My initial thoughts for my last rotation are of excitement as the year is coming to an end, as well as the fact that this rotation is a musculoskeletal placement. I am looking forward to this rotation as I have not had much clinical experience in the musculoskeletal area and I would eventually like to work in this field once I graduate.
I think as a final year physio student, I will have a greater role in this field as oppose to other areas. I am hoping to be able to manage a full caseload by the end of the placement. As this is the area I wish to work in once graduated, I’m hoping I will be able to consolidate my communication skills, clinical reasoning skills as well as my manual therapy techniques.
I am slightly nervous and apprehensive about this placement, as I haven’t had much hands on clinical experience in the area, and I’m not sure how great my manual techniques are. However, I am hoping during these five weeks I will be able to refine them and be able to apply them effectively. I’m not sure as to the level of supervision I will receive on this placement. I am hoping in the early days I will be able to sit in a few sessions, as well as have a small caseload of my own and then progress from there.
I have revised musculoskeletal techniques, but I am also hoping to learn other alternatives to types of treatments that may be more beneficial to specific types of patients.
By the end of the placement, I am hoping to be confident in the musculoskeletal field, be able to manage a caseload independently, refine my manual therapy techniques, as well as gain insight and additional knowledge in the area.
Sunday, June 26, 2011
Sunday, June 19, 2011
Final Entry
At the end of my five weeks of my cardio placement, I have successfully learnt how to assess and treat a surgical cardiac patient. Although, I was not able to run the ward, I was able to manage an individual case load.
Throughout the placement, I consolidated my communication skills. I was able to provide pre-operative and pre-discharge education to a group of patients at one time. I was able to answer questions confidently which, in turn, consolidated my theoretical knowledge. I also further developed my skills in working with other members of the allied health team, liaising and working with team members more closely with specific patients.
My weakness on this placement I feel was time management. As I was not familiar with mobilising patients with a multitiude of attatchments, I found I struggled with time whilst setting up the patient's attatchments before mobilising. However, by the end of the five weeks, I was able to mobilise a patient with attatchments more efficiently than I was towards the beginning of the placement.
I also was not given the opportunity to run the ward, so I am still uncertain as to whether I would be able to manage a larger caseload than I was given, particularly in terms of time management.
I did however consolidate my theoretical and practical skills, and by the end of the placement, I was able to treat more acute patients in intensive care. I feel more confident being able to assess and treat patients in the cardiorespiratory area and have learnt more theoretical knowledge in a practical setting.
Throughout the placement, I consolidated my communication skills. I was able to provide pre-operative and pre-discharge education to a group of patients at one time. I was able to answer questions confidently which, in turn, consolidated my theoretical knowledge. I also further developed my skills in working with other members of the allied health team, liaising and working with team members more closely with specific patients.
My weakness on this placement I feel was time management. As I was not familiar with mobilising patients with a multitiude of attatchments, I found I struggled with time whilst setting up the patient's attatchments before mobilising. However, by the end of the five weeks, I was able to mobilise a patient with attatchments more efficiently than I was towards the beginning of the placement.
I also was not given the opportunity to run the ward, so I am still uncertain as to whether I would be able to manage a larger caseload than I was given, particularly in terms of time management.
I did however consolidate my theoretical and practical skills, and by the end of the placement, I was able to treat more acute patients in intensive care. I feel more confident being able to assess and treat patients in the cardiorespiratory area and have learnt more theoretical knowledge in a practical setting.
WEEK 5
S: 75 year old male presented to hospital with severe ongoing chest pain. The patient has a past medical history of chronic obstructive pulmonary disease, angina, triple vessel disease, and hypotension. He lives in a caravan park with his wife, who is 91 years old and resistant to services or assistance. He was previously walking ~10 metres within the home with a walking stick.
T: To perform a full subjective history and appropriate treatment for the patient.
A: I asked the patient numerous relevant subjective questions regarding the patient's home living situation, smoking history, cough and sputum production, and previous level of mobility. I took the patient's relevant objective measures such as auscultation, oxygen saturation levels, blood pressure and heart rate. I then asked the patient to sit over the edge of the bed, which the patient refused. I then comprimised with the patient and positined him into high sitting, and gave the patient deep breathing exercises to perform throughout the day independently.
R: I was able to obtain a thorough subjective history from the patient, which the patient was willing to answer. However, the patient refused to sit out of bed despite me emphasising the importance. I was able to achieve an effective treatment session, however it was not optimal as the patient was refusing to participate.
E: I think overall, although the session was not the best treatment I could have done, I think I was able to at least achieve an effective treatment. The patient was refusing to participate in any physical treatment which made the session difficult, however I think I handled the situation well providing an alternative which enabled me to achieve something out of the session.
S: I consulted with my supervisor, who agreed to take a similar approach as I did in dealing with a patient that was refusing to participate in physio.
T: To perform a full subjective history and appropriate treatment for the patient.
A: I asked the patient numerous relevant subjective questions regarding the patient's home living situation, smoking history, cough and sputum production, and previous level of mobility. I took the patient's relevant objective measures such as auscultation, oxygen saturation levels, blood pressure and heart rate. I then asked the patient to sit over the edge of the bed, which the patient refused. I then comprimised with the patient and positined him into high sitting, and gave the patient deep breathing exercises to perform throughout the day independently.
R: I was able to obtain a thorough subjective history from the patient, which the patient was willing to answer. However, the patient refused to sit out of bed despite me emphasising the importance. I was able to achieve an effective treatment session, however it was not optimal as the patient was refusing to participate.
E: I think overall, although the session was not the best treatment I could have done, I think I was able to at least achieve an effective treatment. The patient was refusing to participate in any physical treatment which made the session difficult, however I think I handled the situation well providing an alternative which enabled me to achieve something out of the session.
S: I consulted with my supervisor, who agreed to take a similar approach as I did in dealing with a patient that was refusing to participate in physio.
Sunday, June 5, 2011
Week 3
S: 79 year old male admitted to hospital with 8 weeks of sharp abdominal pain, frequent toileting and diarrhoea. The patient underwent a laparotomy procedure, his past medical history included bilateral total hip replacements and removal of a parotid tumour in 2010. He lives with his wife and was previously independent with his mobility and self caring.
T: Perform a subjective history, objective and appropriate treatment for the patient day 1 after the laparotomy procedure.
A: I performed a full thorough subjective and objective assessment. The patient however would not allow me to mobilise him as he was beginning to become quite aggressive and agitated. I then taught the patient bed exercises, deep breathing exercises and a supported cough to perform hourly as an intervention. I also educated the patient on using the pain relief as required to allow the exercises to be performed.
R: I was able to gather a detailed history from the patient. All of the patient’s objective measures such as blood pressure, heart rate, and respiratory rate were within normal limits. The patient’s chest was clear on assessment and the patient had a dry strong cough but was inhibited by pain. As the patient was quite agitated and aggressive towards the end of the session, I was not able to sit the patient over the edge of the bed due to not having consent.
E: Overall, I think I achieved the most I could have out of the session. I was able to try and reason with the patient to do the deep breathing exercises and bed exercises instead of sitting him up and he reluctantly agreed. Reflecting on the session, I think shortening my subjective history taking may have reduced the level of agitation and aggression of the patient. However, at the time of taking the history, the patient was very compliant and there was only a sudden change of behaviour once I began explaining the intervention. Although the session did not go as planned, I was able to provide an intervention, even if it was not the most optimal for the patient.
S: I asked my university tutor for some advice on handling the situation where the patient is non compliant. I compromised with the patient providing an alternative to my initial intervention aim of sitting over the edge of the bed instead which was successful.
T: Perform a subjective history, objective and appropriate treatment for the patient day 1 after the laparotomy procedure.
A: I performed a full thorough subjective and objective assessment. The patient however would not allow me to mobilise him as he was beginning to become quite aggressive and agitated. I then taught the patient bed exercises, deep breathing exercises and a supported cough to perform hourly as an intervention. I also educated the patient on using the pain relief as required to allow the exercises to be performed.
R: I was able to gather a detailed history from the patient. All of the patient’s objective measures such as blood pressure, heart rate, and respiratory rate were within normal limits. The patient’s chest was clear on assessment and the patient had a dry strong cough but was inhibited by pain. As the patient was quite agitated and aggressive towards the end of the session, I was not able to sit the patient over the edge of the bed due to not having consent.
E: Overall, I think I achieved the most I could have out of the session. I was able to try and reason with the patient to do the deep breathing exercises and bed exercises instead of sitting him up and he reluctantly agreed. Reflecting on the session, I think shortening my subjective history taking may have reduced the level of agitation and aggression of the patient. However, at the time of taking the history, the patient was very compliant and there was only a sudden change of behaviour once I began explaining the intervention. Although the session did not go as planned, I was able to provide an intervention, even if it was not the most optimal for the patient.
S: I asked my university tutor for some advice on handling the situation where the patient is non compliant. I compromised with the patient providing an alternative to my initial intervention aim of sitting over the edge of the bed instead which was successful.
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