Hi everyone,
I recently had my rural prac and I was given some good advice from my supervisor that I thought I might share with you all.
I was in outpatients one afternoon when the patient I was expecting didn't turn up. So my supervisor told me I could sit in on her new patient who was due in about 5 minutes. She told me it was a stroke patient and asked me to perform the subjective and objective assessment. Seeings as though I havent had my neuro prac yet, I had a mini freak-out as I realised I had no idea what to do!
I spoke to my supervisor about the fact that I wasn't confident with neuro which was when she gave me the advice which was that if you are in this sort of setting and I patient comes in with a condition that you know very little or nothing about, or arent overly confident in that area, it is best to simply ask the patient what their problem is. If you look at the patient from a hollistic and more functional approach, and find out what they are having trouble with, and what they would like out of physio (goals and expectations), you can use this to guide your treatment. Therefore, you dont need to always do a specific assessment, but guide your assessment and treatment by the patients problems.
I have learnt from this that as long as you can find out what the patients problems are, and provide an effective treatment based on this, you dont need to be an expert in every area. I think this will help in the future if I am faced with a patient im not sure about.
Overall if you follow what the patient says and improve their perceived problems, they will be happy and satisfied with the treatment you have provided. So pretty much you cant go wrong!!
Tuesday, August 26, 2008
Monday, August 25, 2008
Impressed
Hi everyone,
Just a note to - again! - let you know I am reading all your posts, and to also let you know that I continue to be more and more impressed with all of them.
Trudi
Just a note to - again! - let you know I am reading all your posts, and to also let you know that I continue to be more and more impressed with all of them.
Trudi
paeds
I’m doing paediatrics at the moment and the thing I think I mostly find difficult is being able to change my attitude. By this I mean, that I am so used to treating adults for the last 6 months, my supervisor’s are encouraging me to let the barriers down, be silly, make jokes and just have some fun with it all. I think I’m finding it so hard because I still am trying to portray that professional image, whereas with kids, I don’t think it matters as much as it does with our adult population of patients. Kids don’t want to do physio if there is some authoritarian figure trying to tell them to do something, especially if they are in pain. I’m also finding it hard not explaining everything in detail, as kids don’t particularly need to know because they wouldn’t understand, let alone don’t want to know the nitty gritty of why you are doing something. It’s hard I think because it is changing everything we have learned in the last 3 years and putting it completely back to front and upside down and changing all the key things that we have had drummed into us.
Did anybody else have this same issue to any extent, and was there anything that you did to help bring out the inner child in you?
Did anybody else have this same issue to any extent, and was there anything that you did to help bring out the inner child in you?
Sunday, August 24, 2008
Neuro/Safety
I am on a neurology placement at the moment
A patient i was allocated was an elderly gent who had a CVA following a 70% occlusion of his left ICA. Upon assessment his voluntary control of UL and LL was surprisingly good but there was some associated balance deficits mainly in standing but when it came time to assess his perceptual deficits it was evident he was suffering from expressive aphasia. During his subjective he often became frustrated as he could string sentences together but would be unable to verbalise key words unless i stated them then he would agree or disagree.
We finally got into the gym and from my previous chat with him i had gathered he was understanding me and answering my questions well. We were working on his dynamic sitting balance and other issues and he had performed quite well. When it came time to end the session there was 1 last t/f to perform from plinth to w/c. Once we were in standing i asked him to step towards his right towards the w/c once he had shifted his weight onto his left with close guarding and he proceeded to step in the complete opposite direction comprising his balance and safety. We eventually safely negotiated our way to the w/c. Because of the nature of the stroke i was talking to the Dr/OT and was querying receptive aphasia/ideamotor,ideational apraxia all of which they considered not present in this gentlemen.
This situation showed me that although we sometimes tend to take a person ability to perform certan tasks for granted it pays to underestimate their abilities slightly to ensure safety. I will now monitor my patients closely to ensure tasks are done correctly and safely.
A patient i was allocated was an elderly gent who had a CVA following a 70% occlusion of his left ICA. Upon assessment his voluntary control of UL and LL was surprisingly good but there was some associated balance deficits mainly in standing but when it came time to assess his perceptual deficits it was evident he was suffering from expressive aphasia. During his subjective he often became frustrated as he could string sentences together but would be unable to verbalise key words unless i stated them then he would agree or disagree.
We finally got into the gym and from my previous chat with him i had gathered he was understanding me and answering my questions well. We were working on his dynamic sitting balance and other issues and he had performed quite well. When it came time to end the session there was 1 last t/f to perform from plinth to w/c. Once we were in standing i asked him to step towards his right towards the w/c once he had shifted his weight onto his left with close guarding and he proceeded to step in the complete opposite direction comprising his balance and safety. We eventually safely negotiated our way to the w/c. Because of the nature of the stroke i was talking to the Dr/OT and was querying receptive aphasia/ideamotor,ideational apraxia all of which they considered not present in this gentlemen.
This situation showed me that although we sometimes tend to take a person ability to perform certan tasks for granted it pays to underestimate their abilities slightly to ensure safety. I will now monitor my patients closely to ensure tasks are done correctly and safely.
Interpreter
On a recent placement I had a patient who had moved to Australia from Indonesia less than 10 years ago and spoke very good conversational English and therefore I saw her initially with no interpreter. On further questioning I found that although her English initially appeared to be good she struggled with a lot of the questions during the subjective examination. I continued to rephrase the questions and used simple and common terms and managed to get enough information to perform an objective assessment and treatment. Next time I booked her in I also booked an interpreter and asked for ‘Indonesian.’ At the next appointment I attempted to gain further information from the subjective examination although the patient was still having trouble even with the interpreter. I was not sure why I could not get a thorough subjective from the patient.
At the next appointment a different interpreter was used and I was relieved that I was finally able to gain a thorough subjective examination. Following the appointment the patient told me that the interpreter from last week was Malaysian and therefore didn’t speak true Indonesian, which is why she had trouble understanding, whereas this interpreter was from Indonesia and spoke true Indonesian. This made both the patient and myself a lot happier. Really I feel that an Indonesian interpreter should have been booked in for the initial assessment and realise that it is important for gaining as much information from the patient as you can to provide an effective treatment, as well as making the patient feel as comfortable as possible.
At the next appointment a different interpreter was used and I was relieved that I was finally able to gain a thorough subjective examination. Following the appointment the patient told me that the interpreter from last week was Malaysian and therefore didn’t speak true Indonesian, which is why she had trouble understanding, whereas this interpreter was from Indonesia and spoke true Indonesian. This made both the patient and myself a lot happier. Really I feel that an Indonesian interpreter should have been booked in for the initial assessment and realise that it is important for gaining as much information from the patient as you can to provide an effective treatment, as well as making the patient feel as comfortable as possible.
Saturday, August 23, 2008
L CVA
Hi, my placement now is in neuro.
My patient was suffered from L CVA. This patient did surprisingly well on initial assessment without any major complaint, compare to the result showed on MRI.
As we know the results from MRI and presenting S & S of a patient sometimes do not match, but I was still surprised how capable this patient was physically.
The major problems on this patient were dysphasia (expressive > receptive) and dyspraxia. As we all have learned the strategies to address for dyspraxia/apraxia at uni, I was using some of them such as ‘simple commands/instructions’, ‘visual, tactile & kinesthetic input’ and ‘demonstration’ as much as possible.
In terms of addressing for dysphasia, my patient and I made a rule as ‘thumb up’ for ‘YES’ and ‘thumb down’ for ‘NO’. This patient seemed to understand the simple instructions or commands, but some of the responses from this patient were not clear in my head. It could be from my instruction which made this patient confused, could be from cognitive involvement, or could be decreased concentration by long Ax. I have realized there were many possibilities could contribute to this patient which made me difficult to write a note on this patient.
On the 3rd day, this patient presented having difficulty to grab a cup on R UL. During this patient was performing this task, it seemed easier to hold a cup from top using index finger inside and rest of fingers and thumb were outside. As this patient was asked to hold from side way which we normally do, this patient was capable but having difficulty more than from top. At this stage, this patient started having tears in front of me. Imagine how stressful or frustrate knowing the activities or tasks not be done smoothly or taking longer than used to be. In addition, this patient was unable to express self verbally.
I have explained to this patient that it was not the exactly same situation but I could relate to my experience how frustrate not being able to express self. That explanation made this patient more in tears. I have realized I should not say anything to emphasize this patient’s emotion, but it was too late. I started to encourage this patient on keep trying and practicing to get better. At the end of the session, this patient held my hands say nothing but keep nodding the head. Did it mean this patient understood the reasons for having PT Rx or where this patient was heading to? Hopefully this patient was happy with my explanation on the session.
I have learnt that those patients especially who suffered from stroke need lots of encouragement and important to let them see their improvement in each PT treatment even though it was small.
My patient was suffered from L CVA. This patient did surprisingly well on initial assessment without any major complaint, compare to the result showed on MRI.
As we know the results from MRI and presenting S & S of a patient sometimes do not match, but I was still surprised how capable this patient was physically.
The major problems on this patient were dysphasia (expressive > receptive) and dyspraxia. As we all have learned the strategies to address for dyspraxia/apraxia at uni, I was using some of them such as ‘simple commands/instructions’, ‘visual, tactile & kinesthetic input’ and ‘demonstration’ as much as possible.
In terms of addressing for dysphasia, my patient and I made a rule as ‘thumb up’ for ‘YES’ and ‘thumb down’ for ‘NO’. This patient seemed to understand the simple instructions or commands, but some of the responses from this patient were not clear in my head. It could be from my instruction which made this patient confused, could be from cognitive involvement, or could be decreased concentration by long Ax. I have realized there were many possibilities could contribute to this patient which made me difficult to write a note on this patient.
On the 3rd day, this patient presented having difficulty to grab a cup on R UL. During this patient was performing this task, it seemed easier to hold a cup from top using index finger inside and rest of fingers and thumb were outside. As this patient was asked to hold from side way which we normally do, this patient was capable but having difficulty more than from top. At this stage, this patient started having tears in front of me. Imagine how stressful or frustrate knowing the activities or tasks not be done smoothly or taking longer than used to be. In addition, this patient was unable to express self verbally.
I have explained to this patient that it was not the exactly same situation but I could relate to my experience how frustrate not being able to express self. That explanation made this patient more in tears. I have realized I should not say anything to emphasize this patient’s emotion, but it was too late. I started to encourage this patient on keep trying and practicing to get better. At the end of the session, this patient held my hands say nothing but keep nodding the head. Did it mean this patient understood the reasons for having PT Rx or where this patient was heading to? Hopefully this patient was happy with my explanation on the session.
I have learnt that those patients especially who suffered from stroke need lots of encouragement and important to let them see their improvement in each PT treatment even though it was small.
Friday, August 22, 2008
Time limits
Im on my rural prac at the moment covering the wards at the regional hospital. I have one patient who has an extensive medical history. He was transferred from one of the tertiary hospitals in Perth back to this hospital in his home town. I had treated him twice for his cardiorespiratory impairments, one large component of which is ambulation.
There was one comment that he made which made me think about how we do things as a ward physio. His comment was that we dont spend enough "quality" time with patients, that we have a quota and need to fill it. After some conversastion about what he had said, I went away thinking that perhaps there are occassions that we may not be compassionate enough to patients, especially if we have a large caseload to complete that day. Whilst I understand that we cannot spend an hour with each patient in a ward setting, perhaps an extra 5 minutes here and there with the more deconditioned patients might go some way toward keeping their faith in the profession. The next time I saw the patient, I did this and he seemed to respond a little better to the session - so perhaps there is something in this (or maybe its just this patient).
There was one comment that he made which made me think about how we do things as a ward physio. His comment was that we dont spend enough "quality" time with patients, that we have a quota and need to fill it. After some conversastion about what he had said, I went away thinking that perhaps there are occassions that we may not be compassionate enough to patients, especially if we have a large caseload to complete that day. Whilst I understand that we cannot spend an hour with each patient in a ward setting, perhaps an extra 5 minutes here and there with the more deconditioned patients might go some way toward keeping their faith in the profession. The next time I saw the patient, I did this and he seemed to respond a little better to the session - so perhaps there is something in this (or maybe its just this patient).
Subscribe to:
Posts (Atom)