Caton Manor Week 4

One of the main things that I learned this week is that I'm not a big fan of getting 5 patients to treat at the same time. I think that its kinda rude to the patients because they end up sitting around for so long waiting for instruction or one-on-one care. Basically, the main problem is that nursing does not follow the schedule that is given to them from rehab and the tech does not pay attention to the list he has for which patients are treated by which therapists. Sooo...I am working a lot on my concurrent treatment skills...haha. I've talked to the other therapists about this craziness and we all work together to tag team patients which is nice. Its just amazing to me that certain people have difficulty following a simple plan. I understand if kinks happen and you need to be flexible...but actually using a foundation system would be a good idea for all...maybe I'll work on this more my "improvement project"...haha.
I also learned that venous stasis ulcers on LEs can bleed a lot...even pass blood clots. On Wednesday, I was able to work with the OT to get the patient with sarcoidosis with paraplegia and changing levels of consciousness (hallucinations/delirium) to sit up at the edge of the bed. He was a Max Ax2 but his tolerance increased to 20 minutes which was great. And then, I looked down...there was a pool of blood at my feet. Due to his long hx of steroid tx for the sarcoidosis, he has thinning skin at 56 y.o. resulting in numerous wounds on his LEs and sacrum. He was in a state of limited consciousness and didn't even notice his leg which does have sensation. Basically, the blood flowed because of the dependent position of the limb. Nursing was notified and we are not planning to sit him up for a couple of days now.
I have three new patients! First, 49 y.o. male s/p acute stroke of the MCA resulting in R sided weakness. Initially, I was told that he only spoke/understood French...and he has expressive aphasia. I was like "oh man, how am I supposed to do this eval". Basically, I went in, started do like the chicken dance to demonstrate what I wanted him to do. And then, nursing informed me and the PT that he does understand English...I was like...what? Haha. Oh well, I got the initial eval done, he still didn't understand why I wanted to look at this R side which "didn't work" based on our language we developed. The second patient is a 40 y.o. male at end-stage HIV/AIDS. I wish that Dr. Harris-Love could be there to help! He is incredibly weak, very thin (skeletonish), moves slowly, but attentive and alert. He likes to roll his eyes at instruction, haha...but I think he likes me because he has expressed appreciation when I take the time to explain why we are doing things. Also, there is a 78 y.o. male s/p L TKA...he is completely different from the last patient with the TKA. He has so much less pain! However, today...I was worried he had a DVT....so guess what I used. Thats right, the Wells Clinical Decision Rule. From my tally, he was positive....but according to the PT who looked at this further, she ruled him to not bee positive because he rated his tenderness pain only 3-5/10 and it was not significantly warmer from his other limb. I was still a little nervous about it...but you would be too I think when he calf is tender, size difference of 3 cm, s/p major surgery...etc. But, his swelling did fluctuate during the activities and he tolerated treatment well.
I have the new patients because two of my patients went home last week (mainly due to insurance reasons...sadness). The 59 y.o. with severe arthritis, gout and the L TKA and the 30 y.o. with jaundice and generalized weakness, etc. both went home. Their stories are still so interesting to me.
And then, today, I learned that I'm terrible at duck-pin bowling. I went on the rehab outing to a bowling alley in Glen Burnie. And well...I'm just no good...haha. But it was fun. Its kinda made me nostalgic though. Bowling is something to do with friends or family, and I have not been in forever. So I kept daydreaming about the other times I have been bowling. I can say that all of the people in the rehab dept at Caton Manor are quite enjoyable. :-)
How are all of you doing? P.S. the count down has begun....crazy! We are half way done!!