I have recently started a new prac and i am on a general surgical ward with lots of different patients from TKR/THR to pnuemonia to subdural haematomas to traumatic stab wounds. It is an extremely varied case load and provides me with a lot of different pathologies to study all at the one time so it is always interesting.
Today i went to treat a man who has been on the ward for about a week with a presenting complaint of a subdural haematoma and some queried frontal lobe involvement due to behavioural changes. The Physio i have been working with had not yet performed a specific neuro exam and had stuck to general mobility assessments when seeing him.
I have already completed my neuro placement but had not come accross a subdural haematoma yet and thought it would be interesting to do a general neuro exam on him to find out the extent of his deficits.
When i walked into his room i politely introduced myself and my role and what i would be doing with him today. He was rambling on a bit trying to tell me about a bundle of nerves in his spine that are wound up wrong etc. etc. so i proceeded with what i had planned to do and asked him to extend his knee against my resistance. He then yelled at me and told me im not a doctor and i don't know what im talking about and he has a bundle of nerves wound up wrong in his spine...his wife was sitting beside him and looked at me with a bit of sympathy. I ended up not being able to assess anything (he refused) and also i wasn't really achieving anything due to his lack of understanding of what i was asking him to do.
I didn't realise how much frontal lobe aggressive behaviours could alter a persons willingness to comply with treatment and understand what i was trying to look at. I had never had any first hand experiences with someone who had frontal lobe changes before and i just assumed if i explained everything i was doing and why i was doing it the patient would be reasonable. I did not expect him to disregard any information i was trying to explain to him. I suppose i just thought he might be like an person who gets angry easily but still not without reason.
In hindsight i suppose i will just take away from this situation that i never know how someone will react to any given situation and to never assume anything...especially not about people who have suspected frontal lobe changes.
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I'm on my neuro placement at the moment and have a few patients who have behavioural changes as a result of frontal lobe damage. It's quite interesting to see how varied the changes can be. Most of the patients i have are quite happy and not at all aggressive.
They can have days where they're exceptionally depressed and Rx will not work no matter what you do. On days like this I have to compromise and just do some basic Rx in their rooms and don't wheel them out to the gym. I imagine your experience would be quite confronting and i don't think there's much Rx you can do when they're like that. Is that pt always like that or does he vary depending on the time of day or from day to day? Sometimes you just need to find a time where they might be a bit better and as you go along you soon figure out what you can and can't do with them in terms of Rx.
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