STARES 2
SITUATION
In outpatients I had been referred a patient who was approximately 26 weeks pregnant. She had been suffering from back pain for a few weeks. This referral did not give any more information. After talking to the patient I found it was a fairly constant pain that gets worse when she sits for long periods (especially at work when she often crosses her legs or sits slumped to one side). Although she had tried heat packs and other forms of pain relief it did not seem to get better. I pin-pointed the pain to the lower thoracic spine but found it could also go down into her lumbar spine.
On objective examination I found that her most painful movements were left rotation and right side flexion. On palpation there was a little tenderness through the spine, and I found quadratus lumborum on the left was quite tight in comparison to the right side.
TASK
I had to treat this patient’s back pain while taking into consideration the fact she is pregnant (which has physiological effects on the body but can also affect my treatment and the positions I can get the patient into).
ACTION
I thought that opening the spine on the left may be the problem. I started with some rotation snags where the patient rotated to the left. After a set of these there was no change in the patient’s pain levels or range of movement. I then tried snags into right side flexion. After one set of these the patient’s pain levels had decreased and she found it easier to move into right side flexion. I decided to do another three sets into side flexion and by the end the patient’s pain had decreased into side flexion (but had not changed into left rotation).
I decided to treat the left quadratus lumborum which was tight in comparison to the right. I decided to massage the muscle on the left, however I would normally do this in prone. This patient could not lie on her stomach as she was pregnant, so I chose to modify this position where the patient was in standing, supporting herself by leaning over the plinth. I could feel the muscle releasing as I massaged, and after finishing the patient could move into left rotation and right side flexion much more easily. I showed her some stretches to do at home and encouraged her to get her partner to continue with the massage at home.
Next I addressed her posture. She commonly crossed her legs and was sitting slumped to the side without even realizing it. I used proprioceptive taping to make her aware of her posture. The tape would not hold her in a specific posture but would remind her she was doing something wrong if she slumped.
To finish with I taught her some pelvic floor muscle exercises. These wuld benefit her in improving core stability (which may help with her bacj pain) but also prepare her pelvic floor muscles before childbirth.
RESULT
The patient’s back pain had improved during the session and she had a home exercise program to continue with on her own to help prevent the quadratus lumborum from tightening up again (and therefore preventing her back pain from returning). I am planning to see this patient again in one week to see if this treatment has longer lasting results and if she can manage this on her own at home.
EVALUATION
I feel I did a good job with this treatment. Although my first choice of rotation snags were not effective, I changed what I was doing instead of wasting time on a treatment that was not working. I felt I did a good job of modifying my massage by choosing an appropriate position for a pregnant lady. I think it was a good well-rounded treatment session as it included a lot of education, some hands on treatment and exercises for her to do at home.
One thing I did not do so well was getting the patient to move around too much. I did my assessment in standing, before getting her to sit on the plinth, then lie down. This part was good, however in my treatment I had her lie down, then sit, the lie, then sit again, then on the floor for an exercise. This is particularly uncomfortable for someone with back pain (especially when they are pregnant).
STRATEGIES
I should structure my treatment so I do everything I need to in one position before getting them to move into another. I need to think ahead of what I will likely be doing throughout the session.
Monday, May 31, 2010
Saturday, May 15, 2010
STARES WEEK 1
Women's Health Prac
SITUATION
I was seeing a young male patient with a continence problem. One of the things I needed to assess was if he was emptying his bladder completely when going to the toilet. It is important information for me to know. If he is not emptying completely then there will be a residual volume, which means less urine can then be stored in the bladder. To look at his bladder (and see how much urine is in there) real time ultrasound (RTUS) can be used.
TASK
I had to use the RTUS to look at the patient’s bladder pre and post void to see how much urine was being stored in there and if he was completely emptying it when going to the toilet.
ACTION
I asked the patient to lie on the plinth then I prepared him with the paper towels in place to stop the gel getting on his clothes. He had done this before with my supervisor so was used to the procedure. I then prepared the ultrasound head with gel and placed it over his bladder. It was quite easy to identify it on the screen as he had a moderate amount of urine in there (the fuller the bladder the easier to see it by ultrasound). After using the RTUS machine to measure the size of the bladder I asked the patient to go to the toilet. After this we did the whole process again and I needed to re-measure the size of his bladder.
RESULT
The second time I could not find his bladder using RTUS, which means he had emptied it properly. I did have my supervisor check as well, just in case I had made an error when trying to find it. She could not find it either, so we came to the conclusion that it had been completely emptied.
EVALUATION
Overall I felt that I used the RTUS effectively. I could find the patient’s bladder but needed to be shown how to measure the size of it. I was worried when I could not find it the second time, but was reassured it was because it had been emptied, not because I had the ultrasound head in the wrong spot. One thing I could improve on is how I was set up. My supervisor is left handed, so she had the machine set up to hold the ultrasound head in her left hand and use her right hand on the controls (to measure the bladder). I left it set up in this way, which made it a bit awkward when I had to use my left hand to hold the ultrasound head. I would have been more comfortable to have it in my right hand.
STRATEGIES
I should make sure I am prepared before jumping into a procedure with the RTUS. Next time I should position the machine on my left, instead of my right, so I can use my dominant hand. The machine sits on a trolley with wheels so it would be very easy to move (I would just have to be careful of cords that need to be plugged into the wall). Having had this experience, I think I will be more prepared for next time I use the RTUS but can apply this lesson to all things: be completely prepared before starting a procedure!
Women's Health Prac
SITUATION
I was seeing a young male patient with a continence problem. One of the things I needed to assess was if he was emptying his bladder completely when going to the toilet. It is important information for me to know. If he is not emptying completely then there will be a residual volume, which means less urine can then be stored in the bladder. To look at his bladder (and see how much urine is in there) real time ultrasound (RTUS) can be used.
TASK
I had to use the RTUS to look at the patient’s bladder pre and post void to see how much urine was being stored in there and if he was completely emptying it when going to the toilet.
ACTION
I asked the patient to lie on the plinth then I prepared him with the paper towels in place to stop the gel getting on his clothes. He had done this before with my supervisor so was used to the procedure. I then prepared the ultrasound head with gel and placed it over his bladder. It was quite easy to identify it on the screen as he had a moderate amount of urine in there (the fuller the bladder the easier to see it by ultrasound). After using the RTUS machine to measure the size of the bladder I asked the patient to go to the toilet. After this we did the whole process again and I needed to re-measure the size of his bladder.
RESULT
The second time I could not find his bladder using RTUS, which means he had emptied it properly. I did have my supervisor check as well, just in case I had made an error when trying to find it. She could not find it either, so we came to the conclusion that it had been completely emptied.
EVALUATION
Overall I felt that I used the RTUS effectively. I could find the patient’s bladder but needed to be shown how to measure the size of it. I was worried when I could not find it the second time, but was reassured it was because it had been emptied, not because I had the ultrasound head in the wrong spot. One thing I could improve on is how I was set up. My supervisor is left handed, so she had the machine set up to hold the ultrasound head in her left hand and use her right hand on the controls (to measure the bladder). I left it set up in this way, which made it a bit awkward when I had to use my left hand to hold the ultrasound head. I would have been more comfortable to have it in my right hand.
STRATEGIES
I should make sure I am prepared before jumping into a procedure with the RTUS. Next time I should position the machine on my left, instead of my right, so I can use my dominant hand. The machine sits on a trolley with wheels so it would be very easy to move (I would just have to be careful of cords that need to be plugged into the wall). Having had this experience, I think I will be more prepared for next time I use the RTUS but can apply this lesson to all things: be completely prepared before starting a procedure!
Monday, May 10, 2010
Fremantle Women’s Health
Fremantle Women’s Health
I am very excited to be starting my women’s health placement as it is an area I am really interested in. My expectations come from talking to a previous student and one of my supervisors. I am expecting:
1. I am expecting to be supervised by a number of different physios, especially being between Fremantle Hospital and Kaleeya.
2. I expect to do a lot of observing rather than hands-on work as we will not have covered a lot of the post-grad techniques. Having said that, I expect I will be able to do some continence work (as we covered this at uni) and some work in the pregnancy area.
3. I expect my role as the student will be to learn as much as possible and take advantage of learning things we may not necessarily learn at uni from very experienced physios. I will probably be expected to perform subjective assessments even if I cannot do all the treatment.
4. I expect I will have to complete some sort of project or presentation while on this placement as the previous student did.
I have a few concerns, including the fact I don’t think I know enough in this area! I have revised everything from our Women’s Health unit so am planning to learn new things as I go. I have been told I am at Kaleeya in the mornings and Fremantle hospital in the afternoons so I am very concerned about getting parking at Fremantle at this time! My final concern is that some of the patients may have sensitive issues or situations, so I just have to do my job and not be awkward about any of it.
I am very excited to be starting my women’s health placement as it is an area I am really interested in. My expectations come from talking to a previous student and one of my supervisors. I am expecting:
1. I am expecting to be supervised by a number of different physios, especially being between Fremantle Hospital and Kaleeya.
2. I expect to do a lot of observing rather than hands-on work as we will not have covered a lot of the post-grad techniques. Having said that, I expect I will be able to do some continence work (as we covered this at uni) and some work in the pregnancy area.
3. I expect my role as the student will be to learn as much as possible and take advantage of learning things we may not necessarily learn at uni from very experienced physios. I will probably be expected to perform subjective assessments even if I cannot do all the treatment.
4. I expect I will have to complete some sort of project or presentation while on this placement as the previous student did.
I have a few concerns, including the fact I don’t think I know enough in this area! I have revised everything from our Women’s Health unit so am planning to learn new things as I go. I have been told I am at Kaleeya in the mornings and Fremantle hospital in the afternoons so I am very concerned about getting parking at Fremantle at this time! My final concern is that some of the patients may have sensitive issues or situations, so I just have to do my job and not be awkward about any of it.
Subscribe to:
Posts (Atom)