I had three patient's who had total knee replacements (TKR) all around about the same time. It was really interesting to treat all three at the same time as i was able to gain an understaning of how everyone is different.
One patient's epidural wasn't working day 1 post op so her first day was a bit of a disaster. I thought she might take a while longer than the other two patient's to recover and ultimately would be a hospital inpatient for longer. This patient surprised me though and was ready for discharge a day earlier than the other two TKR patients. (day 6)
Another patient had no complications at all and the CPM machine was applied religiously twice daily from day 1 post op and was standing and ambulating (although short distances at first) day 1 post op. This patient however was a bit non complient with exercises and her attitude was a little less desireable than the other two (for instance she refused to even try elbow crutches as a progression from the wheeled zimmer frame as "crutches weren't for her"). I originally assumed this patient would be first to get discharged out of the three as she had no complications and was on track with all of her clinical pathway milestones (i.e. achieving increasing active flexion, walking independently with her frame etc.). This patient surprised me as she was ready day 7 post op which was the same or more than the other two patients who had a complicated post op period.
The third total knee replacement patient was on track day one and day two post op (CPM twice daily, ambulating with supervision and a frame day 1 and day two) however when her epidural was due to come out her pain cover that day (day three) was inadequate and i didn't manage to do anything apart from one session of mild CPM that day. This patient is also legally blind (so she can make out faces and smiles etc. but no finer details) so i was unable to just leave her to do her exercises by herself initally because she couldn't just read it off the handouts. I assumed this patient would take the longest but she surprised me by being discharged on day 7.
On reflection it was interesting to me to consider these three cases. All TKR's took roughly about the same ammount of time from operation until discharge despite the huge differences these people experienced on their road to recovery. It showed me that despite someone's obvious disability (i.e. lack of sight) it wont necessarily affect their abitlity to recover. I can't help but wonder if attitude in these cases plays more of a role. The sight impaired patient always tried everything i asked of her and always performed exercises i asked her to review with me while the other patient whose road to recovery was without complication was almost the opposite in willingness to try. It reinforces to me that attitude has a large role in paving the road to recovery.
1 comment:
This is incredibly true!!! No matter what the physical disability if the attitude is right then the path to recovery is hindered. I noticed this on my ortho in-patients placement but I think it was made even clearer on my neuro placement.
I was on an acute stroke ward so alot of the patients were only a few days post CVA. We had an excellent example of positive attitude and trying to do everything we asked of her. In this lady we had her standing and walking within 10 days. There was another patient who had a similar stroke and every time we went in to treat her and asked her to think about "moving with us" she kept telling us not to worry as there was no point. This lady was about 2 weeks post CVA when i completed my placement and she was still being hoisted. The first lady was walking!! Obviously, it doesn't solely depend upon a positive attitude but it definitely helps.
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