staceyhambel

I think one of the areas where I have learned and grown during this quarter is within the physical aspect of providing therapy and knowing when it is important to provide a kind, reassuring hand or gesture.   My first day at Grant I was uncomfortable with all the wires, tubes, bags and smells - but I quickly got over it.  I had to the whole place is like that and I realized that sometimes what we are asking the patients do is so hard and it takes a reassuring pat on the back or words of encouragement to get them going or keep them going.  I’m more comfortable finding that area where I feel comfortable touching or providing those words of encouragement before I started at Grant.

**Completion Note

Student completed field work assignment at Grant Medical Center with Marlena Manu, COTA.

So, I start this page warning you it is about poop - actually explosive diarrhea, but there is more of a point to the story - just bare with me.  I tried to tell this story to my husband and he said “Stacey, I don’t like talking about your poop let alone someone else’s please don’t tell me anymore”.  So, I am sharing with you - if you have a weak stomach or feel the same as Keith (my husband) turn back now.

We (Marlena, Steve and I - OTA, PTA, and OTA/S) treated a patient that had been in a MCC (motorcycle collision), he was on the motorcycle.  He was doing relatively well, he is an incomplete paraplegic and has several broken bones.  He broke his right wrist and two of his digits of the same hand and one of the OTs had already made a splint for him; it was on him when we treated him that morning.  He had more swelling around the area when the OT made the splint and now it was loose and wasn’t fitting properly (or doing what it was supposed to do), so Marlena said we would later to tweak the splint for him and he agreed.

This patient was in good spirits and talked to us (althought it was difficult with the trach and no valve to keep the air from coming out).  He did really well with both treatments (trying to do things) and was motivated.

Later in the afternoon Marlena and I went back into his room to make his splint better fit.  I had went upstairs to fill the hotwater tank on the cart and Marlena was just outside the patient’s room.  When I arrived at the patient’s room I heard two individuals inside the room and I saw several sheets and two pillows covered with diarrhea on the floor.  The items were in viewing distance of anyone that passed by the hallway. 

The two individuals were laughing about the amount of poop and laughing with others that were passing by outside.  It made me feel uncomfortable for the patient.  I put the cart in front of the soiled sheets and could barely tolerate the converations between the two and passerbys.  One said,  ‘Jen, you should really lay off the greens for a while - too much ruffage in your diet’.  It was too much for me, I thought it was disrespectful to the patient and to the others that are professional in treating him.  When we sat him up that day he couged and couged and couged and then his nose started running and it ran and ran.  We let him cough and sucked all the yucky stuff out and then held the tissue up to his nose so he could blow his nose.  Is it glamorous, no but this man was unable to do it - let him have his dignity and help him without making it a big deal and making him uncomfortable.

When Marlena and I entered his room and re-fitted him with the new splint this man’s entire demeanor had changed.  He barely made a sound or even looked our way and I very much believe it was how those two individuals treated him.

I was only at Grant for one day this week (floors 5, 8 & 9). We have been working with a particular patient that we thought had been transferred to inpatient rehab somewhere in Columbus; however, she was still in the hospital just in a different room.  They are waiting on a Medicare number.  This patient had a left CVA and she is moving her leg fairly well, but her shoulder, elbow, wrist and fingers are a different story.

When we got to her room on Wednesday she stated that she had just gotten back from a walk with her room-mate.  Marlena thought she was talking about her hospital room-mate, but it was actually her room-mate from home that had been visiting with her.  She was so proud that she was up and about walking in the hallway and then Marlena told her she shouldn’t be doing that because it was unsafe.  She explained the safety precautions, the room-mate really doesn’t know how prevent a fall if the patient would start to fall.  The patient was so upset, she started crying.  She said she is just so frustrated with not being able to get things going - just staying in bed all day long waiting to go to rehab.

The patient participated in various exercises, most were isometric exercises (putting weight thru her right shoulder into her wrist and palm) - I don’t know if I explained that right.  It looks like she is leaning on the palms of her hands, really focusing on the right side.  Then we did exercises moving a towel across her table, pushing it away from her (extension) and also side to side (abduction and adduction).  She had alot of trouble with these exercises, so we tried them after she layed back in bed (without gravity) and she was able to do initiate about the first 20 degrees of motion - which is huge for her, and then she cried some more.

Progress Note:  Student is learning growing more in the development of therapeutic use of self; the timing of your words and tone of your words and how important those items are in providing treatment to patients.

Things were pretty good this week, and frankly I saw quite a few cranky C-R-A-N-K-Y people this week which wasn’t necessarily a bad thing  It’s all part of the learning experience, how to treat those that are crankier than others and provide the best treatment I can without thinking bad thoughts in my head.

Something that was pretty funny (at least in my mind) the prize winner for crankiness gave Marlena (COTA, I’m shadowing) and I a flower after treating her.  She threw other people out of her room.  Honestly, we were given a heads up on how this woman was behaving so we were somewhat prepared and Marlena had her gameface on I was just along for the ride!  It was interesting to hear them ‘bark’ at each other (in the most therapeutic way of course) - somehow this works for this patient, it was apparently what she needed?  For instance when Marlena asked her would she be living by herself when she went home, the patient without missing a beat calmly stated “No, my 3 boyfriends and I live together in the same house”.  I forgot to mention this woman was 74 (oh yeah, she doesn’t have any boyfriends - just looking for a response) She was a dandy!!

I did see a shoulder replacement and that patient was a peach, a fiesty one!  I’m telling you it was an interesting week dealing with personalities, trying to deal with personalities and still provide treatment.

Progress Note:

Student continues to learn more about diseases, disease names and abbreviations used at facility.  Student continues to practice critical thinking and overall documentation skills used at facility.  Student and COTA reviewed interview/data gathering assignment.  Student continues to observe OT functional activities demonstrated, and specifically how instrumental therapeutic use of self is in providing education, communication and cooperation during the activities.

Stacey L. Hambel, S/OTA 2 May 2009

It was kind of funny that we talked about communication in class and how important saying the right thing is - or saying it the right way - or sometimes when you are not saying anything, but your body is.  Because I have been seeing alot of communication mishaps if you will.  From communicating with patients, to their families, and fellow staff members sometimes people are just rude (not my COTA), but other staff - like RNs, etc.

 WOW!  This is the 4th week and I think they are starting to forget that I am a student and I am seeing more of what really happens on a daily basis. 

The last two weeks I have been mostly on Floor 7 (which is Trauma) I saw a patient with a right humeral fracture and a left radial and left olecranon fracture, how about that?  He also fractured two cervical vertebrae, but the doctor decided not to operate on those.  So he was in a neck collar.  I tell all of this, to tell about his spouse.

Very nice woman, full of questions and seemed to be anxious - but more squimish around medical stuff? She was particuarly apprehensive about the collar.  She said that the patient had previously broken his arms, but she just couldn’t handle the neck.  She was very nervous about hurting him more (reinjuring him).  She asked Marlena (COTA, I am working with),  ‘what am I supposed to do with that thing?’ (referencing the collar).

The COTA I am working with explained the procedure and we worked some basic ADLs with him.  We also explained, demonstrated and had his spouse demonstrate how to do strengthening exercises (the ones he could do) and how to take off his collar so it could be washed.  She wasn’t as comfortable with the collar, but she did it. 

As Marlena (COTA) was working with the patient doing UE strengthening, I saw the spouse writing down a description of the exercise.  I waited until she was done and then I said, as a student I do the exercises  with the patient because I am learning.  If you want, you could do them to it helps you learn what the movement is.  So she tried it and then Marlena had her work with her husband some more and actually stabilize his arm and then passively move it.  She was o.k. with it, a bit squimish.  It seemed she needed that reassurance that she wasn’t going to hurt him.

Trauma is pretty crazy.  I thought that being deployed and coming back home made me appreciate my family and home and the things that I have, but seeing the things that happen to people it makes me appreciate all that I have.  Sometimes I feel I complain about how bad my knee hurts and now I look at some of the patients that no longer have the ability to feel what a crappy knee does feel like.  It certainly puts things in perspective and sometimes it is very sad.

SOAP NOTE:

S:  “I imagine I am a sponge, absorbing as much OT info as I can possibly hold onto”

O:  Student shadowed Marlena, COTA and learned valuable information about education, functional activites and demonstration of ADLs with patients.  Student mostly located rehab closets on various floors and secured adaptive equipment.  Student assisted COTA with patient EOB sitting and stand transfers.  Student observed therapy provided by OT and OT providers to recent paraplegic patients.  Student witnessed sliding board transfer from wheelchair back into bed.

A:  Student has not acquired educational resources or necessary experience to be proficient, but is continuing with academics and observation hours.

P:  Student will continue with clinical fieldwork every Wednesday and Friday until Spring quarter erminates.     

Stacey Hambel,   S/OTA 26 APR 09                                                                                          

This week I was on the the 7th floor or ‘the trauma floor’.  We didn’t see many traumas because when we were going into their room for therapy, they were out for testing or unable to participate due to a new diagnosis.  It was a bit slower, which you wouldn’t think would be the case - but it’s just how this week worked out?

What was interesting about this week was the conversations regarding pain/prescriptions that the patients had with their doctors (while we were providing treatment in their room) or with us (the rehab staff). 

For instance, there was a patient with respiratory failure who had surgery for another diagnosis (lower abdomen).  He was in a great deal of pain, but he told the doctor when he took the medicine he lost track of things - so he wouldn’t take it (he was able to push a button for medication, when he felt he needed it).  He also voiced that he was afraid this medicine was ‘habit-forming’.  This man was scared and even though he was in a great deal of pain, he was not taking the morphine by choice (pushing his medication button).

Since the doctor was in with him he told him he would change the medication and see how it worked with him, but they didn’t want him to be in any pain.  He also reassured the patient and said that the staff would make sure that he would not have a habit from taking this medicine.  He explained how they taper the dose off, and how he is using it only because he needs it.

The patient understood this and seemed to be less anxious about our therapy after the conversation with the doctor.

Progress Note:

Feeling more comfortable participating in OT services during my clinical hours at Grant Medical Center.   As the COTA explains the exercise, I will demonstrate the UE strengthening exercise and perform with the patient - this reinforces my learning.  Better awareness of the need for clear explanations of demonstrations/situations to the patient and staff.

This week I am still on floors 5, 8 and 9 and seeing a host of diagnoses.

I had the opportunity to see a modified barium swallow test.  The patient that I blogged about earlier this week who suffered a right CVA had this test done on Friday when I was at Grant.  This was his second test, he failed the first.  What they are checking for with this type of test is to see if a patient is able to swallow liquids, so they can eat without choking.

The test normally starts with a thin fluid, then nectar, on to honey and lastly pudding.  The patient is positioned so that the test is recorded by radiograph and the speech language pathologist performs the test with the radiologist.  There are a few things that they are looking for: like to see how long it takes the patient to swallow the fluid, if the fluid penetrates, if the fluid is aspirated, if the bollis (pudding) clears the throat, and how the tongue pumping action is. 

The patient’s epiglottis never folded over like it should, it just inverted slightly.  So the liquid was being aspirated into other areas and eventually the lungs - he was able to cough some of it up?  The patient did pass parts of the test, but the SLP did not pass him.  He explained to me why he would not pass him.  He said this patient is just not cognitively able to make decisions on not eating and allowing him to eat puts him at risk.  It doesn’t mean he won’t ever eat, just not right now.  He needs intensive rehab therapy, which he will get at Riverside, but he needs the PEG tube before they will accept him?  Going to Riverside is this man’s best shot (and only shot) at ever recovering?

During this test you could almost see where things weren’t working, he had good tongue pumping action and was able to get the liquid down, but then it just sat there?  This was because some of his cranial nerves responsible for this area aren’t functioning (because of the CVA).

The key reason this test was done was so that the patient can have a PEG tube inserted (a more permament temporary feeding tube) so that he can transported to an inpatient rehab center, where he will have more indepth therapy services to recover.

Forgot to include this in my first Journal and being technically deficient, I just wasn’t sure how to add to - so I made an additional post.

Met Marlena Manu, COTA that I will be working with at Grant Medical Center in Columbus, Ohio.   I plan to learn from her in a clinical setting on Wednesday’s and Friday’s (8-4:40) from April 1st through the end of Spring quarter.

This is officially my second week of clinicals, and I am finding my way around the floors (5, 8 & 9) better this week.  I would be lying if I said I could find everything, I still have trouble finding the rehab closet (where we keep our walkers, sock pulls, reachers, etc.).  Everything looks the same on the floors and almost everything is the same –except for where they put our rehab closets, go figure!

Yesterday the COTA training me, started to walk into a room and the patient we were going to see was being carted out for a test.  This man was so jaundiced, when I saw him I thought he had been spray-painted.  I read the initial diagnosis and it did say jaundice, but his face was gold like mustard and it had spread down his arms.  He left for his test, so we had to come back later.

Earlier in the day we were warned of a patient’s family.  They were angry that OT had not been in to see their loved one.  The COTA I was following was suffering from a nasty cold and she had called off the previous day, so in fact no one had seen this patient since monday.  I was apprehensive because I didn’t know how to deal with a family.  Before we could get to the patient’s room the PSA stopped us and asked us if we were OT and told us that the family had been asking about whether we were going to show up today?  It wasn’t looking good.

When we entered the room I met the patient a 68 year old man who had suffered a stroke seven days earlier.  I also met his wife and daughter.  The first thing I saw when I went into the room was a small bulletin board with cards and pictures of family attached.  At the top of the board, it said I ‘heart’ U in big black letters. 

This man had a hemorrhagic stoke, left side affected.  He was having a difficult time sitting for an extending period of time, speaking and atempting to use his right upper and lower limbs.

As the COTA and I worked with him I happened to glance over toward the wife and daughter and  I saw the patient’s wife holding their daughter’s hand and crying.  After we completed our therapy, she asked to speak with us.  She wanted to know if he was going to get any better.  She stated that they had such a good day yesterday- they were having conversations and he was much more alert and today it seemed he was as bad as he was the day he came in. 

The COTA explained that we don’t really know if he is going to get better and that every person is different, we just have to continue to work with him.  Before we left we showed her some of the upper body exercises she could do with him to keep his shoulder/elbow joint fluid.   This woman wanted us to tell her that her husband was going to get better and I know that we can’t because we don’t know that, but I could feel her hurting and that was very hard.

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