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CVA on TIA
On my last placement I was treating a man coming in for a mild TIA which only affected his Right LL (weakness and sensory disturbances) and balance due to R LL weakness. I was treating him for around 4 days for his balance (high level) and some strengthening exercises for his R LL and also weight shifting exercises onto Right to increase WB on R and knee control in R. All was going well and he was ambulating independently around the ward on his WZF. One morning when I went in I couldn’t find the notes for this patient, apparently he was admitted for ED for having another stroke. The physiotherapist was comforting me and told me the patient may be alright – its just that the ward does not have a doctor present all the time, at least when he’s in ED a doctor can attend to him in case something happens. So 2 days after ED, the patient returned to the ward, I had to do his assessment again from the start because he has a new condition now (pt was diagnosed with bilateral cerebellar CVA). It was really interesting to see this - he had severe ballistic movements which frustrates him. It was quite sad to see this to happen especially when you already built rapport with the patient and they are progressing really well. The next few days, I was one of the 2 therapists treating this patient ( we had to have 2 full assist to help him from supine to SOEB otherwise his UL and LL will start to ‘fling’). From there rehab continues…the patient gets quite anxious and frustrated with his uncontrollable flinging movements and our job was to reassure him and get him to relax. From this experience, I believe I can handle emotions better in future if this is to happen again, we must understand the aetiology behind conditions (in this case – previous stroke is a cause for subsequent strokes) and since we can’t stop strokes from happening again, we must be professional and treat as necessary. We can also talk to our supervisors about the experience and I’m sure they will give us some ‘counselling’ of some sort if needed.
2 comments:
"I’m sure they will give us some ‘counselling’ of some sort if needed."
It is important for us to remember this insighful comment. If you work in an acute setting you will eventually come across a patient like this who has deteriorated as well as having a patient of your pass away. It is important to debrief under these circumstances. On a previous placement when i made the comment that i didn't really like morning tea and would rather write up my notes I was told that going to morning tea was an important time to connect with the other physios, to be able to debrief/discuss patients and events of the day. (it also makes you look like you have good time management skills!!)
thats a sad situation! Its good that you've learnt how to deal emotionally with a situation such as this, because it is an important skill for the future when you will inevitably have to deal with families and loved ones of patients who have a poor outcome or are dealt with unpredictable set backs in their rehab. I found also talking to other students on prac helful, not just your supervisor.
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