Wow, it's been 4 weeks! 1/4 of the way there! Had to write up another "biweekly planning form" for school and almost forgot til last night. Didn't realize that it was time already again! Things are going great. Loving this setting actually much more than I thought I would. Sad thing though...one of my favorite patients died yesterday. It all happened so fast. She had chronic liver failure and then her kidneys started to weaken about 1 1/2 weeks ago so they put her on continuous dialysis. After a few days it seemed as if things were turning for the better, she got moved to step down and was on dialysis 2-3x/week. The social worker had talked to us about her going home by this weekend. Then seemingly out of nowhere she started to go into kidney failure and began having respiratory complications. She went back to ICU yesterday morning and was gone by the time we got back up there right after lunch. So sad. She was the sweetest little lady. I couldn't help but stop by to say hi to her even on days when we weren't treating her just to see her pretty smile. It hit me kinda hard when they told us she passed. I was getting kind of attached to her, since she was such a long term patient. She's been here the entire time I've been here. She had quite the personality too. Always made me laugh. She was an elderly black woman with barely any teeth, and so hard to understand the first couple times I worked with her. Had some difficulty even the last few visits but could make out most of what she'd say just out of getting used to it and all. But anyway, my CI would always push, push, push this patient to stand more, walk more, etc. This lady would do it, but wasn't always happy about it! :) She could give my CI looks that could kill small children in about .8secs literally. But then when CI would turn her back, this pt would turn sharply at me and grin so big! Ha, told her we were just gonna keep playing "good cop, bad cop." Ah, man I'm gonna miss her! Didn't think I'd be able to get too attached to patients in acute care, considering the first 2 weeks our turnover rate was so large. People were in and out in a matter of like 2 days.
There is only one other patient that I have right now that is considered "long term." She'd been here already 2-3 months before I showed up. She had a gastric-bypass gone bad. Was actually in a coma for like a week, then had a few other medical complications, developed some bad pressure sores from being in bed and unable to move for so long. Yesterday afternoon we got her OUTSIDE of her room for the first time in months! She walked with a walker for 40ft...twice! I was so pumped, considering the frustration and difficulty we've had with her over the last couple weeks. She isn't the easiest person to work with. She has very lazy tendencies, spends at least 20-22hrs of the day laying in bed. Even though she is now moderately independent with getting up out of bed and transferring to the bedside chair. All we do now is just try to get her to walk more and supervise in case she lost her balance or something. I've pushed over and over again that she needs to get the foley catheter out now that she is able to safely transfer out of bed and could get to a bedside commode. But that would require her to get up multiple times each day, so she has been pretty hesitant about it. There have been many frustrating days working with her due to her lack of self motivation. And the fact that she tells nursing staff that she can only get out of bed with PT, and has been refusing occupational therapy lately. She's been here way too long and her insurance ran out the first of Sept. But her house was taken away from her since she could make payments on them for so long and her family lives on the pacific coast. Anywho, I think I've begun to make some improvements with her though. She's come a long way since I've gotten to see her. She isn't the nicest person, she orders people around a lot--"get my water," "put my socks on," "fix my sheets," "I'll do it 5x but no more," etc. I feel like she's trying to control what she feels like she still can contribute some control to, since she's been in the hospital for so long and cannot always dictate everything that happens. So unfortunately we see that a lot with patients in acute care...they can't control other aspects of care, but they do have the opportunity to refuse therapy. I've actually found out that you have to introduce an idea to her and then let in sink in for at least day or two before you try it. That way she kind of feels like she still decides when she does it. I've expressed this theory with her social worker and the other PTs/OT in our department. They obviously have a little different view of her though since they've dealt with her "issues" for some time now and are pretty much fed up with all of it. My CI feels like I'm getting through to her so every afternoon she just lets me go in and direct the days treatment. Which I feel has helped in her progression through treatment, to see a fresh face. And I try to motivate her each day and challenge her to go a bit further the next day. But I think it's mostly the approach. You have to almost talk to her as a child, be sweet and smile, kind of pat her on the back and tell her how much you believe in her, that sort of thing. Hopefully it'll continue to work. Told her my long term goal for her was to walk to the elevators so we could then walk to the Starbucks on the first floor. If she did that before I left, I'd buy her what she wanted from Starbucks!
No comments:
Post a Comment