Daily Dairy - Week 1

Week 1 (12 April - 16 April 2010)


Day 1

7:30 - 10:00

Orientation - I was introduced to the physiotherapy staff and was informed about the basic procedures to be followed in OPD. Mr Matswiki is currently in charge of the physiotherapy students whilst Mrs L Louw is on leave.
We met and became aquainted with two Wits students who gave us the "know how" of the department.






10:00 - 13:00

Patient assessment and treatment
Food arrangements were made and payed for.


13:00 - 14:00

Lunch - Food provided by the hospital's kitchen staff.

14:00 - 16:30

Patient assessment and treatment
Cerebral Palsy health talk - I observed and assisted the Wits students whilst they conducted a CP talk in the Maternity ward at Elim hospital. It was brought to their attention that the ante-natal patient's knew nothing about Cerebral Palsy and they felt that it would be a suitable time to inform them about the condition.






Day 2

7:30 - 10:00

Patient assessment and treatment

10:00 - 10:30

Breakfast

10:30 - 15:30

Home visits - We (Two Wits students and three MEDUNSA students and Mr Matswiki)ventured into the Watervaal community for a home visit. I got one patient who I will be using for my Case study.Bungeni Health Cente - We then went to the Bungeni community centre and I assisted the Wits students with their health talk (Cerebral Palsy).The talk was given to the patients who were sitting in the waiting area.
We were allowed to leave (knock off) at 15:30 as we worked through our lunch.

Day 3

7:30 - 10:00
Patient assessment ant treatment (OPD)
10:00 - 10:30
Breakfast
10:30 - 13:00
Patient assessment and treatment (OPD)
13:00 - 14:00
Lunch
14:00 - 16:30
Patient assessment and treatment (OPD)




Day 4

7:30 - 10:00

Patient Assessment and Treatment (OPD)

10:00 - 10:30

Breakfast

10:30 - 13:00

Home visit. My patient had a CVA in November 2009 due to uncontrolled Hypertension. She is still not receiving antihypertensive medication which is a concern for me as I do not want to over exert the patient incase she suffers another stroke. She is also quite depressed about her condition and is not very enthusiastic about maintaining her home program as she feels she is too old (76 yrs) to overcome this problem. I am very optimistic that I will improve the patient's functional capabilities and I will try my best to keep the her motivated.

13:00 - 14:00

Lunch

14:00 - 16:30

Ergonomics assessment - Mr Matswiki suggested that I conduct an ergonomic assessment on a staff member at Elim hospital. The client is a receptionist in the dietetics department and spends a lot of her day at a desk infront of a computer.

Problems Encountered

Posture Related: (Patient is seated in front of a computer typing)

The patient has increased cervical lordosis.
Her neck is flexion and laterally rotated to the right
Her trunk is in flexion and is rotated to the right
Right shoulder is depressed and protracted
Right elbow is in extension
The right wrist is in excessive extension and is not supported on the desk
Feet are in Plantarflexion (wearing heels)

Work station:
The desk is too high and far away from the patient.
The screen is tilted downwards
There is decreased work space, there is no place to put the mouse (printer in the way)
Poor ventilation (Only 1 half opened window is open of a total of 4)
Chair height too high

Lifting an object from floor:
Incorrectly done. Patient stains back as she stretches in her chair to reach for object on the floor.

Recommendations:

Use the other adjustable chair in the office instead of current chair.(increase the height to match desk height.
Remove high heel shoes and insert a flat object (books or bricks) under feet so that feet are flat.
Move printer to the other desk to create more space especially for mouse placement.
Change angle of monitor (tilt upwards)
Posture correction - hips 90 - 100 degrees flexion, Trunk in neutral, knees at 90 degrees, feet flat, elbow at 90 degrees and wrist supported on table in slight extension.
Regular stretches (hourly). Open all windows and bend knees when picking up objects.
I will treat the patients current back pain on monday.

Day 5


7:30 - 10:00


Patient assessment and treatment (OPD)


* I saw a patient who was diagnosed with Cerebral Palsy (CP). I struggled to do a thorough assessment and treatment as I could not understand the caregivers and could therefore not communicate with my patient (20 yr old female). The patient was rather heavy and it was difficult to change her position alone and I required assistance from the caregivers who could not understand what I needed from them. I unfortunetly did not have someone who could translate for me. I feel I need more assistance with CP and in the future I will ask for more help from the clinicians if they are available.


10:00 - 10:30


Breakfast


10:30 - 13:00


I was given two patients in the New surgical ward at Elim Hospital. My one patient could not understand a word of english and I found it rather interesting giving her an exercise program using body language. I somehow manage to show her how to do an exercise program. (Definetly one for the books).


I was also informed that most patient's over 50 yrs of age are not operated on.(Which I find shocking as I feel most may have a good prognosis if ORIF is done). I feel that most of the orthopaedic patients are poorly managed. They spend a long period of time in skin traction and I can see why patients may develop leg length discrepancies or other complications.


Jacomie and I asked the new Orthopaedic Surgeon working at Elim if He would be willing to allow us to observe orthopaedic surgical procedures. He told us that he'd get back to us next week.


We found out that students are allowed to leave (knock off) at 13:00 on a friday which I was rather thrilled about as it gave me more time to complete unfinished work.