Sunday, December 20, 2009

A complex case review

I have a patient at the moment who is severely underweight. She was admitted to the ward with a fractured neck of femur or # NOF. She was intoxicated when she presented to ED, and was admitted to my ward. She underwent surgery having a DHS (dynamic hip screw) procedure.
I had known this patient from a prior admission. She is 39 years old and has a history of drug and alcohol abuse, and depression. Last admission she had a pressure ulcer, had lost endless amounts of weight and was very de-conditioned. She was and still is a high pressure area risk. She "lives alone" however has a partner who is very supportive. She also has a supportive sister living in the area.
Pain has been a major issue for this patient, so from the very start it was hard for the physiotherapist to work with this patient. I decided to not have any involvement on the ward until she was actively participating and the medical team had sorted a plan for her.
I visited the patient to check in with her every few days, and i liaised with the physiotherapist often also. The nursing staff and medical team kept me in touch with what the plans were.
Last MDT we were up to the stage of figuring out a plan for her, as she was becoming more actively involved with physio. In the MDT we decided it was best that we organized a daily routine for her to help facilitate progress and get her more involved in therapy. The following day the physio and I met with the patient and discussed a daily routine, including physio sessions, rest times, self care tasks, leisure activities, and eating periods. I liaised with the dietitian re: meals.
I completed a daily planner, provided the patient with some sudoku's which she loves to do and sat down to look at some goals.
The concern i have now is that she has developed a broken area on her sacrum and will not remove the pillows from under her so that the air mattress can do what it is designed to do. She has great bed mobility, but this doesn't solve the problem of sleeping at night.
So hopefully over the next few days i will convince her to remove the pillows, wish me luck...the RN staff have had none...
I look forward to working with this patient every 2 days working on her activity tolerance and her independence with self care tasks.

Jess

1 comment:

Anonymous said...

我是天山,等待一輪明月。.........................