Week 3- What a Shitty Week… Seriously!

No, I mean it though- this week I have dealt with more poop than I have the past two weeks. That’s part of inpatient care though, especially in a nursing home. I don’t really mind so much I guess though. I’m not the one actually cleaning it up or anything but I’m there more to assist the patient and the CNAs with moving the patient around so they can be cleaned up. This is actually part of physical therapy believe it or not. A lot of people think healing from injuries when they think of physical therapy but in a nursing home setting, it’s very different from that. One of the big focuses in this setting is getting the patient as independent and safe as we can. Part of that independence is the ability to move around in bed… bed mobility. This is something we work on, rolling side to side, when the CNAs need to clean up a patient that has a bit of mess going on. Now, granted, it’s not the most pleasant job. It’s smelly usually but, again, I’m not the one cleaning up the actual poop, just helping move the patient around so it could be much worse.

I can’t help but to feel bad for these patients too. I know that is an embarrassing situation for them and it’s our job to make sure they don’t feel bad about something they have little control over. See, many of these patients are spending the majority of their time laying in bed. Then, we come in and ask them to sit up, sit on the edge of the bed and stand up. Think about what that is doing to your GI tract… moving it around, stretching it out, and causing it’s contents to shift… there’s only one place for it to shift to. So that’s what seems to happen most of the time and is exactly what happened with the patients I had this week.

One of the patients I was working with fell and broke his femur (the big bone in your thigh) and his tibia and fibula (both of the bones in your lower leg). They were pretty decent breaks and there was a lot of time between when he broke these bones and when he received medical attention. He was on his way to the bathroom in the middle of the night and fell in the bathroom. He laid there until 5:30 in the morning when he felt it was appropriate to call his son. That amount of time allowed this guy’s leg to swell up quite a bit. He also has a history of diabetes and had an enormous amount of swelling in his leg so the doctors decided to splint him up and send him to the nursing home to get some of the swelling down a little bit before performing surgery. He was was quite immobile due to the excruciating pain he felt any time he moved his leg. So, when we went into his room and helped him to stand up (not putting any weight on his broken leg, obviously) so we could help him to the bathroom… things started moving and he barely made it to the toilet in time.

One of the other patients is a very similar story- younger (60’s) woman who just had her hip replaced. We helped her to stand up for the first time in 3 days since her surgery. Guess what happened….! That’s why alllll the residents wear briefs while they are staying here. This woman is also morbidly obese so we had some good bed mobility practice with her while the CNAs helped to clean her up.

Other than the poop I’ve dealt with this week, it’s actually been a really great week. I am noticing that my CI is giving me more freedom and independence and more responsibility with each week that goes by. This week she started having me go and get the patients from their rooms by myself. That’s not really that hard of a thing to do but she would always make sure she was there with me, even if I were doing all the work, just in case. Now she’s trusting me enough to go and get the patients myself. She also just sits off to the side when we get down to the gym working on paperwork. She is letting me completely direct the patient’s care for that day. Letting me pick the exercises and going through them all on my own. She just tells me to let her know if I have any questions or need her help following behind with the wheelchair or something like that. It makes me feel good to know that she is trusting me enough with these patients to direct their care. I mean, they are still HER patients after all… even if I am directing their care. There are a few patients, maybe 4 or so, that whenever we see them, I do everything- get them, treat them, take them back and write their notes (the FUN part of physical therapy…. paperwork and documentation!)

Our midterm evaluation is coming up next week… I’m excited to see where my CI rates me and what things we come up with to start working on more. I know she mentioned to me that she wants me to take more responsibility with directing certain patient’s care, including communicating with the PTAs (physical therapy assistants) what interventions I want to be focusing on with each patient. THAT makes me nervous because the PTAs that I work with have a LOT Of experience and are very knowledgeable and now I am going to be asked to give THEM direction and tell them what to do! YIKES!


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