My current placement is on cardiopulmonary based and many of my patients have a current or past history of cancerous complications. Sometimes, I tend to forget this part of their case history and focus with tunnel vision on the cardiopulmonary impairments and solutions. I'm learning to implement more skills than what my placement classification identifies, in order to best treat the patient, as I'm sure you have found already.
I walked into my new patient's cubicle the other day to find her sitting in the chair, head in hand, eyes closed and breathing rapidly. Alert that something was wrong, I began to gently question her about how she felt and her symptoms. She was very pleasant and responsive, but still short of breath as she talked and seemed concerned. She had the tendency to offer me large amounts of information and as I listened I noticed this phrase she used repetitively - "panic attacks". At first I skipped over it, but after hearing her mention it again I asked further. Her response was that she was suffering a panic attack ever since she had been admitted to hospital (over a week) and it was distressing her as she had never had one before. Her normal status was independency for ADLs, without a cough or dyspnoea. Being a good cardiopulmonary student I did my objective assessments and began putting things together. Auscultation showed she did have increased secretions bibasally, and she had a moist ineffective cough with 93% SpO2. I began to explain to her how secretions trapped in the lungs impede gas exchange. I used props to explain this and the fact that this was the likely reason for the breathlessness, not panic. Especially as most panic attacks do not last over a week (to my understanding). If you could have seen her face - the relief was complete. Her breathing calmed, her SpO2 improved to 97%, and she looked more alert and interested. It was quite amazing to me. Then I realised, her history of colon cancer must have been quite a fearful time for her. It is understandable that in this new, scary situation of feeling chronically short of air she would react with significant fear. By addressing the patient's mental approach to her situation, it actually achieved the majority of my physical treatment aim for that session.
How often do we get bogged down in close-answer questioning techniques for our chatty patients, because we are sure we know what we are looking for? We become good at making quick judgements and connections, but also assumptions. I assumed her anxiety was part of her normal disposition and was prepared to cope with it. I didn't consider it as an important factor until further into our discussion. A patient's medical history does have a compounding effect on their approach to health problems and how they cope with new issues, so we can't really dismiss any of it, can we?
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2 comments:
Well done V. I agree in that the PMHx is very important. Even if it has been dealt with and nolonger presents physical problems the psychological implications can be lasting. The way they have previously responded to physiotherapy Rx may benefit or hinder what we can do. In this ladies case she may have lacked early education and your education has been very benefitial. I think that we can become too focussed on what we think the problem is and we have all these learnt techniques that we wish to implicate but we fail to listen to all presenting factors. Feel free to share your props that as i have stuggled to create a prop of mucus trapped in an airway. Nice work V.
It's amazing how explaining things to the patient can positively affect the course of the treatment session. Great job. I agree that as physios we make heaps of assumptions based on what we've read in the patient's files and what we know about their conditions. I guess as we gain more experience handling different types of patients, making very quick decisions will be so much easier and then we can easily decide whether or not to stick with our assumptions.
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