Hi everyone!
Sorry for the delay in posting.
I am currently doing my cardio placement in RPH, but today my post is from a case on my last prac (Gerontology). The main aim of that particular ward is to allow patients additional time to gain confidence on their feet and extra rehab b4 going back home/hostel/NH.
I had an elderly lady diagnosed with unstable angina with a PMH of IHD, AMI, PVD and dementia. During her initial Ax, she was doing pretty well, and I got her to amb down the corridor of the ward. Since she was considered "medical" due to her angina, I kept asking SOB/chest pain/radiation symptoms. She was walking fine initially, then after 15m from being steady & safe, she suddenly wanted to sit, and FAST!!! She started to complain, on questioning of severe bilateral calf pain with a grimace on her face. This case is more complex than expected as her dementia made her lack insight, and was verbally non-spontaneous (would only tell you if asked).
Over the next few days, I got her on a walking program to increase her ex tol and walking endurance. Nearing the end of her stay, she was struggling ~35m with multiple rests. By then, the doctors were pushing for her to go back to her hostel. The requirement for her hostel was Indep amb ~40m, and she was almost barely reaching that mark. I expressed my concerns to the team and my supervisor, but they still wanted her back. I knew for certain that if "anything" happened, she will well be under that mark. I gave her a 4WW to go back with, and expressed all my concerns in her D/C summary.
It's not easy to decide who stays and who goes. Hopefully with more clinical experience, I'll be able to decipher that more easily.
Mark
Sorry for the delay in posting.
I am currently doing my cardio placement in RPH, but today my post is from a case on my last prac (Gerontology). The main aim of that particular ward is to allow patients additional time to gain confidence on their feet and extra rehab b4 going back home/hostel/NH.
I had an elderly lady diagnosed with unstable angina with a PMH of IHD, AMI, PVD and dementia. During her initial Ax, she was doing pretty well, and I got her to amb down the corridor of the ward. Since she was considered "medical" due to her angina, I kept asking SOB/chest pain/radiation symptoms. She was walking fine initially, then after 15m from being steady & safe, she suddenly wanted to sit, and FAST!!! She started to complain, on questioning of severe bilateral calf pain with a grimace on her face. This case is more complex than expected as her dementia made her lack insight, and was verbally non-spontaneous (would only tell you if asked).
Over the next few days, I got her on a walking program to increase her ex tol and walking endurance. Nearing the end of her stay, she was struggling ~35m with multiple rests. By then, the doctors were pushing for her to go back to her hostel. The requirement for her hostel was Indep amb ~40m, and she was almost barely reaching that mark. I expressed my concerns to the team and my supervisor, but they still wanted her back. I knew for certain that if "anything" happened, she will well be under that mark. I gave her a 4WW to go back with, and expressed all my concerns in her D/C summary.
It's not easy to decide who stays and who goes. Hopefully with more clinical experience, I'll be able to decipher that more easily.
Mark
2 comments:
Hi Mark,
It must be difficult to know what to do when everyone wants a patient to go home, but you don’t think they are ready… I think it’s great that you gave her a 4WW, at least that way if she can’t make the 40m she can take a seat on the walker. I also think it’s good that you wrote all of your concerns on her D/C summary, so that it’s documented and no one can say they weren’t aware of her mobility situation prior to D/C.
Do you know whether or not her hostel has a physio or physio assistant available that could help her with improving her walking distance even more when she gets home?
Mel
Mel,
The hostel does not have a physio, therefore there would not have been any more rehab for her. If I could do it again, I would also have referred her on for follow up community physio.
On the bright side of things, it is comforting to know from the patient that she was going back to a helpful community that looks out and helps each other (walk to dining room together, social activities...etc)
Mark
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