after this placement I feel more confident within my skills as a physio being communication particularly as well as types of treatment techniques for head injured patients which can also be transferred to stroke as the presentation can be quite similar physically. I felt more confident by the end of the placement and feel I would be able to manage a case load for the neurosurgery population effectively.
Week 5
S: 44 year old indigenous male 3 weeks post collapse with left and right intraventricular bleeds and associated left sided hemiplegia. Past medical history included diabetes, obesity, hypertension, alcohol abuse, and smoking. The patient (pt) has no fixed address, occasionally stays with brother, pt unemployed. Current Glasgow coma scale score (GCS) of 3/15 trache in situ and oxygen saturation 98% on 2L of oxygen via swedish nose.
T: Perform appropriate assessment and treatment session for the patient.
A: I performed relevant assessments needed such as GCS, chest, passive range and tone assessment to direct my treatment. As the patient was in a stuperosed state, I was able to perform suctioning via trache, passive range to provide some proprioceptive input and stretching to avoid contractures due to abnormal tone. I then did rolling to provide vestibular stimulation as the patient was unable to be sat out of bed due to continual opening of bowels.
R: The treatment session was effective overall. I was able to clear secretions via suctioning allowing increased breath sounds throughout upon reausculatation.
E: I struggled with passive range exercises as the patient was obese, and also particularly because the patient was in a stuperosed state and had no voluntary control of any limbs, I found it physically demanding. I struggled to find an appropriate position to perform these exercises in without placing my back at risk.
S: I seeked help from the supervising physio. He was able to show me different ways of handling the patients limbs. However, it also was suggested by the physio that if it was too physically demanding, I would not be able to continue to see the patient. I was able to utilise these different positions effectively and safely and was able to continue to see the patient.
T: Perform appropriate assessment and treatment session for the patient.
A: I performed relevant assessments needed such as GCS, chest, passive range and tone assessment to direct my treatment. As the patient was in a stuperosed state, I was able to perform suctioning via trache, passive range to provide some proprioceptive input and stretching to avoid contractures due to abnormal tone. I then did rolling to provide vestibular stimulation as the patient was unable to be sat out of bed due to continual opening of bowels.
R: The treatment session was effective overall. I was able to clear secretions via suctioning allowing increased breath sounds throughout upon reausculatation.
E: I struggled with passive range exercises as the patient was obese, and also particularly because the patient was in a stuperosed state and had no voluntary control of any limbs, I found it physically demanding. I struggled to find an appropriate position to perform these exercises in without placing my back at risk.
S: I seeked help from the supervising physio. He was able to show me different ways of handling the patients limbs. However, it also was suggested by the physio that if it was too physically demanding, I would not be able to continue to see the patient. I was able to utilise these different positions effectively and safely and was able to continue to see the patient.
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