Situation- I had been referred to a male patient who’d had surgery performed and had 1 leg in a POP and was to be Non-Weight Bearing (NWB) on it for 6 weeks. I thought this would be a routine assessment and treatment, but it turned out this gentleman was a larger fellow, weighing more than twice my own weight, which changed the situation a little.
Task- My task was to have the patient capable of independent ambulation prior to his discharge.
Action- I originally planned to treat this patient on my own, but after performing a subjective assessment and seeing the pt, I decided I was going to need some more help. After checking the Safe Working Limit (SWL) for large axillary crutches(AC’s) and zimmer frames(ZF) (the patient was safe to use both), my supervisor and I got the patient ambulating with the crutches.
Result- The patient was quite unsteady with the crutches, but did not want to use a ZF. After another unsteady 5m performance on the crutches, I convinced the patient to try the ZF. He turned out to be much safer and more capable with the ZF and preferred it to the crutches. He was discharged the following day after demonstrating 40m independent ambulation with the ZF.
Evaluation- I feel my actions were effective, initially getting the extra assist for ambulation with the patient, then to cease crutch use in favour of the ZF. My strength here was seeing the patient holistically and recognising his need to be ambulating independently before discharge. This meant the patient was discharged with a realistic aid for his needs after 3-4 days on the ward.
Strategies- Viewing the patient holistically and recognising he was not just an age and diagnosis, meant he was discharged without delays.
Ozzman out!
Monday, August 31, 2009
Sunday, August 16, 2009
Entry 3: Assessment / Analysis and Planning
Situation- My patient was a middle-aged female who had a total hip replacement 4 days earlier and I was seeing her for the third time. See had been told she could go home the following day, which she was very excited about. In previous sessions she had been ambulating independently with a zimmer frame (ZF) and had trialled a wheeled zimmer (WZF) but was not confident with it.
Task- My task was to assess her mobility to determine what aid she would take home and to run through her exercise program to assess her understanding and performance of the exercises prior to discharge.
Action- Before starting I checked the progress notes to see if anything of relevance had occurred since I saw her last and checked her obs, all was good. Then I had a chat with my supervisor to tell her my plan. This included a walk with the WZF and if possible 2 elbow crutches (EC’s) as well as running through the exercises, she thought this was good plan.
I walked the patient 30m with the WZF and was happy she would be capable of using it at home, so I asked if she’d like to try EC’s and she said yes. After 2m with the EC’s she said she wasn’t comfortable and she said she’d prefer the ZF over the WZF, so she went back to her room with the ZF. We then went through the exercises and finished up.
Result- The patient decided that although she was ok with the WZF, she preferred and felt safer with the ZF. After liaising with my supervisor, I decided that because of the patient’s desire to go home, it would be best to discharge her with the aid she feels safe with rather than keeping her in hospital for longer to progress on to the WZF, she was booked for outpatients rehab anyway and she could progress to the WZF when she feels capable.
Evaluation- I think this was a good result because the patient and I were both happy, she was going home and I was satisfied she was safe to do so. I think my strengths here were my communication and my ability to think of the patient holistically, to enable her to go home happy.
Strategies- Giving the patient a certain degree of choice/freedom with their treatment seems to be a strategy that worked well for me on this occasion.
3 weeks down, 2 to go!
Ozzman out!
Task- My task was to assess her mobility to determine what aid she would take home and to run through her exercise program to assess her understanding and performance of the exercises prior to discharge.
Action- Before starting I checked the progress notes to see if anything of relevance had occurred since I saw her last and checked her obs, all was good. Then I had a chat with my supervisor to tell her my plan. This included a walk with the WZF and if possible 2 elbow crutches (EC’s) as well as running through the exercises, she thought this was good plan.
I walked the patient 30m with the WZF and was happy she would be capable of using it at home, so I asked if she’d like to try EC’s and she said yes. After 2m with the EC’s she said she wasn’t comfortable and she said she’d prefer the ZF over the WZF, so she went back to her room with the ZF. We then went through the exercises and finished up.
Result- The patient decided that although she was ok with the WZF, she preferred and felt safer with the ZF. After liaising with my supervisor, I decided that because of the patient’s desire to go home, it would be best to discharge her with the aid she feels safe with rather than keeping her in hospital for longer to progress on to the WZF, she was booked for outpatients rehab anyway and she could progress to the WZF when she feels capable.
Evaluation- I think this was a good result because the patient and I were both happy, she was going home and I was satisfied she was safe to do so. I think my strengths here were my communication and my ability to think of the patient holistically, to enable her to go home happy.
Strategies- Giving the patient a certain degree of choice/freedom with their treatment seems to be a strategy that worked well for me on this occasion.
3 weeks down, 2 to go!
Ozzman out!
Sunday, August 2, 2009
Entry 2: Communication
I’ve had a good first week on the ortho ward at JHC, it has been a great introduction to the way a hospital runs and the role of a physio in this environment.
Situation- One thing I feel I have really benefited from so far has been listening to some initial assessments and the different ways that you can go about performing them. Conducting my first initial assessment on a patient was a daunting task, but one which I gained a lot from.
I’d probably heard 4 or 5 from my supervisor before I had my first crack and I had done some work with my tutor on them, so I wasn’t feeling too bad. My patient was a middle-aged female who had had a knee procedure performed and post-op instructions were for 0-90° graduated CPM day 1, FWB status and rigorous LL strength training, particularly for quads. I checked her progress notes, x-rays and obs and then went in to get started.
Tasks- So my tasks were to do an initial assessment, teach initial bed exercises, teach crutches and set up the CPM machine.
Action- Under the watchful eye of my supervisor I completed all my tasks pretty easily and finished feeling quite happy with the way things had gone.
Result- Then I had a chat with my supervisor for some feedback and she said I did well for my first time, that I got all the info that I needed for my initial assessment, just that I needed to improve my communication.
Evaluation- She said I need to explain what and why I’m doing things better to the patient and this will help me get the required info easier. I felt this was a good evaluation because at times I did feel as though the patient felt a little lost.
Strategies- Overall it turned out pretty well, I will get better with practice, but it definitely outlines the importance of good communication skills.
Ozzman out!
Situation- One thing I feel I have really benefited from so far has been listening to some initial assessments and the different ways that you can go about performing them. Conducting my first initial assessment on a patient was a daunting task, but one which I gained a lot from.
I’d probably heard 4 or 5 from my supervisor before I had my first crack and I had done some work with my tutor on them, so I wasn’t feeling too bad. My patient was a middle-aged female who had had a knee procedure performed and post-op instructions were for 0-90° graduated CPM day 1, FWB status and rigorous LL strength training, particularly for quads. I checked her progress notes, x-rays and obs and then went in to get started.
Tasks- So my tasks were to do an initial assessment, teach initial bed exercises, teach crutches and set up the CPM machine.
Action- Under the watchful eye of my supervisor I completed all my tasks pretty easily and finished feeling quite happy with the way things had gone.
Result- Then I had a chat with my supervisor for some feedback and she said I did well for my first time, that I got all the info that I needed for my initial assessment, just that I needed to improve my communication.
Evaluation- She said I need to explain what and why I’m doing things better to the patient and this will help me get the required info easier. I felt this was a good evaluation because at times I did feel as though the patient felt a little lost.
Strategies- Overall it turned out pretty well, I will get better with practice, but it definitely outlines the importance of good communication skills.
Ozzman out!
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