On my last cardio prac I saw a whole variety of pts with the majority being COPD pts many of whom were still smoking!
I did however have the opportunity to meet a CF pt. He was in his mid 20’s and was well aware of the fact that his only had a hand full of years to life. Yet he was so full of life and said he enjoyed living life everyday like it may be his last! He said he’d learnt how to cope with his condition from a young age and was pretty compliant with his management of CF. Meeting him helped me understand CF much better and get an insight about how he coped with his condition.
This situation got me thinking and made me realise just how valuable life is and how ungrateful some pts are with respect to their conditions and how they manage them. It makes you want to show these patients who have been choosing to harm themselves for years with smoking, drugs and drinking just how to value their lives. It’s like no matter how much to tell a pt that smoking is a bad habit and it does you more harm and good sometimes it just goes in one ear and comes out the other! Educating pts is something we have a great influence over. I guess if we keep on drilling the message into the pts we encounter somewhere along the line it will make a difference and make them realise that life is precious............
Saturday, November 29, 2008
D/C issues
During the first week of my cardio prac I was given a pt that had come with an increasing SOB and AF from a rehab home. The thing about the pt was that he was just D/C from the ward 2 days ago to this rehab facility and was there for further rehab. The first time around he had come in with an infective exacerbation of COPD.
The first time I got him up for a walk he was only able to ambulate 30m and required 2 rests because of his increased SOB. The doctors wanted to D/C this pt soon as that felt like he was medically stable. They requested for the PT to do a 6MWT and with the test this pt was able to ambulate only 40m in 6 mins. It took him a good 4 mins to recover from his SOB. From his prior 6MWT results he amb 165m.
With this info in hand I had a chat to my supervisor and we deemed him unfit for D/C home. However every other health professional dealing with him had all written in his notes that he was safe for D/C home! With a chat to the doctors it was decided to send him back to the rehab home as he still required intensive rehab before going home as he lived by himself, had stairs in his house and was independent prior to admission. Once all the arrangements were made this pt was D/C to the rehab home.
I believe it is important to discuss the pts situation with the doctors and the medical team during the ward meetings. Even though everyone else is deeming this pt safe for discharge with the information we have we know that this pt will be a risk to himself if he does not receive further rehabilitation. It all about team work and working hand in hand with the other professionals as each one of us specialise in our own areas. It is always about the patients care and safety.
The first time I got him up for a walk he was only able to ambulate 30m and required 2 rests because of his increased SOB. The doctors wanted to D/C this pt soon as that felt like he was medically stable. They requested for the PT to do a 6MWT and with the test this pt was able to ambulate only 40m in 6 mins. It took him a good 4 mins to recover from his SOB. From his prior 6MWT results he amb 165m.
With this info in hand I had a chat to my supervisor and we deemed him unfit for D/C home. However every other health professional dealing with him had all written in his notes that he was safe for D/C home! With a chat to the doctors it was decided to send him back to the rehab home as he still required intensive rehab before going home as he lived by himself, had stairs in his house and was independent prior to admission. Once all the arrangements were made this pt was D/C to the rehab home.
I believe it is important to discuss the pts situation with the doctors and the medical team during the ward meetings. Even though everyone else is deeming this pt safe for discharge with the information we have we know that this pt will be a risk to himself if he does not receive further rehabilitation. It all about team work and working hand in hand with the other professionals as each one of us specialise in our own areas. It is always about the patients care and safety.
Learning never stops!
I believe in all our pracs it has become evident about this continued pursuit of learning as a physio. At practically all my placements there was a continuing education class or a presentation of some sort by the physios at the practice or externally employed individuals or sometimes the students were made to make a presentation on a topic’s. I myself had to do at least 5 different presentations at different stages of my pracs. With each presentation I did, I found myself understanding the topics I choose much better and sometimes it got me thinking about the different pts I had dealt with and how it may be applicable to them with the way i approach and handle them. It also developed my public speaking skills and made me more confident in presenting my topics. I found these sessions enriching as topics being presented usually lead to discussions where everyone was asked for their opinions and suggestions. It was a good consolidation of knowledge especially since sometimes there were senior physios’ around who could assist highlighting key issues especially with their wealth of experience in the field. This easy and open channel of a learning environment definitely creates an all rounded enriching experience.
It’s really nice to see this continuing evolution of our knowledge especially since uni has just finished.
It’s really nice to see this continuing evolution of our knowledge especially since uni has just finished.
Wednesday, November 26, 2008
Male PT’s Vs female pt!
In my Singapore “rural” prac I had a 14year old female pt who’d come in with a referral for an ongoing knee pain for the last 6 mts following a volleyball game and also for general strengthening program. At the time of my initial assessment I had my pt, her mother and my male PT supervisor sitting in the same area with me. As I began to question my pt I began to get the feeling that she didn’t really want to be at physio and gave me one word answers. So it was really difficult to identify what the problem might be and I must admit it did frustrate me a little! My supervisor also tried asking questions pertaining to her injury but she was still pretty uncommunicative. So it was decided that I go straight into an objective assessment. While doing all my knee assessments I didn’t really find anything wrong with the knee other than the fact she tended to tense up at times!. I felt like I was going nowhere with her so I asked my supervisor to have a go and see if I was missing any important info out!. The minute he put his hands on her she tensed up so much it was interesting to notice!. I was just wondering what was wrong with this girl and felt like I was wasting time treating her as she didn’t seem any bit interested to be here. But my supervisor on the other hand picked up this signal and immediately asked her if she was uncomfortable with him assessing her and if she would prefer a female physio with her next assessment. The patient immediately said yes! So it was decided that we would just get her walking on the treadmill and her next appointment will be with a female PT who would conduct a more detailed assessment. My supervisor left the room with the pt’s mother and I continued to monitor the pt while she was on the treadmill. I began to generally chat to her and to my amusement she began chatting to me so easily and opening up more about her injury! I took all the info she subjectively gave me and documented it in her notes so as the next therapist could have a brief handover.
From this prac I have learnt that we should pick up behaviour patterns of pts while we are assessing them, and it may demonstrate what they are feeling at that particular time hence influencing my approach to treating them. As a physio we should not undermine ourselves and look at possible factors that may also influence the outcome of treatment. We are all about team effort and if we ever have a situation like this be open and seek help from other physio’s as they may be able to assist with any problems.
From this prac I have learnt that we should pick up behaviour patterns of pts while we are assessing them, and it may demonstrate what they are feeling at that particular time hence influencing my approach to treating them. As a physio we should not undermine ourselves and look at possible factors that may also influence the outcome of treatment. We are all about team effort and if we ever have a situation like this be open and seek help from other physio’s as they may be able to assist with any problems.
NO such things as recipes with Rx
It was my cardio inpatient prac and I was given this pt who’d come in a few weeks prior for a lung biopsy and was back in hospital with an infective exacerbation of COPD. The results of the biopsy also confirmed the Dx of Lung Cancer.
From my initial encounter with her to the last day of my prac her health just kept deteriorating. It was like everyday I went in to see her something new had developed overnight. I found her to be my most challenging patient during this prac. There were some days when I’d go in to see her and she would be unable to do anything as just sitting up in bed made her feel so breathless. So my treatment with her on those days were just calming her down and trying to make her feel comfortable. Her SpO2 was 81% on 15L via HFNP. She was supposed to be on BiPap but she just was not tolerating this very well. By the end of 2weeks she just kept on getting more hypercapnic, no sport of intervention was helping her. At a family meeting it was decided she was to be kept comfortable meaning she was to be given morphine whenever she wanted and was considered palliative.
From this experience it brought to my attention that each patient is different and there are no ‘recipes’ or set treatments that you carry out with them. The condition in which the patient is in on a day by day basis varies and new conditions may arise and treatment for these conditions must be carried out. It is important to pay attention to the treatments rendered to these patients so as to facilitate their recovery to the best of our capabilities.
From my initial encounter with her to the last day of my prac her health just kept deteriorating. It was like everyday I went in to see her something new had developed overnight. I found her to be my most challenging patient during this prac. There were some days when I’d go in to see her and she would be unable to do anything as just sitting up in bed made her feel so breathless. So my treatment with her on those days were just calming her down and trying to make her feel comfortable. Her SpO2 was 81% on 15L via HFNP. She was supposed to be on BiPap but she just was not tolerating this very well. By the end of 2weeks she just kept on getting more hypercapnic, no sport of intervention was helping her. At a family meeting it was decided she was to be kept comfortable meaning she was to be given morphine whenever she wanted and was considered palliative.
From this experience it brought to my attention that each patient is different and there are no ‘recipes’ or set treatments that you carry out with them. The condition in which the patient is in on a day by day basis varies and new conditions may arise and treatment for these conditions must be carried out. It is important to pay attention to the treatments rendered to these patients so as to facilitate their recovery to the best of our capabilities.
Tuesday, November 25, 2008
O2 therapy
O2 therapy..... I always thought of it as something that was prescribed by the doctors and would remain as it was till they decided was was ideal for the patient.
I had a pt that’d come in with as Exacerbation of COPD increased cough, sputum production and SOB over the last 3/7. At the ED department his SpO2 levels were 83% on RA therefore he was given O2 of 3L via NP and thereafter his SpO2 was 90%. Doctors wanted his sats to remain 90% and above. Once he was brought onto the ward in his notes it stated he was to be on 2L O2 on exertion and 1L O2 at rest.
I was to do an initial assessment with this pt and from his subjective found out that he had been prescribed with domiciliary O2 about a year and a half before but this has since been ceased 6 mts ago by his GP.He reports his COPD is well managed and he is usually pretty active and only of the last weeks has been unwell and thus this admission. After completing my subject and object assessment with this pt decided that his main problems were impaired airway clearance, impaired gas exchange, decreased ex tolerance and dyspnoea.
I decided to begin by taking him for a walk on O2 to help mobilise his secreations, increase his tidal vol and improve the gas exchange. Just as I was about to carry out my treatment, I was caught off guard when my supervisor asked me if I wanted to modify my treatment. Dumbfounded, I had no reply. Upon probing from my supervisor, she suggested thinking about discharge planning and looking at things as a big picture. If the patient come into hospital without home O2, we need to be thinking about sending home either without home O2 or if there is a need for them to be receiving home O2.
Therefore it was brought to my attention that it’s a great idea to ambulate him on RA and see how he maintains his sats on exertion. From this experience, it is evident that as a physio, it is important to carry out a sound assessment looking at things not just related to physio but as a whole with other health care professionals. We should look into other factors as they affect the patient and knowing the history of the patient takes us a long way as it enables us to get them back into their ‘normal’ standard of living which in turn improves their quality of life resulting in less hospital admissions.
I had a pt that’d come in with as Exacerbation of COPD increased cough, sputum production and SOB over the last 3/7. At the ED department his SpO2 levels were 83% on RA therefore he was given O2 of 3L via NP and thereafter his SpO2 was 90%. Doctors wanted his sats to remain 90% and above. Once he was brought onto the ward in his notes it stated he was to be on 2L O2 on exertion and 1L O2 at rest.
I was to do an initial assessment with this pt and from his subjective found out that he had been prescribed with domiciliary O2 about a year and a half before but this has since been ceased 6 mts ago by his GP.He reports his COPD is well managed and he is usually pretty active and only of the last weeks has been unwell and thus this admission. After completing my subject and object assessment with this pt decided that his main problems were impaired airway clearance, impaired gas exchange, decreased ex tolerance and dyspnoea.
I decided to begin by taking him for a walk on O2 to help mobilise his secreations, increase his tidal vol and improve the gas exchange. Just as I was about to carry out my treatment, I was caught off guard when my supervisor asked me if I wanted to modify my treatment. Dumbfounded, I had no reply. Upon probing from my supervisor, she suggested thinking about discharge planning and looking at things as a big picture. If the patient come into hospital without home O2, we need to be thinking about sending home either without home O2 or if there is a need for them to be receiving home O2.
Therefore it was brought to my attention that it’s a great idea to ambulate him on RA and see how he maintains his sats on exertion. From this experience, it is evident that as a physio, it is important to carry out a sound assessment looking at things not just related to physio but as a whole with other health care professionals. We should look into other factors as they affect the patient and knowing the history of the patient takes us a long way as it enables us to get them back into their ‘normal’ standard of living which in turn improves their quality of life resulting in less hospital admissions.
supervisors make u or break u!
I believe at each prac your supervisor either brings out the best in you or is out to break you. I must say I have been pretty lucky to have gotton really good supervisors that really motivate you and guide you when need be and are also really open and pretty approachable. I however did have one supervisor that was someone who was just too difficult to communicate with. She seemed to have this set way of how she wanted things to be done and completely hounded for little bits of information.
She had this look that somehow made me feel really small. She wanted me to rattle off handovers of all my pts without looking at any piece of paper, I found this really difficult not just having to remember information of the patients but also verbalising it. It was like every time she came up to me to ask me things I’d get this massive mental block and feel stuck. My mind would go blank. She kept telling me that if I did not get good at this I would not make it through this prac and I was determined to be competent!
I voiced this out to my CCT and was in dire need of help because I felt I should not have to become incompetent in this prac because I was unable to give good handovers without looking at any notes! So with my encouraging CCT we came up with a “cheat card” it had basic heading just so I could begin to visualise and think systematically. I put this “system” into place and I must say it really helped me to think systematically because I was a bit of a scatter brain. It just put lots more information into perspective and helped me verbalise this information to my supervisor much better.
I did make it through this prac but I must say however it is pretty difficult to develop skills on a prac if you have a supervisor who is pretty harsh and overwhelming! I also got some advice from a fellow student who said every time she had an overwhelming moment with her supervisor she took a step back from the situation and built a “glass wall” around her so she felt safe and was able to think much better. I did try this out and well it worked sometimes but not every time. Overall it was a great learning experience for me and I did get much better at it by the end of the prac!
She had this look that somehow made me feel really small. She wanted me to rattle off handovers of all my pts without looking at any piece of paper, I found this really difficult not just having to remember information of the patients but also verbalising it. It was like every time she came up to me to ask me things I’d get this massive mental block and feel stuck. My mind would go blank. She kept telling me that if I did not get good at this I would not make it through this prac and I was determined to be competent!
I voiced this out to my CCT and was in dire need of help because I felt I should not have to become incompetent in this prac because I was unable to give good handovers without looking at any notes! So with my encouraging CCT we came up with a “cheat card” it had basic heading just so I could begin to visualise and think systematically. I put this “system” into place and I must say it really helped me to think systematically because I was a bit of a scatter brain. It just put lots more information into perspective and helped me verbalise this information to my supervisor much better.
I did make it through this prac but I must say however it is pretty difficult to develop skills on a prac if you have a supervisor who is pretty harsh and overwhelming! I also got some advice from a fellow student who said every time she had an overwhelming moment with her supervisor she took a step back from the situation and built a “glass wall” around her so she felt safe and was able to think much better. I did try this out and well it worked sometimes but not every time. Overall it was a great learning experience for me and I did get much better at it by the end of the prac!
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