PMH

On the 3rd week of my ortho ip placement, I treated a 65 y.o lady from Sydney with # R tib fib as a result of a fall , she is currently on holidays in Perth. She has to remain NWB for 6 weeks. It is now day 3 and to date she only manages transfers. I took her to the rehab gym to do a mobility review and to practice ambulation in the parallel bars. Prior to her fall, she is independent with her ADLS but she has poor exercise tolerance. When ambulating within the parallel bars, she was struggling to weight bear through her upper limbs as she hop forwards, she has really poor upper limb strength. She managed one lap on the parallel bars doing mini-hops and shuffling her left foot instead of stepping through. She looked really exhausted and her RR has clearly increased. I didn't really take notice of this and i just assumed that it was because it was her first time ambulating after her operation. I took her to the gym again the next day for ambulation in the parallel bars, her quality of movement doesn't seem to have improved and she is as exhausted as she was yesterday. There was nothing listed in her PMH. I then decided to ask her if she is normally this puffy and exhausted with walking, and she said yes, and it was since her MVR that she has limited exercise tolerance. I then decided that i should go easy on her and keep monitoring her PR. I told my supervisor about it and she said that the doctor may have missed it as she is from Sydney and her PMH may have been purely subjective. I was glad that I was able to pick up the signs and manage to alter my treatment to suit the patient. When the patient was discharged, she was given a zimmer frame instead of e/c as she has weak UL strength and her husband was taught how to assist her when going up and down step.