assessment

S: When working on the oncology ward Assessment is a very important part of Physiotherapy. In this particular incident my patient had already been diagnosed with cancer and had been admitted for chemotherapy. My assessment however had to be thorough and concise so that I could identify any other problems this pt might experience along with their cancer treatment. I am required to go into the room and assess this pt. I must build rapport and then maintain the pts dignity with any assessments such as auscultation. I must also be diligent in meeting all parts of my required assessment including auscultation, cough, chest expansion, spo2, social hx and previous level of function.

T: in order to reach a desired outcome, I would have to complete a respiratory and mobility assessment of this pt. the respiratory assessment would identify further intervention this patient would require whilst having chemotherapy. The mobility part would allow the allied health and medical staff to be aware of the level of assistance this patient required or whether they were independent. The mobility assessment must also include the oxygen requirements this patient has and any walking aids. Once you have recorded all of your finding systematically you must then begin to analyze your findings into a problem list for this pt.

A: for this pt, I entered the room and worked on building quick rapport with the pt. this is important because when assessing a pt you are invading their personal space and it goes a long way to first build that rapport. Firstly I started with a subjective assessment. Keys questions to ask are; home situation, whether they were previously independent, if they might have been a primary carer for someone else, mobility qns regarding home, such as stairs, previous exercise tolerance, whether they are a smoker or have a past history of smoking and lots of further within these general guidelines. Then I got the pt to cough and assessed its quality i.e strength, texture, effectiveness and productivity. Then I auscultated to check for air entry into the lungs and any added sounds. The next step is to check chest expansion and spo2 using a pulse oximiter. Assessing oxygen saturations is very important because it indicates how the patient might react to mobilizing. Then I walked with the pt using a WZF and noted how they went in regards to balance and endurance. Also noting whether they required any assistance and o2 which, in this case, they did not. Then I recorded all my findings and liaised with the nurse regarding this pts mobility status which was independent with T/F’s and independent with a WZF over 50m//spo2 maintained at 98%.

R: As a result of my actions I obtained an in depth evaluation of my assessment that showed what sort of physiotherapy involvement this pt required. I was able to write in the pt notes a detailed O as part of my S,O,I,E,R. I recorded the pts vitals, then under a respiratory heading I recorded all my respiratory related findings. Under mobility, I recorded how far the pt can walk, assistance required and any walking aids used. As a result further allied health and medical staff could refer to my notes to see what other problems this pt was experiencing at that particular time. They could also compare assessment finding from a later date with mine, to monitor any changes in the pt. when consulting this pt, further health professionals could refer to my notes for the mobility status to allow them to safely and effectively mobilize the pt without first having to assess mobility.

E: over all I think my assessment was quite successful. My strengths included
• Building a good rapport with the pt so that I could assess them and maintain their dignity.
• Choosing the appropriate aid prior to mobilization based on the subjective assessment, this allowed a safe start to mobilization.
• Performing the assessment in sequential order. This means doing things like assessing the cough before auscultation, because the pt is required to cough before auscultation regardless.
Some of my weaknesses included
• Taking too long to auscultate which can cause the pt to become short of breath or dizzy due to prolonged deeper breathing.
• Not giving the pt a clear indication of the role for physiotherapy and hence the need for our initial assessment.
• During mobilization I wasn’t able to effectively monitor the spo2 levels because the probe had slipped off the finger.

S: some strategies to improve on or use for next time, specifically those addressing some of my weaknesses include
• Refining your auscultation landmarks so you can quickly and effectively listen to the breath sounds before the pt begins to fatigue.
• Explain how far you want the pt to walk during mobilization. This includes an explanation that you want to assess how far they can walk, so they should walk however far they feel they can manage. Another handy tip to remember is to explain to them however far they walk they must also turn around and walk back, so they should keep that in mind.
• Explain the importance of monitoring spo2 when mobilizing. The probe can be uncomfortable especially when using a WZF or walking stick. However even if the pt is asymptomatic when de saturating it is important to note that they are still building up a toxic environment which can be detrimental. You can then clip the pulse oximeter to the frame or your pocket so that it doesn’t pull.