Very busy days

7 evaluations yesterday, 1 full blown ADL, and 5 other short treatments. What a day.
It was most difficult because many of the evals were complex. Allow me to demonstrate...
  1. L TKA. Very basic. Started off in pain and then walked into the hallway. No problem to write up, will likely go home from acute care.
  2. 95 y.o. thalamic CVA. A very unreliable historian. She understood yes/no only. Once to the EOB, however, she did jump up with a walker and head right out the door. (sidenote- physical recovery almost always comes quicker than cognitive recovery. Frustrating, and potentially dangerous. Reminds me of a TBI story)
  3. Frontal lobe CVA. Dysarthria, flaccid RUE. Frustrated at not being able to communicate with nurses and dietary staff. Promised her a communication board, which I really didn't have time to make that day, but she really needed.
  4. Pneumonia w/ complications that landed pt. in the ICU. Some minimal spontaneous movement w/ agitated, but not able to respond to commands. Just extubated that a.m., so no comment from the pt.
  5. Elderly man w/ THR after falling. No memory of hip precautions. No social support system. We were able to stand at the EOB w/ MAX Ax2 for a minute or two, but that was it. Usually at this many days out from surgery, a pt. can at least walk to a chair.
  6. R TKR that I knew from acute care. An interesting case, as she is able to do many of the basic functional tasks that are required by OT before discharge. However, she has very little knee flexion, and it is always a PT goal that a pt. have at least 90* knee flexion after surgery. It's a strange part of the OT/PT relationship, as I'm not grabbing legs and bending them, but it won't matter how "functional" she is if she has to get a surgery redone.
  7. The last of the day transferred from another hospital and was quite exhausted. Pneumonia, GI Bleed, Renal Failure. He's super weak.
So that left a lot of complicated goals to write up (on top of the 3 peds notes from the previous day that I didn't have time to write). I did end up forgetting a treatment and having to document at the nurses' station since I had already locked up the office.

My ADL was with Mr. A, a pleasant, but lonely gentleman admitted w/ CHF and COPD. He doesn't want to go home w/ O2, but right now is struggling to do anything without it. We worked w/ the pulse oximeter on doing short bursts w/o the O2. His O2 cord wasn't long enough to go into the bathroom, and the nurses were saying that he'd only been using the O2 intermittantly over the weekend. However, an O2 % rating in the 70s (should be 90% or above) after a trip to the bathroom warranted getting after the nurses to get him a longer cord. The hour moved very slowly due to rest breaks as he rollercoastered up and down the O2 saturation levels. He is getting better w/ energy conservation techniques. I was a little depressed because the nurses were talking about him going downhill and that he was going to "go quick, when his time comes." I hope he can get better and also go home to a better situation.

Peds practice is picking up again. Getting another few evals and busier evenings. The peds + girl scout tuesday combination is getting hard on me... still working on finding a balance.

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