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.