Hi,
I just wanted to write about what I felt last Thursday at my placement. As it was the last week of this placement, my supervisor wanted to check on my caseload and gave me 10 patients to see. So I started to see the first three patients who were in high priority.
The first patient was 64yo male patient who has oesophagocarcinoma which my grandma died of two years ago and the survival rate after op is only 15-20%. I met this patient in my first week and has seen him twice a day to improve his lung function and walking tolerance. Although he seemed doing well with physio, he has had two re-operation due to gastric fistula. After repeated operations, he seemed losing confidence and anxious about his future. He reminds me of my grandma and it's hard for me to see him going through all that. Anyways he was very anxious and his voice was shaking during physio session with me.
Then I saw this BKA patient to ambulate him on zimmer frame and do some bed exercises. He didn't look well and finally threw up in front of me as soon as I applied compression bandage on his stump.
Hoo..Next patient is a very fragile 91yo lady, who admitted with abdominal distention and docs suspect that she has a cancer, and I met her for the first time. By accident, while I was sitting in physio gym behind the board, I heard when the doc and her family were having a meeting about sending her to the palliative care department.
All of these accumulated and I got very emotional and was in tears. I think I was never exposed to the environment where there are so many sick patients, and I couldn't stay in hospital any longer on that day and my supervisor sent me home early. Sometimes it's hard to control my emotions and don't know how to deal with it even though I know it's not professional to show tears in front of patients.
In Sun
Sunday, March 30, 2008
Thursday, March 27, 2008
Reflection on my cardiopulmonary placement
Hi All,
This is my last week of cardiopulmonary placement so I have decided to reflect what I have learnt throughout last 4 weeks.
I have had an opportunity to treat post CABG and valves repair surgery. I have assessed patients with respiratory problems and when appropriate enrolled them to pulmonary rehab classes. Being on medical/surgical ward, I had some straightforward patients as well as some more complex patients such for example male with bilateral ankles fracture managed with external fixation, female with flap (thumb-thigh) plus external fixation. I was helping in supervising pulmonary rehab classes twice a week. I found that most of people participating in these classes are highly motivated and eager to exercise despite having some limitations. It was great experience-“living evidence base physiotherapy” when these patients were telling about how much difference pulmonary rehab program made in their lives, how their quality of life improved and exercise tolerance increased as well as management of breathless/fear.
I had opportunity to observe and learnt some things we had not been exposed to at Uni such as teamwork, interpersonal skills. My supervisor has been bombarding me with questions in unstressed manner, which was great! He has been willing to share his experience and always encouraging me to look “outside box”.
Daria
This is my last week of cardiopulmonary placement so I have decided to reflect what I have learnt throughout last 4 weeks.
I have had an opportunity to treat post CABG and valves repair surgery. I have assessed patients with respiratory problems and when appropriate enrolled them to pulmonary rehab classes. Being on medical/surgical ward, I had some straightforward patients as well as some more complex patients such for example male with bilateral ankles fracture managed with external fixation, female with flap (thumb-thigh) plus external fixation. I was helping in supervising pulmonary rehab classes twice a week. I found that most of people participating in these classes are highly motivated and eager to exercise despite having some limitations. It was great experience-“living evidence base physiotherapy” when these patients were telling about how much difference pulmonary rehab program made in their lives, how their quality of life improved and exercise tolerance increased as well as management of breathless/fear.
I had opportunity to observe and learnt some things we had not been exposed to at Uni such as teamwork, interpersonal skills. My supervisor has been bombarding me with questions in unstressed manner, which was great! He has been willing to share his experience and always encouraging me to look “outside box”.
Daria
Monday, March 24, 2008
Anxious patient
Hi All,
I am on my Cardio placement and this week I have learnt how important non-verbal communication is.
My patient is 75 years old after CABGx3 and MVR (nil complications). When I came first time the patient reported to me how well she was after surgery, how diligently she was performing her exercises and that doctors and nursing staff were saying to others patients that they should take example by Mrs.SK. Later during the same visit patient told me that she is excepting to stay at hospital for 8-12 weeks! Additionally, patient mentioned that is scared to stay at home on her own during night. In patient’s notes, I found that Mrs.SK had pharmacological treatment for depression. She is 7 days post CABG, independent with self-caring and ambulation around ward (including stairs), able to perform her HEP independently and correctly, no chest problems. However, patient complained that her (R) hand and leg shaking. At the beginning, I worried about this shaking so I reported to my supervisor. My supervisor made me aware that it does not need be “serious neurological sign” but just anxiety++. Each time when I have been treating this patient, I was trying to match evidence for example auscultation, SpO2/HR/BP) with what patient was saying. I was looking as well for any discrepancy between patient’s performance, verbal and non-verbal communication. During team meeting, other AHS members bring anxiety issue out, too. From the physio point patient is safe for discharge but I think patient would benefit from psychological/counselling referral. As this particular patient is from non-English background with limited English skills, it makes this situation even more complicated.
I would like to know if you have treated similar patient and how you dealt with anxious++ patient from non-English background. Thanks for any suggestions.
Daria
I am on my Cardio placement and this week I have learnt how important non-verbal communication is.
My patient is 75 years old after CABGx3 and MVR (nil complications). When I came first time the patient reported to me how well she was after surgery, how diligently she was performing her exercises and that doctors and nursing staff were saying to others patients that they should take example by Mrs.SK. Later during the same visit patient told me that she is excepting to stay at hospital for 8-12 weeks! Additionally, patient mentioned that is scared to stay at home on her own during night. In patient’s notes, I found that Mrs.SK had pharmacological treatment for depression. She is 7 days post CABG, independent with self-caring and ambulation around ward (including stairs), able to perform her HEP independently and correctly, no chest problems. However, patient complained that her (R) hand and leg shaking. At the beginning, I worried about this shaking so I reported to my supervisor. My supervisor made me aware that it does not need be “serious neurological sign” but just anxiety++. Each time when I have been treating this patient, I was trying to match evidence for example auscultation, SpO2/HR/BP) with what patient was saying. I was looking as well for any discrepancy between patient’s performance, verbal and non-verbal communication. During team meeting, other AHS members bring anxiety issue out, too. From the physio point patient is safe for discharge but I think patient would benefit from psychological/counselling referral. As this particular patient is from non-English background with limited English skills, it makes this situation even more complicated.
I would like to know if you have treated similar patient and how you dealt with anxious++ patient from non-English background. Thanks for any suggestions.
Daria
Friday, March 21, 2008
hypothyroidism and heart conditions
It was my second last week on my cardio placement this week. I've met a number of patients who has undergone cardiac surgery such as CABG and also has hypothyroidism in the past medical history. So, I was wondering what it is and what's the relationship between hypothyroidism and heart conditions.
As background information, the thyroid gland is located at the base of the neck, just below Adam's apple and releases hormones such as thyroxine, triiodothyronine and calcitonin, which regulate all aspects of metabolism in our body. they maintain the rate at which the body uses fats and carbohydrates, control body temperature, influence heart rate and regulate the production of protein.
Causes of hypothyroidism are autoimmune disease, treatment for hyperthyroidism, radiation therapy used to treat cancers of the head and neck, thyroid surgery removing all or a large portion of thyroid, meds such as lithium, congenital disease, pituitary disorder, pregnancy and iodine deficiency.
Person with this disease presents with fatigue, depression, mod weight gain, cold intolerance, sleepiness, muscle cramps, vague aches and pains, etc. Mostly it's well controlled by medication though untreated hypothyroidism can lead to cardiomyopathy, worsening heart failure and pleural effusion.
Heart problems are common complication of hypothyroidism primarily because high levels of LDL cholesterol, an increase in total cholesterol levels and impaired the contractility of the heart leading to an enlarged heart and heart failure.
Thus, it's important to screen the condition by blood test and also control by the synthetic thyroid hormone levothyroxine (for instance, you can find Levothyroid in patient's med chart).
Hope it's useful information if you were wondering about hypothyroidism:)
As background information, the thyroid gland is located at the base of the neck, just below Adam's apple and releases hormones such as thyroxine, triiodothyronine and calcitonin, which regulate all aspects of metabolism in our body. they maintain the rate at which the body uses fats and carbohydrates, control body temperature, influence heart rate and regulate the production of protein.
Causes of hypothyroidism are autoimmune disease, treatment for hyperthyroidism, radiation therapy used to treat cancers of the head and neck, thyroid surgery removing all or a large portion of thyroid, meds such as lithium, congenital disease, pituitary disorder, pregnancy and iodine deficiency.
Person with this disease presents with fatigue, depression, mod weight gain, cold intolerance, sleepiness, muscle cramps, vague aches and pains, etc. Mostly it's well controlled by medication though untreated hypothyroidism can lead to cardiomyopathy, worsening heart failure and pleural effusion.
Heart problems are common complication of hypothyroidism primarily because high levels of LDL cholesterol, an increase in total cholesterol levels and impaired the contractility of the heart leading to an enlarged heart and heart failure.
Thus, it's important to screen the condition by blood test and also control by the synthetic thyroid hormone levothyroxine (for instance, you can find Levothyroid in patient's med chart).
Hope it's useful information if you were wondering about hypothyroidism:)
Monday, March 17, 2008
listen to the patients
I'm in cardiothoracic ward on my cardio prac and got the mid-placement assessment last week. I had 2 sessions with this patient who underwent Ivor Lewis oesophagectomy due to adenocarcinoma 6 days ago.
Subjectively he was quite well and keen on mobilising in the morning, so he ambulated about 100m with only one rest and did DBXs with supportive coughs. When I saw him second time in the afternoon though his face looked quite flushed and anxious. When I was ambulating him, I thought he could at least walk the similar distance which he made in the morning. He sat down in a chair for a short rest after about 25m walk and told me he couldn't do anymore and refused further treatment. I think there is very fine line; when I have to listen to the patient and modify my treatment, and when I push the patient a bit so that he can achieve more than what he is actually capable of. On top of that, he is quite impulsive and anxious. Because he has so many drains and IV lines, I always have to make sure that everything is sorted out on the trolley before he actually gets up, though he tends to stand up too quickly. I should, therefore, make clear instructions and assure him throughout the treatment.
So my point is that I always have to listen to what the patient tells me and be flexible depending on patient's personality and behaviour type. You cannot expect that the patient's condition would be same even on the same day, and every patient is different and individual.
Hope you all are enjoying your prac:)
Subjectively he was quite well and keen on mobilising in the morning, so he ambulated about 100m with only one rest and did DBXs with supportive coughs. When I saw him second time in the afternoon though his face looked quite flushed and anxious. When I was ambulating him, I thought he could at least walk the similar distance which he made in the morning. He sat down in a chair for a short rest after about 25m walk and told me he couldn't do anymore and refused further treatment. I think there is very fine line; when I have to listen to the patient and modify my treatment, and when I push the patient a bit so that he can achieve more than what he is actually capable of. On top of that, he is quite impulsive and anxious. Because he has so many drains and IV lines, I always have to make sure that everything is sorted out on the trolley before he actually gets up, though he tends to stand up too quickly. I should, therefore, make clear instructions and assure him throughout the treatment.
So my point is that I always have to listen to what the patient tells me and be flexible depending on patient's personality and behaviour type. You cannot expect that the patient's condition would be same even on the same day, and every patient is different and individual.
Hope you all are enjoying your prac:)
Sunday, March 16, 2008
Supportive supervision (Daria's Post)
Hi All,
I am on my Cardio placement and on Wednesday, I had experienced hard time from one of my new patients.
Mr.NT is 65 years old male after CABGx5 with pulmonary complication. I checked the patient’s X- ray and blood results. I found that the patient has ¯Hb (below 90).When I came to perform cardiopulmonary subjective and objective assessment and gather missing SHx information I could felt that patient is not in “good mood” however; the patient let me do assessment. I found some very “interesting information” such for example patient was using puffer (Ventolin) 2 puffs every 2 hours. I went to my clinical supervisor to present my findings and discuss my treatment plan( DBExs, supported huff ect). Additionally, I was going to provide some information to the patient about Ventolin and reviewed his technique. When I came back, the patient was standing at doorframe and he stated that either I take him outside or I can go away. I did not wanted be bossy and tell that I in charge so first, I tried to explain to the patient what is treatment plan and why. I mentioned as well that I would like to have a look how he is using his puffer. Automatically, patient commented this that I am saying he is using wrongly his puffer. I kept trying to clarified and explained, however in vain. Finally, I decided to clarify whether the patient refusing treatment. The answer was yes. I went to my clinical supervisor and I reported this situation and documented in patient’s notes.
My supervisor was supportive and said I should treat this as a good experience and do not take personally. Later afternoon my supervisor asked me again if I am OK and added that this patient was grumpy to other medical staff too. He refused blood transfusion and was unpleasant to nursing staff. He said that not all patients are compliant.
It is hard especially at the beginning do not take this sort of situation personally but it was good lesson. I am glad I had this lesson now.
Daria
I am on my Cardio placement and on Wednesday, I had experienced hard time from one of my new patients.
Mr.NT is 65 years old male after CABGx5 with pulmonary complication. I checked the patient’s X- ray and blood results. I found that the patient has ¯Hb (below 90).When I came to perform cardiopulmonary subjective and objective assessment and gather missing SHx information I could felt that patient is not in “good mood” however; the patient let me do assessment. I found some very “interesting information” such for example patient was using puffer (Ventolin) 2 puffs every 2 hours. I went to my clinical supervisor to present my findings and discuss my treatment plan( DBExs, supported huff ect). Additionally, I was going to provide some information to the patient about Ventolin and reviewed his technique. When I came back, the patient was standing at doorframe and he stated that either I take him outside or I can go away. I did not wanted be bossy and tell that I in charge so first, I tried to explain to the patient what is treatment plan and why. I mentioned as well that I would like to have a look how he is using his puffer. Automatically, patient commented this that I am saying he is using wrongly his puffer. I kept trying to clarified and explained, however in vain. Finally, I decided to clarify whether the patient refusing treatment. The answer was yes. I went to my clinical supervisor and I reported this situation and documented in patient’s notes.
My supervisor was supportive and said I should treat this as a good experience and do not take personally. Later afternoon my supervisor asked me again if I am OK and added that this patient was grumpy to other medical staff too. He refused blood transfusion and was unpleasant to nursing staff. He said that not all patients are compliant.
It is hard especially at the beginning do not take this sort of situation personally but it was good lesson. I am glad I had this lesson now.
Daria
Thursday, March 13, 2008
how do you treat that?
Here I am down in Surfton (anme changed to protect the innocent... eat yer hearts out, Brent, Shadi & Nick) doing the rural thing.
Patient with a sub-archnoid L parietal haemorrhage was referred to us for a mobility review. Notes said she was mobilising independently, "but probably shouldn't be". So I go see the pt. do the sujective routine, then a mobility review. Bed mob, STS to sit again, Amb all perfectly safe & indep. I have 10 min. before I have to cruise over to senior's centre for Stay on Your Feet, so I go back to physio gym and grab a step to make sure pt can negotiate her 1 step FE. She does it no prob, even when I get fussy on her and ask her to do the step without touching the WZF (she used the door frame: safe, fast and steady). No sign of ataxia, synergistic movement, weakness or other motor defects... So I write up the notes and head off to SOYF.
Later that day, I cop an earful from one of the staff physios who says I need to treat and not just assess. Of course, I listened and accpeted the feedback without question.
After reflection, I wasn't sure if I should do anything different. I mean, I couldn't see any impairments, so what should I treat? I fulfilled the request at the heart of the referral and no other impairments were evident... Ironically, I would have had to do more Ax to find something to Rx!
So my questions is: should I try to ask the physio what he/she would have done (to learn from the situation - but hard to do without making it sound like I am questioning his / her call) or just forget about i?
Patient with a sub-archnoid L parietal haemorrhage was referred to us for a mobility review. Notes said she was mobilising independently, "but probably shouldn't be". So I go see the pt. do the sujective routine, then a mobility review. Bed mob, STS to sit again, Amb all perfectly safe & indep. I have 10 min. before I have to cruise over to senior's centre for Stay on Your Feet, so I go back to physio gym and grab a step to make sure pt can negotiate her 1 step FE. She does it no prob, even when I get fussy on her and ask her to do the step without touching the WZF (she used the door frame: safe, fast and steady). No sign of ataxia, synergistic movement, weakness or other motor defects... So I write up the notes and head off to SOYF.
Later that day, I cop an earful from one of the staff physios who says I need to treat and not just assess. Of course, I listened and accpeted the feedback without question.
After reflection, I wasn't sure if I should do anything different. I mean, I couldn't see any impairments, so what should I treat? I fulfilled the request at the heart of the referral and no other impairments were evident... Ironically, I would have had to do more Ax to find something to Rx!
So my questions is: should I try to ask the physio what he/she would have done (to learn from the situation - but hard to do without making it sound like I am questioning his / her call) or just forget about i?
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