Situation: Patient C 28yo Male. Admitted with fractured femur following a MBA. PMHx: depression, suicide attempts, ETOH >5/day. SHx: lives at home with wife, 4 children, his parents and brother. Smoker 10/day.
Task: Day 1 post op- aim was to get patient up on crutches today and hopefully d/c in a couple days.
Obs were stable but his Hb=79, Which was very low.
Action: Discussed with Intern regarding Hb. Doctor happy for patient to be mobilise today as long as patient is not symptomatic. I did my subjective Ax, and patient c/o minimal pain and slight dizziness. Pt was Independent in bed mobilty and lie to sit, however i decided that pt was to be 1x standby assist for STS and ambulation 6m with EC as patient was fairly wobbly on crutches and a bit dizzy. The patient was fairly impulsive and wanted to do everything independently and before instruction.
Result: I had to make my instructions clear and ensure the patient was co-operative, which i think i did well. It was important for the patients safety that he did not rush getting up with being a bit dizzy and wobbly even though he knew how to use crutches from previous use. Patient ambulated 6m on EC before too painful and tired.
Evaluation: I think i did well with my mobility ax. I didnt realise just how impulsive he was till he got up and out of bed without instruction to do so. So i had to tell him to wait for my commands and i believe my patient education was good. I noticed patient's R knee was swollen when patient got back into bed. So i got some tubigrip and educated pt on tubigrip and ways to get rid of swelling.
Strategies: Ensure patient does not get up before demonstration and instructions are completed.
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