After completing this unit I feel great. I learned so much over the 5 weeks and I saw and experienced many new things. I got a much better understanding of dementia especially and how to handle people with moderate to severe dementia. I also got so much info and feedback from our supervisor who was very supportive and approachable over the whole time. My confidence also grew in meeting and interacting with new residents and also in the level of my patient handling skills.
I have leaned that in aged care, time limits and restrictions are not possible as each resident takes a different amount of time to do certain things. Ive also learned that in places like BF, it is actually the residents home and no matter how much you want them to give something a try, or know how much they need to do exercise, you cannot make them do exercise, it is their choice. I think it is this concept that the families of the residents also may not get.
Thursday, November 13, 2008
Week Five- Case 3
Week Five- Thurday 13th November
We were on our final bus outing with 12 residents and during a tea and cakes a lady had a TIA. It was quite scary at the time as I had never actually seen one happen before. The 2 PTA's were there trying to get her attention and get her out of it. The main thing to avoid was her choking or blocking her airway so they held her head up from being stooped over while I tried to jeep her upright in her chair. She was breathing/gasping quite deeply and her hand/legs did tremor.
After about 10mins she finally came out of it which was when the RN from BF was on the phone. We got her standing up then back down, raising both arms up and gripping onto my hands as a base check to see if we still needed to get an ambulance. She was well enough to go back on the bus home.
I think the situation was handled well for what we were able to do. We protected her from further injury by stabiling her and removing any potential hazards (ie teeth). We were also able to stay relatively clam while we got the neccessary information from the RN over the phone. In a similar situation, I think they will now have a wheelchair on the bus just in case something similar or worse happens.
We were on our final bus outing with 12 residents and during a tea and cakes a lady had a TIA. It was quite scary at the time as I had never actually seen one happen before. The 2 PTA's were there trying to get her attention and get her out of it. The main thing to avoid was her choking or blocking her airway so they held her head up from being stooped over while I tried to jeep her upright in her chair. She was breathing/gasping quite deeply and her hand/legs did tremor.
After about 10mins she finally came out of it which was when the RN from BF was on the phone. We got her standing up then back down, raising both arms up and gripping onto my hands as a base check to see if we still needed to get an ambulance. She was well enough to go back on the bus home.
I think the situation was handled well for what we were able to do. We protected her from further injury by stabiling her and removing any potential hazards (ie teeth). We were also able to stay relatively clam while we got the neccessary information from the RN over the phone. In a similar situation, I think they will now have a wheelchair on the bus just in case something similar or worse happens.
Week Five- Client 2
Week Five- Tuesday 11th November
This patient suffers from painful arthritis in her left hand. She gets pain all the time but especially inthe mornings. The physio department bought a wax bath while we were there and we thought that this lady should benefit from using the wax. She also was keen to come down and try it. After all the tests, warnings, explanations etc were given, she put her hand in and had a very exaggerated reaction to the heat, but as soon as her mind was taken off her hand she showed no symptoms of it being too hot.
I think that by distracting her from the hand we were able to see that it was just her mind that was causing her pain and that if was safe to continue treatment. In a similar case, we would probably do the same thing in trying to divert their attention away from the area being treated. The next day the same lady wanted to come back do it again saying that it wasnt that hot, her reaction the next time was defiently more appropriate and she had also just watched another resident have it done to them without any complaints!
This patient suffers from painful arthritis in her left hand. She gets pain all the time but especially inthe mornings. The physio department bought a wax bath while we were there and we thought that this lady should benefit from using the wax. She also was keen to come down and try it. After all the tests, warnings, explanations etc were given, she put her hand in and had a very exaggerated reaction to the heat, but as soon as her mind was taken off her hand she showed no symptoms of it being too hot.
I think that by distracting her from the hand we were able to see that it was just her mind that was causing her pain and that if was safe to continue treatment. In a similar case, we would probably do the same thing in trying to divert their attention away from the area being treated. The next day the same lady wanted to come back do it again saying that it wasnt that hot, her reaction the next time was defiently more appropriate and she had also just watched another resident have it done to them without any complaints!
Week 5- Client 1
Week Five- Monday 10th November
This patient is one who we have been seeing over our whole time at Bethanie. She suffered from a right side hemi-paresis, which has resulted in left side paralysis and also left side neglect. We noticed this becasue she would never respnd or look at the person who was standing on her left side.
We do stretches with the left arm of this patient. I think we do it well and always encourage her to do other exercises with her right hand to try and distract her from the stretch. To improve this treatment we could massage her left arm before doing the streches to try and improve the available ROM. When she looks particularly tight we do massage lightly.
Overall things have gone well today, we also did our end of unit assessment of a resident with Kate looking on and marking us. I think I did pretty well!
This patient is one who we have been seeing over our whole time at Bethanie. She suffered from a right side hemi-paresis, which has resulted in left side paralysis and also left side neglect. We noticed this becasue she would never respnd or look at the person who was standing on her left side.
We do stretches with the left arm of this patient. I think we do it well and always encourage her to do other exercises with her right hand to try and distract her from the stretch. To improve this treatment we could massage her left arm before doing the streches to try and improve the available ROM. When she looks particularly tight we do massage lightly.
Overall things have gone well today, we also did our end of unit assessment of a resident with Kate looking on and marking us. I think I did pretty well!
Friday, November 7, 2008
Week Four- Case 3
Week Four- Thursday 6th November
Case 3
In the activity centre, there is a large plasma TV and a Nintendo Wii. The Wii is available for the residents to use but it is not used very often. The OT department are responsible for the machine and even they don’t know how to work all the parts of it. We went to our supervisor and asked what she thought about us trying to get it going in the group activity classes. She and the physio department really wanted to see it get up and going so we had full support from them to learn how to use it and then teach the residents.
I think we showed initiative in bringing up the idea and trying to get the residents to learn something new and fun. We spoke to the right people to make sure we weren’t stepping on anyone’s toes and organised appropriate times to practise. We then set up the game during an activity/games group and brought people over who we thought would be interested. By the end of the session we had 6 men around the TV who all had a go at playing one or all of the games.
The most successful sport was the boxing, this was because they didn’t have to press any buttons and the movements needed to box were fairly straight forward. Golf and tennis were the next easy to play and the hardest was ten pin bowling as it required timing while pressing/releasing buttons. To improve the group next time, we could try and get more people to come and even just watch other residents play. There is the social aspect as well in encouraging the people who are playing and congratulating and reacting to good or bad shots.
Week Four- Client 2
Week Four- Wednesday 5th November
Client Two
I was a little concerned with the presentation of this patient. She was attending the open gym session and was on a circulation booster for her feet. Her left foot became very discoloured and was a deep purple colour. Her left side is also her affected side of her right hemi-paresis. Communication with this patient was also a little more difficult as she suffers from expressive aphasia. But she did indicate it was painful over her toes and around the heel.
I think I palpated the area well, I was very gentle and was really only seeing if the areas was hot which it wasn’t. I then suggested we just elevate the foot until the physio came and had a look. When we did this the colour went back to almost normal within 10seconds. As I hadn’t seen anything like this before, I was a little unsure of what to do next. The physio and registered nurse then came in and had a look, they too were unsure but just took her back to her room to elevate it. Later I saw the resident with a pressure stocking on but she still indicated it was sore and hadn’t got any better since we first noticed it in the morning.
In a similar case I would know to elevate the limb straight away to try and reduce the discolouration. I would then continue to manage the pain based on what the resident prefers ie heat/ice. This day has again been an interesting one. Seeing the resident with an unusual condition just makes you think a little more about what could possibly be the problem and how you can reduce the symptoms.
Week Four- Client 1
Week Four- Monday 3rd November
Client One
This client was another resident who suffered from lymph oedema of her arm. As I had previously done a lymph oedema massage on a different patient I knew the technique which was required for it to be effective. I was fairly confident about meeting the resident but I knew her condition would be slightly different to the one I’d seen previously and would need to adjust my technique accordingly.
I think that I approached the resident well as I was told prior to seeing her that she doesn’t always respond well to change/new people. I made sure I knocked on her door, introduced myself clearly, asked her if she wouldn’t mind if I did her massage and reassured her that I had done this type of massage before. The PTA was also present to give me any feedback.
To possibly improve the session would be to put the residents arm in a more relaxed position ie use more pillows to prop it up or take her to a more comfortable chair so she can really relax during the treatment. I would also continue to check if the technique I was doing was one that she preferred.
Overall I think the day has gone well as I again got to see a different resident with an interesting condition. I can continue to practise and improve the massage technique for lymphatic drainage.
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