week 5 STARES

STARES 3:

Situation – A 93 year old woman was admitted to Peel Health Campus for pneumonia. The patient has past medical history of HTN, osteoporosis, AF, IHD and frequent falls. Pt fell in hospital two days prior to planned discharge and # L inferior and superior pubic rami and # L maxilary atrium. Pt previously was independent with all activities, walked with a walking stick and lives at home by her self with her daughter living next door and providing care. Currently presents as being drowsy and disorientated with slurred speech from previously distinctive south african accent. Patient is non ambulant and requires hoist transfers to get from bed to a tilt in space chair.

Task – Pt was seen for initial elerdy assessment and initial treatment session. This included assessment of orientation, communication, vision, joint ROM, muscle strength, tone, co-ordination, sitting and standing balance (static and dynamic), functional ability’s within bed and ambulation and a COVS.
Action – In the pts room I began my assessment by doing all the tasks required in supine for example- orientation (time, place, person), rolling L and R, muscle ROM and strength, tone, sensation and proprioception. I then asked the pt sit up on th edge of the bed but she required 2 A. in sitting I assessed -sitting balance (internal and external perturbations), co-ordination tests and vision. I then asked the patinet to stand where I was unable to assess standing balance due to fatigue and dizziness. I returned the pt to bed where I did active assisted ROM of the L LL, active R LL exercises and UL exercises in long sitting. The pts slurred speech and diroeientation to place and to her injuries made it more difficult to conduct the assessment and treatment.
Result – the result of this treatment was that it was successful but longer than I had anticipated. However the main aim of our session was to identify the patients main activity limitations and impairements to help guide treatment sessions and discharge planning. Results as follows; oriented to time and person but not place, decreased L LL strength and AROM secondary to #, normal sensation, proprioception, tone and co-ordination. 1A rolling, 2 max A supine to SOEOB, 2 A STS. Full hoist for other t/f’s as pt unsafe for standing hoist and unable to ambulate.

Evaluation – Overall I think that my assessment was thorough and I now know what my pts impairements are and gives me a guidline for further treatment sessions. I feel that my assessment process has improved since the beginning of prac and the more I do I think I will continue to improve. I think I can still improve on making it run smoothly even though now I am at least making it easier for the patient by not making her sit up and ly down continuously during assessment and treatment.


Strategies – I think the main things I can do to improve is to practice the techniques on friends and families and keep asking for opportunitues to learn and practice. Also learn new techniques for treatments by reading EBP and broadening my treatment ideas for this pt and many others.