I think I was right to feel nervous and scared before my placement as the first day was quite an overload of information, procedures and protocols. Also seeing a pt day1 post op on our own was a bit of a shock! But as I became more familiar with the day to day routine it became a very educational and rewarding experience.
We were requried to know about fractures, healing times,medications, medical conditions appropriate referrals, post op orders, certain splints/aids/frames/pressure garments. And we were required to carry out a full subjective ax, mobility ax, various other objective measures, documentation, participation in handover meetings, filling out referrals (outpatient depts, Kaleeya, RITH, TCS, other hosptials and health campus's) and in our last 2 weeks coordinating the other physio's on the ward.
One thing I didn't anticipate was the amount you need to liase with other members of the hosp esp OT, nursing staff, doctors and discharge planners. The daily handover meetings were essential to keep up with changing medical status and discharge plans.
Sunday, August 30, 2009
Topic Three: Intervention/Planning
Situation:
80yo lady with #NOF and Parkinson's disease. Balance, involuntary movements and amount of freezing fluctuates thoughout the day according to meds cycle. Day to day progress also varies. Pt lives alone so cannot be discharged from physio until her meds are under control and she can function safely and independantly.
Task:
Give pt exercises and strategies to better cope with her Parkinson's symptoms
Action:
From an ortho point of view this lady has made very good progress, getting up first day of pathway with almost equal WB through the affected leg. Therefore focus was on adressing her balance and freezing. I took pt to the gym to practise turning using the fig8. Also reinforcing strategies to use in the event of her freezing up ie. 1,2,1,2; R L; clock turning. For balance reactions also did some rhythmic stabilisations mainlly focussing on AP direction as opposed to lateral stabilisations as she tended to fall backwards
Result:
Pt had no trouble with the turning aspect of the fig 8. I would have progressed to turning in a more sharp circle to prepare for her home environment. The pt found the balance exercises and rhythmic stabs a little more difficult mainly due to her fear of falling backwards.
Evaluation:
Ortho: doing extremely well in terms of mobility, WB and ambulation. Following pathway
Neuro: symptoms are preventing her d/c home. Unsafe due to unpredictability of symptoms (dyskinesia vs freezing).
Patient t/f to rehab ward for further treatment and monitoring of her medications
Strategies:
Treating the pt as a whole and adressing all impairments not just the broken bone
80yo lady with #NOF and Parkinson's disease. Balance, involuntary movements and amount of freezing fluctuates thoughout the day according to meds cycle. Day to day progress also varies. Pt lives alone so cannot be discharged from physio until her meds are under control and she can function safely and independantly.
Task:
Give pt exercises and strategies to better cope with her Parkinson's symptoms
Action:
From an ortho point of view this lady has made very good progress, getting up first day of pathway with almost equal WB through the affected leg. Therefore focus was on adressing her balance and freezing. I took pt to the gym to practise turning using the fig8. Also reinforcing strategies to use in the event of her freezing up ie. 1,2,1,2; R L; clock turning. For balance reactions also did some rhythmic stabilisations mainlly focussing on AP direction as opposed to lateral stabilisations as she tended to fall backwards
Result:
Pt had no trouble with the turning aspect of the fig 8. I would have progressed to turning in a more sharp circle to prepare for her home environment. The pt found the balance exercises and rhythmic stabs a little more difficult mainly due to her fear of falling backwards.
Evaluation:
Ortho: doing extremely well in terms of mobility, WB and ambulation. Following pathway
Neuro: symptoms are preventing her d/c home. Unsafe due to unpredictability of symptoms (dyskinesia vs freezing).
Patient t/f to rehab ward for further treatment and monitoring of her medications
Strategies:
Treating the pt as a whole and adressing all impairments not just the broken bone
Monday, August 17, 2009
Topic Two: Intervention
Situation:
34yr old single mother with whiplash injury from car accident. Patient also totally blind and son blind in one eye. Lives alone with son and usually independant in all ADL's. Patient has developed a resting tremor that increases with movement/effort (tremors only present since accident). Also complains of severe muscle cramps which she recieves heat packs and hot towels for. Unable to t/f independantly, x1 assist lie to sit and sitting balance, x2 assist STS and standing balance. Non-ambulant.
Task:
Return patient to previous level of function and independance. Determine underlying cause for the unexplained tremor/cramps.
Action:
Patient underwent Cx spine MRI, head MRI, neuro review, pysch review with no conclusive explanation but deemed safe to mobilise and ambulate.
When I saw pt, there was a visible resting tremor, as a preparatory treatment for t/f's I applied approximation/pressure to her shoulder, hip, knee and ankle joints.
Result:
Tremor ceased immediatly. Pt reports first time she has been still since accident. Pt able to independantly t/f to SOEOB and maintain sitting balance independantly. STS x1 min assist, standing independantly with ZF.
Evaluation:
As a result of my intervention, this patient was able to make huge progress in a short amount of time to work towards achieving her goal of functional independance. My strengths in this case was having the confidence to suggest a carry out an intervention which others had not considered. As this Rx is not common on a ortho ward, I was able to demonstrate my knowlege and clinical reasoning in another area of physio based on her neurological presentation.
Strategies:
Thinking outside the ortho box and considering/using other techniques in our physio tool box!
34yr old single mother with whiplash injury from car accident. Patient also totally blind and son blind in one eye. Lives alone with son and usually independant in all ADL's. Patient has developed a resting tremor that increases with movement/effort (tremors only present since accident). Also complains of severe muscle cramps which she recieves heat packs and hot towels for. Unable to t/f independantly, x1 assist lie to sit and sitting balance, x2 assist STS and standing balance. Non-ambulant.
Task:
Return patient to previous level of function and independance. Determine underlying cause for the unexplained tremor/cramps.
Action:
Patient underwent Cx spine MRI, head MRI, neuro review, pysch review with no conclusive explanation but deemed safe to mobilise and ambulate.
When I saw pt, there was a visible resting tremor, as a preparatory treatment for t/f's I applied approximation/pressure to her shoulder, hip, knee and ankle joints.
Result:
Tremor ceased immediatly. Pt reports first time she has been still since accident. Pt able to independantly t/f to SOEOB and maintain sitting balance independantly. STS x1 min assist, standing independantly with ZF.
Evaluation:
As a result of my intervention, this patient was able to make huge progress in a short amount of time to work towards achieving her goal of functional independance. My strengths in this case was having the confidence to suggest a carry out an intervention which others had not considered. As this Rx is not common on a ortho ward, I was able to demonstrate my knowlege and clinical reasoning in another area of physio based on her neurological presentation.
Strategies:
Thinking outside the ortho box and considering/using other techniques in our physio tool box!
Sunday, August 2, 2009
Topic One: Communication
Situation:
Young male, day3 post tib/fib fracture. Had been progressing slowly and is needing lots of motivation to get out of bed. Nursing staff pressuring us to get him up and out to free up the bed. Lives about 40mins from hospital and home has 30 stairs which were unavoidable. After eventually getting him to the gym, practising stairs, he was deemed safe to go home but said he didn't want to go and why couldn't go tomorrow. Mum also didn't want to pick him up becasue she had just got home
Task:
Reassure patient to gain his confidence. Question as to why he didnt want to go home. Inform mother of the need for him to go home today
Action:
Practised the stairs an extra few times so he really got the hang of it. Gave him alternate options of getting up the stairs if he felt tired or leg was too sore once he got home. Spoke to the mum on the phone, answered her queries and gave her the ward contact info if she had any other questions.
Result:
Patient discharged from the hospital that afternoon, taxi was offered to take him if mum didnt want to come but she ended up making the trip back to get him.
Evaulation:
Strengths- communication with both patient and his mother, gave clear explanations and reasons for the decisions made
Weakness- could have informed the mother of our discharge plan earlier so she could have made arrangements to pick him up
Strategies:
Get a better idea of timeframes expected for patient stays, eg medical, age and urgency factors
Young male, day3 post tib/fib fracture. Had been progressing slowly and is needing lots of motivation to get out of bed. Nursing staff pressuring us to get him up and out to free up the bed. Lives about 40mins from hospital and home has 30 stairs which were unavoidable. After eventually getting him to the gym, practising stairs, he was deemed safe to go home but said he didn't want to go and why couldn't go tomorrow. Mum also didn't want to pick him up becasue she had just got home
Task:
Reassure patient to gain his confidence. Question as to why he didnt want to go home. Inform mother of the need for him to go home today
Action:
Practised the stairs an extra few times so he really got the hang of it. Gave him alternate options of getting up the stairs if he felt tired or leg was too sore once he got home. Spoke to the mum on the phone, answered her queries and gave her the ward contact info if she had any other questions.
Result:
Patient discharged from the hospital that afternoon, taxi was offered to take him if mum didnt want to come but she ended up making the trip back to get him.
Evaulation:
Strengths- communication with both patient and his mother, gave clear explanations and reasons for the decisions made
Weakness- could have informed the mother of our discharge plan earlier so she could have made arrangements to pick him up
Strategies:
Get a better idea of timeframes expected for patient stays, eg medical, age and urgency factors
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