Week 4

S// This entry revolves around a 78yo female Pt who was BIBA following a 5/7 Hx of worsening respiratory function, symptoms including SOB, reduced ex tolerance, reduced functional mobility which meant she was no longer able to complete ADL's without assisstance. PMH included angina, HTN, chest infection, stroke. SHx-Pt lives alone in single story home is I with most ADL's has some assistance from family for shopping.
T// I was asked to complete an initial Ax on this lady and then make a plan for continuing rehab. To complete a thorough initial Ax i needed to reed through her notes thoroughly, look at her blood results and other investigations from the computer. I then made a list of the information i needed to get from my Ax. This included subjectively-why in hospital, level of function since admission, level of function prior to deterioration and social history. Objectively-Full chest Ax (sats, chest expansion, auscultation, cough) and mobility Ax (transfers and ambulation)
A// After introducing myself I began my subjective Hx taking and realised immediately it was going to be difficult. I had read in the notes that Pt had expressive dysphasia following her stroke, however i didn't realise the level of the impairment. This Pt had severe expressive dysphasia and it made understanding her responses extremely difficult but i persevered. However, i had to keep asking her to repeat herself which i began to realise she was finding frustrating (and understandably slow). My objective Ax was fine and got all info i needed.
R// I left the session with all the info i needed to make an ongoing plan for this lady however i did have a few gaps in my sunjective where i could not understnad her answers.
E// On the most part i collected everything i needed from my initial Ax but i made hard work of it (both for me and for the Pt). My glaring weakness was my communication skills with this patient. And this was only a problem because i had read the PMH from the notes thoroughly but had not attached enough significance to the implications of expressive dysphasia. I believe my chest and mobility assessment was good.
S// After speaking to my supervisor and also the OT's i learned that the key to questioning with a Pt with expressive dysphasia is YES/No questioning or closed questions rather then open ended questioning. It seems so obvious now but as this was the first time seeing a Pt with this impairment I was unsure. I was also a little naieve in the extent of communication difficulties a Pt with expressive dysphasia can have. At least i know for the future. And everytime I have seen the Pt since i have used the yes/no questioning with great results.

It was my firs