Thursday, October 9, 2008
pt's comment vs PT's observation
Week 2 of my orth ip placement. A 58 y.0 lady was going to be discharged from the hospital after the revision of her THR (post-op order PWB). I was going to teaching her how to use her e/c when going up and down the stairs. On s/e she reported that she only has one step going into the house and going to the shower but i decided to do the stairs (~4steps) that they have in the gym as she is a 58y.o previously independent lady. Prior to practicing the stairs, I told her to walk ~5 m within the gym with her crutches just to double check that she is really safe with it. We were going up the steps and she looked as though she was struggling (breathless) but still manage to keep up with conversation, she was rushing through her movements too. She told me that she is fine and wants to keep going, I was going to allow that but my supervisor stopped me and told the patient to take a breather. After ~ 2 minutes we went down the stairs. She rested in her wheelchair and had a glass of water, still look breathless but very involved in conversations. I told her that we are going to practice the stairs one more time and if that is okay with her and if she's feeling dizzy or fainty or pain, she said she'd be happy to do it again (my supervisor asked my why i chose to do it again as the patient looked as shes struggling, I told her that i wanted the patient to be really familiar with the e/c when going up and down stairs). We practiced the stairs again after ~10 minutes of rest, and this time the patient manage the stairs well and with less difficulties. After the treatment session, my supervisor told me that it was a good idea to re-check her stairs mobility. My supervisor was worried that the patient was not coping well during the treatments session. I then told my supervisor that I have seen this patient for a few days now and she always look breathless but she still manage well (i.e. obs stable and able to keep up with conversations, nothing significant in her PMH) and the patient reported that she is feeling okay. I trusted that the patient is telling the truth and i trusted my gut feelings, but I am still not quite sure if it is the right thing to do. Anyone has any comments feel free to post them up.
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