what do i do? click here i am sure it`s nothing u expect
well, my third placement is all about pediatrics ie children. i am in a very renowned facility, the royal childrens hospital brisbane. we get kids from all over queensland, pretty amazing. the physio department has, again, so many different parts. we have the cardio-respiratory stream, neuroscience, developmental pediatrics, hydrotherapy and orthopaedics. i am learning in the last three areas.
so usually they ask for physio in regards to acute chest physio post OP becasue the analgesics decrease lung function and we have to get the kids to use their whole lungs when they lie in bed and are in pain, rather just shallow breathing. so, altho cardio-resp is an area on its own, its something else i have to do, GREAT, but its not that hard and it's really cool to auscultate them and hear stuff and then do exercises, make them cough up heaps of stuff and then auscultate again and the crackles are gone or shifted, quite spectacular. the physiology is bit tricky but i think i understood most of it at uni so its not too bad to apply the few principles and its not that i have to know different conditions. not yet, thats my last placement.
apart from that i do a pre and post OP assessment to see what their function is and to assess what changed during surgery. so i dont only look at the affected limb, often i cant do anything anyway cos they might present with a massive fracture so make sure not to touch that limb at all. but, i still have to assess their lung function, cough ability, muscle strength, flexibility, circulation and ask questions about school, hobbies, home environment, goals etc.
sooooooooo, where to start? hm. kinda hard because so much is happening everyday and i have the urge to tell u guys all that stuff every day but never get a chance to jump on the net for longer and write. but now i have time so lets open the book of my third placement and read some stories:
well, my third placement is all about pediatrics ie children. i am in a very renowned facility, the royal childrens hospital brisbane. we get kids from all over queensland, pretty amazing. the physio department has, again, so many different parts. we have the cardio-respiratory stream, neuroscience, developmental pediatrics, hydrotherapy and orthopaedics. i am learning in the last three areas.
so i start my day with reading charts from my patients to get a bit of an overview and to NOT get totally smashed by my supervisor but being able to answer some questions especially in regards to conditions, there are a million kids conditions and because i dont have one but three areas i have 3 times as much to look up. so i try to skim thru the patients i got allocated and jump on wikipedia, lol, he just is my best friend of all times, and look up all the words and conditions that look chinese to me so i actually know whats wrong with my kids. at 8:30 I go upstairs to my ward, acute orthopaedic ward, and follow the wardround with the doctors to see what we are up to with all the little fellows. from there i can gather information who is due for surgery, what surgery, who came out of surgery, who they wanna discharge (which means i have to make sure they are safe to go home in terms of HOW they go home, walking, crutches, wheelchair etc, is the home environment safe? are they able to manage school with stairs and long distances etc pp...write letters for the teachers, give out appropriate equipment, refer to local physio, give home exercise programme...) how did it go, well tolerated, complications, what further services they want, what sort of painkillers they are on, could be epidural (into spine), PCA (patient controlled anasthetic, so they can push button when they are in pain and get morphin or similar) or just normal stuff taken orally. this has big implications of the sort of treatment we can do and not to forget the contraindications...safety is issue number one, obviously, these kids are sick and weak!
so usually they ask for physio in regards to acute chest physio post OP becasue the analgesics decrease lung function and we have to get the kids to use their whole lungs when they lie in bed and are in pain, rather just shallow breathing. so, altho cardio-resp is an area on its own, its something else i have to do, GREAT, but its not that hard and it's really cool to auscultate them and hear stuff and then do exercises, make them cough up heaps of stuff and then auscultate again and the crackles are gone or shifted, quite spectacular. the physiology is bit tricky but i think i understood most of it at uni so its not too bad to apply the few principles and its not that i have to know different conditions. not yet, thats my last placement.
apart from that i do a pre and post OP assessment to see what their function is and to assess what changed during surgery. so i dont only look at the affected limb, often i cant do anything anyway cos they might present with a massive fracture so make sure not to touch that limb at all. but, i still have to assess their lung function, cough ability, muscle strength, flexibility, circulation and ask questions about school, hobbies, home environment, goals etc.
then when they come out of surgery, i assess again, get their lungs going again as well as look after the good body parts since not moving causes deconditioning straight away. u would not believe how quickly u lose your muscle and how much your joints stiffen up if not moved regularly. so i do bed exercises with them, teach them some stuff they can do on their own, get parents and nurses involved to encourage and facilitate and see them, depending on severity and condition, up to 3-4 times a day.
if the doctors and surgeons give green light to move the "bad" leg for example, we can start moving that, but then u have to coordinate that with the timing of their analgesics cos otherwise they are in too much pain and then the nurses wanna shower him and they have to go to xrays, or they sleep, or they have just eaten, or they are drowsy etc. so thats something really hard, to coordinate it all cos these kids are quite busy with all their appointments etc.
we also have to help the nurses to move that kid, so we have to get them out of bed in an appropriate manner (quite tricky if they are weak, in pain, have pins and screws adn plates everywhere or even have an open external frame with screws piercing the skin from outside- something that gave me a short funny feeling in my stomach the first time i saw it, apparently it doesnt hurt...) so there is a LOT of work on the ward to get all your kids done and coordinate.
and then, what i never expected, there is soo much paperwork. everytime u see a patient u have to write in their chart, which is often really hard to find because nurses, doctors, other allied health professionals etc have a look at them so i spend a bit of time chasing up patients charts also. then i have to write letters for schools, referrals to other physios, organize referrals with the docs if i cant authorize it, organize equipment loans, discharge summaries....yeah, lots of paperwork. i can kinda understand bit more now, why doctors have such a bad writing, cos they have to make a lot of entries....its ridiculous, i tell u, its just a scribble, i cant read it most of the time, praying i didnt miss some crucial information.
ok so much for the work on the ward. thats only one third of my tasks at the moment. and cos i dont wanna bore u, i stop here. i try and tell u a bit about 2 of my very special amazing patients, holy lord, they tried to built a pipe bomb.....check it out here
