Week 3: final placement

Situation:
55 yo man transferred to Fremantle hospital for medical admission with diabetic ketoacidosis.

PMHx: type 1 diabetes mellitus, HTN
SHx: lives with wife at home, independent with ADLs
Prev functional status: independent ambulation and mobility with nil aid.

Task: My task was to complete a full physiotherapy assessment of this patient’s chest and mobility.

Action: After completing the assessment I found that he was unsteady on his feet and required O2 to ambulate due to low SpO2 (approx 85% on RA at rest) On subjective questioning I found that he had been walking to the bathroom and back without a frame and without any O2 therapy. He also appeared non-compliant to therapy and didn't understand why physiotherapy would assist him returning home. I spoke with the medical team and learned that the patient must maintain his SpO2 at >94% at rest to be able to go home.

Result: As a result of these findings I educated the patient on the importance of walking with assistance of a frame and oxygen in his current state from a safety point of view for health and also the role of physiotherapy in his management. The patient was very eager to return home and didn’t understand why he was being ‘kept in here’. From a physio point of view my aims were to improve safety with mobility and improve exercise tolerance. Therefore educated the patient on what the SpO2 reading represented on the sats machine and the importance of it for his discharge.

Evaluation: I found that by educating the patient on the requirements for his discharge and the reasons for why I wanted him to ambulate with a frame and O2 proved effective as he had more of an understanding of the reasons behind my actions. He became more compliant with my sessions and was very motivated and focused on improving his SpO2.

Strategies: In the future I will continue to use education and goal setting to motivate patients. I also found that often a patient appears non-compliant because no-one has properly explained the reasons behind the requirements of the patient and so don’t feel like they are being listened to or have any participation in their management.