stares 1 rotation 2 2010

Stares Entry One – Placement 2 2010

Situation:

I was asked to see a Mr H was day 2 post CABG. He had been transferred from ICU the previous day. PMHx: smoker, HTN, previous MI. Today he had not yet been mobilised on the ward. Mr H had only sat out of bed with the nursing staff.

Task:

Ax & Rx of patient. I was aiming to mobilise according to day 2 post CABG path way.

Action:

After doing a thorough Ax (- chest screen and checking obs, pain , SOB, ecetera) and giving this patient breathing exercises to help airway clearance and decreased lung volumes, I deemed this him suitable to mobilise. I told the patient I was going to get him out of bed as I was on one side of the bed preparing the attachments. Before I had a given clear instructions, the patient began to get out on the opposite side to the one I was on. He had on support from me and I was not able to probperly monitor him as he sat up out of bed. After checking he was ok to get up and mobilise, I told him we will be going for a walk soon. As I went to place the trolley in front of Mr H and hook up all of his attachments, he stood up on his own without any support. Once again he was ok, however it was not good practice that I hadn’t been there ready to give full support if necessary. Once the patient was ready, we walked 70m up and down the ward. Mr H had quite a fast walking pace and I had to keep asking him to stop to get his heart rate down as it was rising above 100 BPM. When the walk was finished Mr H felt fine, although a little tired. After a reassessment and some patient education, our session was finished.

Result

Patient was able to ambulate a good distance. I achieved my goals for the patient on that day. Although nothing negative happened to myself or the patient, the session did not run very smoothly and because of this the session was not optimally safe for the patient.

Evaluation

My Rx was not very safe because my instructions to the patient were not clear enough. This patient was very eager to do everything all at once. If you are not there on standby when the patient is mobilising for the first times after major surgery, there is a high possibility the patient could have an accident and undo all the hard work of the surgical team. After trying to run an Rx session with a patient when I was not familiar with the attachments and not clear enough with my instructions, I know this is something I need to improve.

Strategies

• Practice verbal communication on someone who is not a patient – making sure I am absolutely clear about when they are to move.
  
• Get more practice with supervision setting up trolleys with attachments ready for the patient to mobilise.
• Always give the acute surgical patients more assistance than necessary for the first few times you see them until you are familiar with the patient.