Topic 1- Assessment

Situation: I arrived to Collie District Hospital on day 1 and after orientation read the referral for my first out-patient. Patient A was referred for R hip pain post bladder surgery. It was later explained to the patient that whilst in surgery her leg slipped out of the stirrup holding it up, which therefore would have caused many different problems with the hip joint due to the torsion and position of the leg while it was out of the stirrup. The hospital where the surgery was performed, undertook an xray once patient A woke in excrusiating pain post op, however the xray came back clear of any bony problems.
Task: My roll was to discover the source of patient A hip pain through a thorought assessment of the hip joint and to treat as appropriate.
Action: I began with taking a subjective history on this patient, where i was informed she is an ex nurse, and had pain in the groin and hip flexor region, gluteals and hamstrings. I then moved to my objective assessment where i tested the patient's hip ROM, length and neurodynamics. The patient was independent with all transfers and mobility, however complained of increased pain with sitting, walking after and period of time and R sidelying position of sleep. She had decreased hip flexion and adduction due to pain, and decreased muscle length of hamstrings and quadriceps. Straight leg raise (SLR) was positive in this patient. It was also discussed with the patient at the point in regards to the need for an MRI and hospital contacts where given to discuss the patients complaint.
Result: After a thorough assessment my supervisor and i believed that the patient had a hip flexor tear and sciatic nerve aggrevation secondary to the leg being left hanging out of the stirrup for the period of time, however this diagnosis warranted further investigation with an MRI. We believe the patient had a hip flexor tear because of the location and boundaries of the pain, the fact that the leg would have dropped into extension and the decreased strength and intense pain with hip flexion. The positive SLR indicated sciatic nerve irritation and we believe this was secondary to muscle spasms and tightness in the gluteals and hamstrings.
Evaluation: I was fairly happy with my assessment of this patient. I was very nervous as she was my first patient and due to prompting by my supervisor to begin the objective assessment, did not finish my subjective history to the best of my ability. I was very happy with my objective assessment skills and handling for this patient. However, without prompting from my supervisor i believe that i would have completed a full objective assessment without taking into consideration that the patient is in pain and we do not want to increase this or stress the structures too much.
Strategies: I have thought about strategies i could use to improve my assessment skills. I feel that if i do not finish my subjective history it would be more important to get the necessary part of the history and further questioning could still be done during objective assessment and treatment. I have learnt to just test the most necessary objective tests in patients with intense pain to not stress the structures and further examinations could be completed on future appointments, it does not all have to completed straight away if it is deamed not as important in leading to a diagnosis. I believe that now that the first patient is out of the way, i will not be as nervous and i will have more time to prepare before each appointment.