WEEK 3

28.10.08

Almost half way through, time flies when having fun (or when you brain is going 100 miles an hour so the clock becomes irrelevant).

This week we are up to 6 pts a day between Chantelle and I. We have a couple we see together and others we see individually. The more challenging pts take both of us.

We had a new pt today who required a full initial geriatric assessment. The pt was admitted to RPH post fall. She was presenting with Obesity, Diabetes (which are both risk factors for CCF), R CCF which led to oedematous LL, asthma and arthritis, just to list a few of the main ones. For 67 years old this pt was presenting much worse of, mobility wise then some of our older pts with similar lists of medical conditions.

Weighing ~100kg our manual handling was the KEY FACTOR today.

We assessed function using a COVS and just generally looked at her bed mobility and transfers. We also assessed her sitting and standing balance and muscle strength. She had very decreased muscle strength and the extra weight she had to lift didn't help. Oedema also restricted a lot of movements. The decreased muscle strength then impaired her mobility as she found it difficult to roll in bed, struggled with supine to sit as she couldn't lift her LL's, used a rocking motion to get momentum to help her get from sit to stand and could only ambulate 75m before requiring a rest due to fatigue.

From this we summised that our treatment needed to increase ROM and LL strength, which we thought would be most functionally done in standing as she would be carrying her own weight. To help manage the oedema we leave her each day with her feet elevated and educate her on this, as well as instructing her on some ankle pumping exercises to do in the future. Her UL strength wasn't too bad so just strengthening these functionally with sit to stand and supine to sit transfers, using her arms, as well as some weights. For balance we would be aiming to improve her dynamic standing balance as this was her down fall.

Today Chantelle and I were quite efficient in our assessment. We were able to complete the geriatric assessment in good time and covered all of the elements required. We both noticed that we were getting better at doing the assessments, compared to our first attempt in week one.

Our Subjective Ax today was not thorough enough. In future we will include more questions about past mobility and home environment as we only touched this information and didn't go into details.