**Must read Part I and II to fully understand the magnitude of this post**
11am. I walked into Kate's room, fully gowned, masked, and gloved to take on Kate's long-term goal -the shower. She told me she was sore and paying for what she did yesterday, but she was ready to do it. She mummbled, "I can do it. I can do it. I can do it", took a deep breath, and stood up from the edge of the bed with her walker. And just as I was in the process of getting her wheelchair positioned to wheel her to the bathroom, I looked up at her and said, "Can you WALK to the shower?" She looked ahead of her to the bathroom and said, "Well I walked to the commode and back yesterday, so I should be able to". She was able to all right -with me following behind her with her chair, praying her knees wouldn't buckle. With some cuing on hand and feet placement, Kate was IN the shower. Standing. Once she sat down, I started frantically laying towels on the floor to soak up excess water, saying repeatedly, "This is great. Kate, this is awesome. This is so great. Oh my gosh I am so excited." Kate just sat there, not saying a word. I looked up at her and asked, "Aren't you excited about this?!" She smiled and said, "Oh I may not look excited, but I am WAY excited. I cannot believe I just did that". She went to town with her washcloth, and I helped her with her feet, back, and peri area -all the while mummbling the same this-is-great-this-is-awesome-oh-my-gosh-this-is-so-great rant the entire time. I almost cried, I was so happy. After she dried off, got dressed in her gown, and sat back in her wheelchair, I told her, "This is one of those amazing moments that I will remember as a new grad for the rest of my career, Kate." It was the best shower ever. And I wasn't even the one taking a shower.
Tuesday, August 30, 2011
Monday, August 29, 2011
Baby Steps -Part II
**Make sure to read Part I before reading this post. It'll make everything make so much more sense.**
I came to work excited to see what Kate could accomplish today, and left work with her exceeding all my expectations. She was all ready for me when I poked my head in her room at 11am, despite laying supine in bed, staring at the ceiling. I gave her my game plan. We were going to bust out a tricep workout with her sitting on the edge of the bed, she was going to comb her hair since she looked like she just got electricuted, then we were going to have her attempt standing with the wheelchair backed up in front of her so she could hold onto the handles as if it were her walker. Kate fears using her walker to stand because she feels like it will slide out from under her. So we were going to adapt with what we had and ease her into it. Baby steps.
Without me saying a word, she lowered the head of her bed, scooted up to the top of it while laying supine (something she needed max assist x2 with when I first met her), log-rolled with use of the hand rail, and pushed herself up into a sitting position at the edge of the bed as she swung her legs over. I knew it was going to be a great session already. I asked how she felt today and she said, "I am excited to see what new things I can do". So I handed her her theraband and she started on her tricep exercises. She asked me how many she had to do. I told her since she looked pumped today I wanted her to do as many reps as she could till she felt a burn. Then we'd stop, take a breather, and do the same amount of reps two more times. She was up for it and she did them like a pro. We did a few more exercises with dumb bells (1 lb heavier than last week) since she was pretty much being a rockstar. After that, she combed her hair and I pulled it up into a pony tail for her.
Then it was time to stand. I backed the wheelchair in front of her so she could hold onto the handles. With the brakes locked, I leaned into the front of her chair with one knee on the seat and my hands planted on her arm rests to make sure it was stabilized. I must admit, I was a little scared considering it was just us two in the room and she told me her emergency call-button was apparently not working. But I knew she could do it. I wouldn't have asked her to if I didn't feel she could. I told her to take her time -she took a couple deep breaths with her eyes closed, and up she went. Once she was up, she looked at me and smiled. She sat back down and said, "I want to try it with the walker". Sweet. It took her a few seconds to get her mind in gear, but I knew that once she did it a few times, she'd be one step away from conquering her fear of falling when using the darn thing. She did it and I was so proud of her.
On top of all this, she said she wanted to stay standing for four whole minutes. She made it to three and a half when she told me she had to pee. Now typically, she'd be in bed, flat on her back. And all I'd have her do is roll to the side so I could stick her bed pan under her. But she was already standing so I asked if she felt like she could walk to her commode, which sat right outside her bathroom door (about 20 small steps). She said, "Might as well". I followed right behind her with her wheelchair and told her that if she felt like her knees were going to give way, to fall BACK. Not forward. Or better yet, just don't fall at all.
She got to the commode, pivoted, sat on it, realized she wasn't entirely on it, did a partial-stand, and re-adjusted. I may or may not have done a little victory dance. She looked up at me and said, "I did it!". Yes, she did. If she didn't have C. diff, I would've hugged her. On top of all that, she was able to get off the commode, and walk back and get herself into bed at the end of our session. That called for a high five. I told her how proud I was of her as I was leaving work today since her room is one of the last ones on the way out. She was sitting up in her wheelchair, watching television. I told her, "No more bed baths, my friend. Tomorrow you're getting in the shower." She was stoked.
I came to work excited to see what Kate could accomplish today, and left work with her exceeding all my expectations. She was all ready for me when I poked my head in her room at 11am, despite laying supine in bed, staring at the ceiling. I gave her my game plan. We were going to bust out a tricep workout with her sitting on the edge of the bed, she was going to comb her hair since she looked like she just got electricuted, then we were going to have her attempt standing with the wheelchair backed up in front of her so she could hold onto the handles as if it were her walker. Kate fears using her walker to stand because she feels like it will slide out from under her. So we were going to adapt with what we had and ease her into it. Baby steps.
Without me saying a word, she lowered the head of her bed, scooted up to the top of it while laying supine (something she needed max assist x2 with when I first met her), log-rolled with use of the hand rail, and pushed herself up into a sitting position at the edge of the bed as she swung her legs over. I knew it was going to be a great session already. I asked how she felt today and she said, "I am excited to see what new things I can do". So I handed her her theraband and she started on her tricep exercises. She asked me how many she had to do. I told her since she looked pumped today I wanted her to do as many reps as she could till she felt a burn. Then we'd stop, take a breather, and do the same amount of reps two more times. She was up for it and she did them like a pro. We did a few more exercises with dumb bells (1 lb heavier than last week) since she was pretty much being a rockstar. After that, she combed her hair and I pulled it up into a pony tail for her.
Then it was time to stand. I backed the wheelchair in front of her so she could hold onto the handles. With the brakes locked, I leaned into the front of her chair with one knee on the seat and my hands planted on her arm rests to make sure it was stabilized. I must admit, I was a little scared considering it was just us two in the room and she told me her emergency call-button was apparently not working. But I knew she could do it. I wouldn't have asked her to if I didn't feel she could. I told her to take her time -she took a couple deep breaths with her eyes closed, and up she went. Once she was up, she looked at me and smiled. She sat back down and said, "I want to try it with the walker". Sweet. It took her a few seconds to get her mind in gear, but I knew that once she did it a few times, she'd be one step away from conquering her fear of falling when using the darn thing. She did it and I was so proud of her.
On top of all this, she said she wanted to stay standing for four whole minutes. She made it to three and a half when she told me she had to pee. Now typically, she'd be in bed, flat on her back. And all I'd have her do is roll to the side so I could stick her bed pan under her. But she was already standing so I asked if she felt like she could walk to her commode, which sat right outside her bathroom door (about 20 small steps). She said, "Might as well". I followed right behind her with her wheelchair and told her that if she felt like her knees were going to give way, to fall BACK. Not forward. Or better yet, just don't fall at all.
She got to the commode, pivoted, sat on it, realized she wasn't entirely on it, did a partial-stand, and re-adjusted. I may or may not have done a little victory dance. She looked up at me and said, "I did it!". Yes, she did. If she didn't have C. diff, I would've hugged her. On top of all that, she was able to get off the commode, and walk back and get herself into bed at the end of our session. That called for a high five. I told her how proud I was of her as I was leaving work today since her room is one of the last ones on the way out. She was sitting up in her wheelchair, watching television. I told her, "No more bed baths, my friend. Tomorrow you're getting in the shower." She was stoked.
Saturday, August 27, 2011
Baby Steps -Part I
I always end up with the patients who have some kind of virus that requires contact isolation precautions -meaning I treat them in their room, doors shut, fully gowned and gloved and masked and dying of heat. On Monday I evaled a new patient, who I will call Kate, who had these same precautions. Kate is in her late thirties, morbidly obese, and was diagnosed with Clostridium difficile, otherwise known as C. diff. C. diff is an infection of the colon that occurs primarily with people who have been using antibiotics.
Typically when we get a new admit, they are scheduled for a 15-min occupational therapy and physical therapy evaluation, followed by 60 minutes of treatment for each discipline. Sometimes if admits arrive later in the day, we do the 15-min eval and treat the following day. But I like to do the whole 75 minutes because I feel that the 15-min eval time does not give me a clear picture of what my patient can do in terms of their daily tasks. With the 60-min treatment following the eval, I get to see their bed mobility, how they transfer out of their wheelchair with their walker, on and off the toilet, toilet hygiene, how they manage and don their clothes, how they transfer in and out of the shower, can they reach their feet and lower back to wash, can they locate their grooming materials while standing at the sink, can they balance well when reaching for things at the sink, put their pants on over their toes, pull them up in standing, how is their safety awareness?, are they impulsive, distractible, inattentive... At the same time, I get to converse with them and build rapport for a whole 75 minutes. I leave the eval having a pretty good sense of what they can accomplish. With a 15-min eval, I am in and out and my documentation sucks for whoever has to read it the following day.
So with Kate, I did the whole 75-min treatment, which was definitely needed. Because, due to Kate's generalized muscle weakness, she needed a bed bath. And half the time she was crying so we had to stop and give her room to breathe. Kate was, for the most part, max assist x2 -me and the CNA (my new bestfriend). I gave her a washcloth and had her do what she could on her own, which was wiping her face and chest. With what seems like the simplest task, Kate needed rest breaks. In the middle of it all, Kate needed to use the bed pan. I thought to myself how I'd feel if I were laying flat in a bed, unable to move my legs more than an inch, with two people completely gowned and masked hovering over me, helping me with the most intimate of tasks. Oh how we take things for granted. I told Kate that I hated being fully gowned. She told me she didn't blame me and that her son even refuses to visit her because it's such a pain to get all gowned up. I said, "That's not what I meant. I feel very impersonal in this. Like I'm here to conduct experients on my patients". We laughed.
Despite Kate's situation, she was a very pleasant lady. Our long-term goal was to get her in the shower. But first we had to get her to transfer safely into her wheelchair. The physical therapy assistant (PTA) and I did a lot of collarborating this week. Whenever she'd come back to the gym from her room, I'd chase after her and ask her how Kate did. There was always progress being made. She was able to get Kate up in a static standing position for one minute. Her main problem was pushing herself up from the bed with her arms. Her triceps were so weak and she had so much weight to carry. So we started with tricep exercises with her semi-reclined in bed. Then we progressed to her holding herself up in bed with her elbows locked and pumping herself up and down as best she could (even if it was just a centimeter) during bed mobility tasks. Kate broke down once during that session because she said her son came in to celebrate his birthday with her but she couldn't do anything for him. She couldn't be a mom. But that motivated her even more to continue with her exercises.
When I walked by her room the other day, one of the CNAs was getting all gowned up to go in. Kate's door was slightly open and I could see her sitting in her wheelchair, watching tv -her hair braided back. I stopped in the hall and called her name. She had a BIG smile on her face and we waved at eachother. She said in her cute, nasally voice, "Hello world! ..I'm suppose to say that to everyone who sees me today sitting in my chair". I loved it. And I told her I liked her hair. She stayed in that chair for 5 and a half hours, which I think was a little too much after being in supine for so long, because the next day she was worn out.
She had the energy the next day to go from supine to sitting on the edge of the bed. But when I got the CNA to help me assist her to do a partial-stand-pivot transfer, Kate freaked out. With time, we attempted it twice, but there was no way I was going to risk her falling on her face and going back to square one. So we decided to do a bed bath with her sitting on the edge of the bed. I gave her a couple washcloths and told her to go to work, and I'd be there to help with what she couldn't do. She was able to wash down to the top of her feet, part of her peri area, her chest and armpits, and her face. She was doing great. She combed her hair and I braided it. She put her gown on and rolled back in bed, lifting her legs up with just a few verbal cues on hand placement. I raised the head of her bed and then, out of nowhere, Kate started crying. I asked what she was so sad about. And she said, "I feel like I disappointed you. We were so excited to get in the shower today and I thought today was the day that I could do it". I told her, "Kate! I am going to tell you FIVE things that you did GREAT today". Here was my list that I pointed out to her (literally):
1. You got yourself up to the edge of the bed, where you sat with no assistance for about 30 minutes.
2. You washed your own legs and feet! Remember how I had to do that for you with you laying flat in bed the other day?
3. You washed part of your privates! How awesome is that?! (We laughed)
4. You got yourself back in bed with NO help from me to get your feet up.
5. Your hair's all combed! Granted I did the braiding. But I couldn't have done it if you hadn't have combed it! (We laughed again).
I told her that yes, she may not have gotten in the shower today, but to put her focus on what she COULD do today that she COULDN'T do yesterday. It all brings her one step closer to reaching her goal of getting in the shower. Baby steps. She was getting there.
I am hoping that once she is able to safely transfer to her wheelchair and her C. diff sample comes back negative, I can take her on an outing to the store. That was her long-long-LONG term goal. And I really want to make it happen to lift up her spirits. I told her yesterday how proud I was of her and that I was looking forward to seeing what we could do Monday. She was all smiles.
Typically when we get a new admit, they are scheduled for a 15-min occupational therapy and physical therapy evaluation, followed by 60 minutes of treatment for each discipline. Sometimes if admits arrive later in the day, we do the 15-min eval and treat the following day. But I like to do the whole 75 minutes because I feel that the 15-min eval time does not give me a clear picture of what my patient can do in terms of their daily tasks. With the 60-min treatment following the eval, I get to see their bed mobility, how they transfer out of their wheelchair with their walker, on and off the toilet, toilet hygiene, how they manage and don their clothes, how they transfer in and out of the shower, can they reach their feet and lower back to wash, can they locate their grooming materials while standing at the sink, can they balance well when reaching for things at the sink, put their pants on over their toes, pull them up in standing, how is their safety awareness?, are they impulsive, distractible, inattentive... At the same time, I get to converse with them and build rapport for a whole 75 minutes. I leave the eval having a pretty good sense of what they can accomplish. With a 15-min eval, I am in and out and my documentation sucks for whoever has to read it the following day.
So with Kate, I did the whole 75-min treatment, which was definitely needed. Because, due to Kate's generalized muscle weakness, she needed a bed bath. And half the time she was crying so we had to stop and give her room to breathe. Kate was, for the most part, max assist x2 -me and the CNA (my new bestfriend). I gave her a washcloth and had her do what she could on her own, which was wiping her face and chest. With what seems like the simplest task, Kate needed rest breaks. In the middle of it all, Kate needed to use the bed pan. I thought to myself how I'd feel if I were laying flat in a bed, unable to move my legs more than an inch, with two people completely gowned and masked hovering over me, helping me with the most intimate of tasks. Oh how we take things for granted. I told Kate that I hated being fully gowned. She told me she didn't blame me and that her son even refuses to visit her because it's such a pain to get all gowned up. I said, "That's not what I meant. I feel very impersonal in this. Like I'm here to conduct experients on my patients". We laughed.
Despite Kate's situation, she was a very pleasant lady. Our long-term goal was to get her in the shower. But first we had to get her to transfer safely into her wheelchair. The physical therapy assistant (PTA) and I did a lot of collarborating this week. Whenever she'd come back to the gym from her room, I'd chase after her and ask her how Kate did. There was always progress being made. She was able to get Kate up in a static standing position for one minute. Her main problem was pushing herself up from the bed with her arms. Her triceps were so weak and she had so much weight to carry. So we started with tricep exercises with her semi-reclined in bed. Then we progressed to her holding herself up in bed with her elbows locked and pumping herself up and down as best she could (even if it was just a centimeter) during bed mobility tasks. Kate broke down once during that session because she said her son came in to celebrate his birthday with her but she couldn't do anything for him. She couldn't be a mom. But that motivated her even more to continue with her exercises.
When I walked by her room the other day, one of the CNAs was getting all gowned up to go in. Kate's door was slightly open and I could see her sitting in her wheelchair, watching tv -her hair braided back. I stopped in the hall and called her name. She had a BIG smile on her face and we waved at eachother. She said in her cute, nasally voice, "Hello world! ..I'm suppose to say that to everyone who sees me today sitting in my chair". I loved it. And I told her I liked her hair. She stayed in that chair for 5 and a half hours, which I think was a little too much after being in supine for so long, because the next day she was worn out.
She had the energy the next day to go from supine to sitting on the edge of the bed. But when I got the CNA to help me assist her to do a partial-stand-pivot transfer, Kate freaked out. With time, we attempted it twice, but there was no way I was going to risk her falling on her face and going back to square one. So we decided to do a bed bath with her sitting on the edge of the bed. I gave her a couple washcloths and told her to go to work, and I'd be there to help with what she couldn't do. She was able to wash down to the top of her feet, part of her peri area, her chest and armpits, and her face. She was doing great. She combed her hair and I braided it. She put her gown on and rolled back in bed, lifting her legs up with just a few verbal cues on hand placement. I raised the head of her bed and then, out of nowhere, Kate started crying. I asked what she was so sad about. And she said, "I feel like I disappointed you. We were so excited to get in the shower today and I thought today was the day that I could do it". I told her, "Kate! I am going to tell you FIVE things that you did GREAT today". Here was my list that I pointed out to her (literally):
1. You got yourself up to the edge of the bed, where you sat with no assistance for about 30 minutes.
2. You washed your own legs and feet! Remember how I had to do that for you with you laying flat in bed the other day?
3. You washed part of your privates! How awesome is that?! (We laughed)
4. You got yourself back in bed with NO help from me to get your feet up.
5. Your hair's all combed! Granted I did the braiding. But I couldn't have done it if you hadn't have combed it! (We laughed again).
I told her that yes, she may not have gotten in the shower today, but to put her focus on what she COULD do today that she COULDN'T do yesterday. It all brings her one step closer to reaching her goal of getting in the shower. Baby steps. She was getting there.
I am hoping that once she is able to safely transfer to her wheelchair and her C. diff sample comes back negative, I can take her on an outing to the store. That was her long-long-LONG term goal. And I really want to make it happen to lift up her spirits. I told her yesterday how proud I was of her and that I was looking forward to seeing what we could do Monday. She was all smiles.
Monday, August 22, 2011
Goodbyes
I usually don't like saying goodbye to people. But at my job, discharge (upon therapist recommendations, of course) is always a good thing. I like to tell my patients, "I've enjoyed working with you, but I hope to never see you in this environment ever again".
I have a patient who is going to be going home on Wednesday. She had back surgery recently and also presents with cognitive problems, which makes recalling (and following) her back precautions next to impossible. She would impulsively twist to reach for a pillow, bend to put her socks on or pick something off the floor.. And I'd find myself telling her, "No- Stop- Wait- Don't do that-", as if I were babysitting a 2-year-old. At one point she didn't even remember having precautions. And when I attached the tab alarm to her, so that nursing staff would be called if she ever attempts getting out of bed unsupervised, I caught her taking it off and hiding it under her pillow when she thought I wasn't looking. I have caught her performing wheelchair-to-bed transfers all alone in her room (brakes unlocked I might add) as I was leaving another patient's room across from hers. I have told her time and time again to use her call button before doing that, but of course when you think you don't actually have precautions, why on earth would you need to call for assistance with anything? Good grief.
I figured that the best thing I could do was have her remember her precautions. She has horrible macular degeneration so posters with big contrasting letters was not an option. So that idea got scrapped pretty quick. Plan B. She did have a talking clock that I've noticed around her neck. Her friend gave it to her on her second day at the facility. With time, she was able to remember and initiate using it to tell the time without asking me. This told me that, with repetition and practice, there was hope that she could remember her back precautions.
I began each session asking her what her three precautions were. BLTs. No bending, no lifting, no twisting. She told me, "That is not going to stick out in my mind because I don't eat BLT sandwiches". She'd remember 2/3 after about a couple minutes of staring at the ceiling. Then I would have her repeat them in her head as I left her room to grab towels for her shower or theraband for her exercises. I'd come back and she'd remember, once again, 2/3. We'd start an activity and before any sort of movement, I'd ask her again. Or on the way back to her room from the gym or before out session ended. 2/3. Then one morning, I went to see her and, when asked what her precautions were and expecting the same 2/3 answer, she told me all three! I jumped for joy, I was so happy! Now the trick was getting her to actually follow them. But we were making progress. Baby steps. This was good.
She could now verbally tell me her precautions, but her impulsivity would always get the best of her. I told her that before she even attempts to move, she needed to stop and say her precautions outloud. This took time and there were days when she would get overwhelmed and emotional and all we'd do was sit together with her rubbing my forarm gently to calm herself down. She told me she just really missed her home. So what did I do? I scheduled a home evaluation.
I love doing home evaluations because, not only does it allow me to assess my patient's home safety and give my recommendations to allow for easy access, but it let's my patient be back in their natural environment and have something to look forward to. There's nothing like home. I scheduled it with her daughter who picked up my patient -sitting all ready to go in her wheelchair and oversized neon green shades nonetheless. I helped her with a car transfer and followed them to my patient's home sweet home. I could see how happy my patient was to step foot into her front doors (Well, back doors. Her front steps didn't have any railings and I absolutely refused to put myself in a situation where there'd be a chance for me to fill out another stupid incident report). We stayed no more than 30 minutes. We went over a few functional transfers -in and out of the shower, on and off the toilet, in and out of bed.. I gave my recommendations for adaptive equipment and things I'd re-organize in the home to make it easier and safer for my patient. The next day, the PT told me she had an amazing session with my patient -she remembered all three precautions, showed more energy, more strength and endurance... She told me she thinks seeing her home and knowing that's where she will be discharging to has picked up her spirits. I couldn't agree more.
I saw her in the afternoon that same day. When I told her I'd be taking her to the gym, she scooted over to the head of the bed to reach for her vaseline. Now I know this may sound a little strange but that was the best thing EVER. And I'll explain why. My patient would continuously twist her entire trunk (BIG no no) to get her vaseline on the night stand at the head of the bed. I always asked her, "What could you have done differently so that you're not twisting?" We'd talk about moving her entire body over, asking for help, using her reacher... The fact that she moved her entire body to get her vaseline that day was a HUGE accomplishment in my eyes. It told me she's remembering SOMETHING. I have no idea what and it could have been mere coincidence. But I'll take it. I was so happy and she was so proud of herself.
So she leaves on Wednesday. She will have 24-hour supervision, which is what her PT and myself have recommended, and home health services for continued therapy. She told me last week during her shower, "What would I do without you?" and I told her, "You're doing all the work. I'm just watching you do it." She took my forarm and started rubbing it gently. I am going to miss her.
I have a patient who is going to be going home on Wednesday. She had back surgery recently and also presents with cognitive problems, which makes recalling (and following) her back precautions next to impossible. She would impulsively twist to reach for a pillow, bend to put her socks on or pick something off the floor.. And I'd find myself telling her, "No- Stop- Wait- Don't do that-", as if I were babysitting a 2-year-old. At one point she didn't even remember having precautions. And when I attached the tab alarm to her, so that nursing staff would be called if she ever attempts getting out of bed unsupervised, I caught her taking it off and hiding it under her pillow when she thought I wasn't looking. I have caught her performing wheelchair-to-bed transfers all alone in her room (brakes unlocked I might add) as I was leaving another patient's room across from hers. I have told her time and time again to use her call button before doing that, but of course when you think you don't actually have precautions, why on earth would you need to call for assistance with anything? Good grief.
I figured that the best thing I could do was have her remember her precautions. She has horrible macular degeneration so posters with big contrasting letters was not an option. So that idea got scrapped pretty quick. Plan B. She did have a talking clock that I've noticed around her neck. Her friend gave it to her on her second day at the facility. With time, she was able to remember and initiate using it to tell the time without asking me. This told me that, with repetition and practice, there was hope that she could remember her back precautions.
I began each session asking her what her three precautions were. BLTs. No bending, no lifting, no twisting. She told me, "That is not going to stick out in my mind because I don't eat BLT sandwiches". She'd remember 2/3 after about a couple minutes of staring at the ceiling. Then I would have her repeat them in her head as I left her room to grab towels for her shower or theraband for her exercises. I'd come back and she'd remember, once again, 2/3. We'd start an activity and before any sort of movement, I'd ask her again. Or on the way back to her room from the gym or before out session ended. 2/3. Then one morning, I went to see her and, when asked what her precautions were and expecting the same 2/3 answer, she told me all three! I jumped for joy, I was so happy! Now the trick was getting her to actually follow them. But we were making progress. Baby steps. This was good.
She could now verbally tell me her precautions, but her impulsivity would always get the best of her. I told her that before she even attempts to move, she needed to stop and say her precautions outloud. This took time and there were days when she would get overwhelmed and emotional and all we'd do was sit together with her rubbing my forarm gently to calm herself down. She told me she just really missed her home. So what did I do? I scheduled a home evaluation.
I love doing home evaluations because, not only does it allow me to assess my patient's home safety and give my recommendations to allow for easy access, but it let's my patient be back in their natural environment and have something to look forward to. There's nothing like home. I scheduled it with her daughter who picked up my patient -sitting all ready to go in her wheelchair and oversized neon green shades nonetheless. I helped her with a car transfer and followed them to my patient's home sweet home. I could see how happy my patient was to step foot into her front doors (Well, back doors. Her front steps didn't have any railings and I absolutely refused to put myself in a situation where there'd be a chance for me to fill out another stupid incident report). We stayed no more than 30 minutes. We went over a few functional transfers -in and out of the shower, on and off the toilet, in and out of bed.. I gave my recommendations for adaptive equipment and things I'd re-organize in the home to make it easier and safer for my patient. The next day, the PT told me she had an amazing session with my patient -she remembered all three precautions, showed more energy, more strength and endurance... She told me she thinks seeing her home and knowing that's where she will be discharging to has picked up her spirits. I couldn't agree more.
I saw her in the afternoon that same day. When I told her I'd be taking her to the gym, she scooted over to the head of the bed to reach for her vaseline. Now I know this may sound a little strange but that was the best thing EVER. And I'll explain why. My patient would continuously twist her entire trunk (BIG no no) to get her vaseline on the night stand at the head of the bed. I always asked her, "What could you have done differently so that you're not twisting?" We'd talk about moving her entire body over, asking for help, using her reacher... The fact that she moved her entire body to get her vaseline that day was a HUGE accomplishment in my eyes. It told me she's remembering SOMETHING. I have no idea what and it could have been mere coincidence. But I'll take it. I was so happy and she was so proud of herself.
So she leaves on Wednesday. She will have 24-hour supervision, which is what her PT and myself have recommended, and home health services for continued therapy. She told me last week during her shower, "What would I do without you?" and I told her, "You're doing all the work. I'm just watching you do it." She took my forarm and started rubbing it gently. I am going to miss her.
Monday, August 8, 2011
Incident Report #1
I filled out my first incident report the other Friday for my first hip patient. In tears nonetheless, I filled it out as best I could. Here's what took place:
My patient, who has had screws implanted into his hip, was pulling his pants up in standing while holding his front wheel walker with one hand. He is currently toe-touch weightbearing status. Well I was right beside him providing contact gaurd assistance because he told me he felt sleepier than usual. His pants must have caught on his foot or something because he spontaneously let go of his walker to use both hands to pull his pants up. He lost balance (did not fall though thank goodness) and leaned into his right leg. I held onto him and pushed him upright. I asked him if he was ok and all he said was, "I felt it snap". I about passed out. He was able to walk back to his bed with his walker and lay down. I sat on the edge of his bed and just stared over him. He kept saying, "I'm ok. I'm alright. Don't worry." He said he felt just fine, he just felt a snap. Shit shit shit shit shit. So I left to talk to physical therapy and nursing. They said they'd monitor it but they weren't too concerned since he wasn't in pain and could walk back to his bed.
I saw a couple more patients after him and then visited him on my lunch break. I walked in to find him ambulating to the bathroom with his walker. So of course I thought, he must be fine. I asked him and he said, "I'm in a lot of pain". He said it was a sharp pain. An 8/10 pain level. Shit shit shit shit shit. I then went to our rehab director, who is also our OT mentor. She gave me my first incident report to fill out, just in case a complication occurred, and told me she'd follow-up with nursing to make sure they get an x-ray done. I went back to the gym and filled it out in tears, with Andriana and Dani, my two ex-classmates/co-workers, comforting me (these are the times when I am so thankful that I work with my friends). I prayed for him to be ok. The PTA who works with him told me there was nothing I could do to prevent it from happening and that if I wasn't there to catch him, he would've fallen to the ground. The director told me, it happens. It's just the population that we work with.
I went to see my next patient once I got myself together, 30 minutes later than planned. As I walked down the hall, the x-ray tech was leaving his room. Towards the end of the session, Andriana knocked on the door to tell me that the x-ray results were in and that everything was normal. She purposefully searched for me to tell me that so I wouldn't continue my treatment session worrying. What a great friend. It was a huge weight lifted off of me. I went back to see him after my session to tell him I was so glad he was ok. He said, "Yeah I was getting worried because the pain was getting so bad I almost cried". "You're gonna make ME cry!" I told him all teary-eyed. He said, "You didn't do anything wrong. It's not your fault". I told him, "I know, but you're my patient and I don't want you to be in pain". "Me neither". We both laughed.
I'm assuming he just pulled a muscle or something. But where did the SNAP come from?! Who knows. His nurse saw me leave his room and asked me, probably knowing I already had an emotional breakdown earlier, "Did you hear his hip is alright?". Ah this is definitely something I never want to experience ever again.
My patient, who has had screws implanted into his hip, was pulling his pants up in standing while holding his front wheel walker with one hand. He is currently toe-touch weightbearing status. Well I was right beside him providing contact gaurd assistance because he told me he felt sleepier than usual. His pants must have caught on his foot or something because he spontaneously let go of his walker to use both hands to pull his pants up. He lost balance (did not fall though thank goodness) and leaned into his right leg. I held onto him and pushed him upright. I asked him if he was ok and all he said was, "I felt it snap". I about passed out. He was able to walk back to his bed with his walker and lay down. I sat on the edge of his bed and just stared over him. He kept saying, "I'm ok. I'm alright. Don't worry." He said he felt just fine, he just felt a snap. Shit shit shit shit shit. So I left to talk to physical therapy and nursing. They said they'd monitor it but they weren't too concerned since he wasn't in pain and could walk back to his bed.
I saw a couple more patients after him and then visited him on my lunch break. I walked in to find him ambulating to the bathroom with his walker. So of course I thought, he must be fine. I asked him and he said, "I'm in a lot of pain". He said it was a sharp pain. An 8/10 pain level. Shit shit shit shit shit. I then went to our rehab director, who is also our OT mentor. She gave me my first incident report to fill out, just in case a complication occurred, and told me she'd follow-up with nursing to make sure they get an x-ray done. I went back to the gym and filled it out in tears, with Andriana and Dani, my two ex-classmates/co-workers, comforting me (these are the times when I am so thankful that I work with my friends). I prayed for him to be ok. The PTA who works with him told me there was nothing I could do to prevent it from happening and that if I wasn't there to catch him, he would've fallen to the ground. The director told me, it happens. It's just the population that we work with.
I went to see my next patient once I got myself together, 30 minutes later than planned. As I walked down the hall, the x-ray tech was leaving his room. Towards the end of the session, Andriana knocked on the door to tell me that the x-ray results were in and that everything was normal. She purposefully searched for me to tell me that so I wouldn't continue my treatment session worrying. What a great friend. It was a huge weight lifted off of me. I went back to see him after my session to tell him I was so glad he was ok. He said, "Yeah I was getting worried because the pain was getting so bad I almost cried". "You're gonna make ME cry!" I told him all teary-eyed. He said, "You didn't do anything wrong. It's not your fault". I told him, "I know, but you're my patient and I don't want you to be in pain". "Me neither". We both laughed.
I'm assuming he just pulled a muscle or something. But where did the SNAP come from?! Who knows. His nurse saw me leave his room and asked me, probably knowing I already had an emotional breakdown earlier, "Did you hear his hip is alright?". Ah this is definitely something I never want to experience ever again.
Subscribe to:
Posts (Atom)