Week 1 STARES - Joondalup Cardio

Situation
Mrs X is a 39 yr female admitted 2 days prior with suspected panceatitis. Following hospitalization she suffered from significant SOB and decreased exercise tolerance with no known cause for the condition. Chest physiotherapy was requested to assess her cardiorespriratory limitations and intervene with appropriate treatment.

Task
Chest physiotherapy was requested to improve her SOB and exercise tolerance so that she may be able to cope with surgery to treat her pancreatitis and the expected post-op deconditioning / complications more effectively. This involved assessment to determine her current status from a cardiorespiratory point of view and then determining a treatment regime to address these concerns.

Action
Initially subjective questioning was used to gain an insight into the patient’s history. ie. any Hx of SOB, previous exercise tolerance, cough, sputum production, pain, dizziness, home environment & other Social History questioning. I then assessed the patient’s vitals and carried out auscultation posteriorly and assessed the movement of the chest. I had the patient cough & noted if it was productive, moist and it’s strength.

Based on the assessment results and the patient’s previous activity levels I determined that mobilization and deep breathing exercises would be the best intervention based on her presentation and assessment results.

Result
Prior to physiotherapy intervention the patient was significantly SOB so with mobilization this increased. The patient was noticeably shakey and required very close assistance to provide support and reassurance. Re-auscultation did not show any changes.

Evaluation
The desired outcome was mobilization of the patient which was achieved but there were a couple of things that could be worked on. The patient had a number of attachments; IDC, PCA, IV line and O2 supply. I found myself trying to figure out on the spot quickly how to organise things. It is a very simple thing but if one gets it wrong the patient can quickly lose confidence in what the therapist is doing for them.

Also during auscultation I was measuring posteriorly and during the process the patient predictably became SOB. I had warned the patient to let me know if she did feel SOB but I should have constantly been checking on her. Because I had to wait for the patient to recover the session was extended thus lengthening an already long process for the patient.

Strategies
In the next situation I will be prepared to know how to arrange the attachments effectively and efficiently without putting the patient in harms way. I will look at the notes to identify likely scenarios and also upon entering a room I will immediately identify the equipment and how to organize it
With the auscultation, a patient that is markedly SOB there should be planned rest periods so either break the assessment in halves or even thirds so that effect and similar depth breathing occurs throughout to achieve an accurate assessment of the lungs.

Initial Entry - Rotation 1

My first placement for the year will be at Joondalup working on one of the medical wards with a bit of a cardiorespiratory twist. From what I’ve been able to gather so far it is not strictly people with cardio conditions so I will have to draw on my powers from all the other disciplines to make it through in one piece.

At this stage my impression of treating people on a medical ward with cardio problems is that my supervisor will simply determine if they have any cardio issues then decide if they are able to be seen by me. Having only just finished the cardio unit last semester a lot of the information is relatively fresh in my mind but there is certainly going to be a lot of recapping on things covered in university. But in saying that we have learnt a lot from the theory side of things with some prac, but actually putting it into practice with real patients is going to be a whole different ball game.

One of the major factors that makes me slightly anxious is the fact that being on a medical ward means a high percentage of patients will likely have a co-morbidity of some description. This can significantly affecting the treatment given and restrict what intervention strategies I can use. I’m half expecting there to be situation where I assess a patient, decide what the problem list, look in my tool box of possible treatments & slowly cross them off the list due to contraindications as a result of co-morbidities. Despite this I imagine that with time I’ll see that there is always something that a physio can do, it’s just a matter of finding it.

Having been on a placement last year with a small amount of cardio exposure I see my role involving initial & ongoing assessment and treatment of issues determined during these, all under the watchful eye of my supervisor. Initially I would hope there would be a considerable amount of observation to see how experienced clinicians carry out the duties of a cardio physio. I would imagine that there would be a large amount of interaction with the other allied health professionals working on the ward to discuss and determine what the patient’s best course of action is. This will allow me to clearly understand each of their roles within the patient care structure and how to approach things for this placement and prepare me for other hospital situations.

Despite my nervousness ahead of this placement I am looking forward to developing my physiotherapy skills from a clinical point of view as well as professionally. I am also very eager to fine tune my communication and documentation skills so that I may spend more time focusing on aspects that directly benefit the patient such as treatment options and interventions. This will benefit me both now and when I encounter similar scenarios in future.