I am on an orthopaedic inpatient placement where most patients have been fairly straight forward total hip or knee replacements. One patient that I had however was quite interesting. It is standard protocol that patients get up to go for a walk with a pulpit frame day 2 following their surgery and so far most patients have been fine except for the occasional complication with low blood pressure. However, this patient was very unusual in that she was not cognitively all there despite being fine in the pre-op clinic only a couple of weeks before, when transferred to the edge of the bed she was unable to sit on the edge of the bed with less than 2 assist, she appeared to have problems with depth perception and very was very weak and unable to move in bed without maximal assistance of 2 people.
Everybody started to panic that this woman had had an undetected stroke or was in the early stages of a stroke. The neuro physio took a look at her that afternoon and she had improved immensely. They put the behaviour down to being knocked around by the PCA as there was no neurological deficit. This incident really pointed out to me that although you may be working in one field of physiotherapy you must always be looking out for other problems that could be present as the physiotherapist may be the first person to pick this up. I had previously thought that anything like this would have already been picked up by the medical team but this situation really highlighted how important it is to always be aware and on the look out for anything like this and that if you do suspect something you can never be too careful and always make sure that it gets checked out.
2 comments:
I also have had to think about differing areas of physio during my current prac. In the aged care ward the patients range from having had a fall, to problems with their heart, to problems with their lungs, to broken hips and replacements. And if they are not in the ward for one of these problems then they always have something in their PMHx. So While reading their notes i look for any other problems they may have and often need to combine my subjective assessment to incorporate all the questions for a cardio patient, like cough, sputum, SOB etc woth the line of questioning for a falls pt, how many falls last 12 months, how did they happen, where were you etc.
Thats very true trace. My first placement of the year was gerontology and when I was seeing a patient with Parkinsons disease for a follow up, it turned out that he actually came in due to shoulder pain, which turned out to be an impingement problem. After a few minutes of panicking I managed to treat his shoulder- im not sure how effective I would've been though!!
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