Friday, July 27, 2012

Week 9 down

Wow, I can't believe I only have three weeks left!!! I am starting to realize how much I will miss everyone I have met at the facility.
I'm seeing 5 patients now but this week was kind of weird because the case loads were a little low so we had to pass some of our patients to the COTA's so I had 3-4 patients all week.

I did 2 evaluations by myself this past week. One was a man that has stage 4 melanoma and the other had abdominal surgery (very confusing PMH).
The man who had abdominal surgery is now on my caseload. During the evaluation he was so inappropriate and his son/his sons friend were in the room/hallway just laughing at everything he was saying. I was a little hesitant to take him on as a pt for my caseload but he has been completely different than that first day. My supervisor and I think that his son probably liquored him up (he has a hx of drug/alcohol abuse) before they brought him it. Because of that his notes show a drastic improvement in just the week he has been there and I think he will be d/c'ed next week. I just really do not feel he is appropriate for OT now. This week he refused me 3x in one day and 2x the next day but he finally came down after speaking with the doctor and my supervisor. I just don't know what to do with him anymore so I am crossing my fingers he gets to go home soon.

The man with stage 4 melanoma that I eval'ed just reading his background info made me sad. He noticed a lump under his arm and then let it grow bigger and bigger for 6 months before getting it checked. He was taking care of his mother who was dying and said he just put his own health on the back burner. Makes me so sad because they could have prob caught it before it spread to his spine and sternum.  He said he is real hopeful and has a lot of people praying for him.

My pt with the TKA finallllly got an upgrade in her weight bearing status thank goodness!! She was an independent as possible at w/c level so I really needed her to get weight bearing as tolerated (WBAT) when she went to her appointment this past week. She has been doing so good standing =) She is prob my favorite patients right now because we have really formed the therapeutic relationship and she trusts me and lets me push her a little more than she is comfortable with because I just know she can do it! I'm going to be sad when she leaves next week (that's the plan at least).

My pt who had a stroke is still doing really well. I'm concerned he may be getting depressed though. This week we started working more on his L neglect. He is always looking straight ahead and doesn't really acknowledge anything to the L or R really. I attached a timer to his L forearm and set it to beep every 10 minutes to get him to turn his head to the L side. The first time it took him 11 seconds to find and turn off the timer.  By the end of the session it only took him 3 seconds so that showed a good improvement!

Anyways, that pretty much sums up whats been going on so far... Can't wait to see what these next three weeks bring!

Wednesday, July 11, 2012

week 7

Wow, how is it already week 7?? I'm over halfway through with this placement now.
Things have been going really great. I had my midterm review last week and got really great feedback. My supervisor gave me all 3's (out of a possible 4)- and said I already had enough points to be passing at the end if I just keep on doing what I'm doing. She said that she feels I'm just about at the level of an entry-level practitioner which is amazing because I'm only in my first fieldwork placement!
Today she basically said I would definitely be able to get a job with one of the facilities under the same company as my placement. That is really exciting because right now I am looking to move to Arlington, Va or Charlotte, NC and this company has facilities in both of those cities!

I'm treating 4 patients right now and will probably add a 5th next week. My patients right now are 1. CVA with L hemianopia (meaning he has vision loss in the L side of each eye),  2. R foot fx and R wrist fx, 3. TKA, 4. CABG.

My favorite patient is the guy with the CVA just because he is so interesting and he is the first stroke pt that I have been able to treat on my own. Its fun getting to do some tx for the vision loss. Here are a few things that I have done with him:
1. Put numbers 1-10 on post-its and taped them to the wall - 5 on R and 5 on L but with the numbers mixed up. I had him stand up in front of the numbers and I stood behind him. Then I would call out a number and he had to visually scan through the post-its to find the number I said. This worked on visual scanning and learning to compensate for the loss of vision by turning the whole head to look to the L
2. I set out two rows of playing cards and asked him to scan through all the cards and flip over all the black cards. He left ones on the L side so I had to cue him to look to the left to find them.
3. There is a US quarter map in the dept so I got that out and set it on the table. The quarters are in little slots at each state (i'm sure you have seen them). I instructed him to find 5 quarters with his left hand and hold them in his hand. He was then supposed to keep them in his hand and set them back in their slots one at a night. He had decreased strength and some sensation deficits in his L hand. This worked on in-hand manipulation, visual scanning and fine motor skills.
4. To work on item retrieval- such as gathering clothing in room or items in the kitchen- i placed about 8 colored cones in the room and asked pt to walk about and find each cone.  If cones were to pt's left side, he really didn't see them and so he needed cuing to look to the left side.
5. Ball toss- when i toss the ball to the L of midline he just totally loses sight of it and it just kind of bounces off of his hands because he isn't anticipating it coming at him but its good to cue him to turn to the left and try to focus on the ball the whole time.
6. He has decreased strength in this L UE so we have done some simple strengthening using hand weights

He's really fun to work with and had a great sense of humor. He said that if he needs to look to the left I should just sing The Cupid Shuffle part where they say "to the left to the left to the left the left the left..." if you have heard it you know what I'm talking about it.  We have a fun time in therapy and he keeps me laughing!

Anyways, that's just a little update on what's been going on with my fieldwork since I last posted!