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Interprofessional education
- 2. Case Study Patient X 74 year old, male patient Widowed, 4 children Retired Publican Non-smoker (quit 15 years ago) Uses walking stick Lives with daughter, good family support
- 3. Before meeting the patient Prepared list of questions (Physio, General, Mental) Agreed on 1 person ask questions, take notes If elaboration on given answer needed everyone can join in As Patient had Ultrasound done, catheter inserted we agreed to assess/interview next day Shared workload (info gathering on Pneumonia, Diabetes, Septicaemia, DVT, Parkinson’s Disease)
- 4. Reason for Admission Presented via South Doc in ED Reports shivering, couldn’t hold a glass (weakness) Confusion Pneumonia Temp. 40.8 C, Pulse 130, Resp. Rate 22, O2 Sat. 92% GCS 11/15 Septicaemia
- 5. Medical History Surgery for varicose veins (3 times) Diabetes (sees specialist, administers Insulin at home) Parkinson’s Disease (diagnosed 7-8 month ago, sees Neurologist, Medication, no advancing of illness since then) Ultrasound in Hospital: Fatty liver Fall 2-3 weeks ago (slipped)
- 6. Medication IV Fluids Novorapid Lyrica IV Vancomycin/Tazocin Amitriptyline Azilect Clexin Janumet Atrostatin Allupurinol Clopidogrel
- 7. Treatment Catheter inserted (unable to pass urine)-monitor input/output Oxygen Antibiotics IV Fluids Physiotherapy Bedrest
- 8. Mental State Examination Well groomed, 74 year old male patient, stable Consciousness, good short term memory Good eye contact, cooperative and open, alert and spontaneous response, but appears to have difficulty to concentrate/focus Uses walking stick, good posture Talk active, normal and clear speech, coherent but easy to distract Subjective (Mood): feeling of anxiety and insecurity, fear of going home and being “left alone”, fear of falling and dependency Objective (Affect): Slight confusion and avoiding questions regarding ED admission, death of wife, memory lapse in ED, no delusions, suicidal thoughts or obsessions, reports no alcohol intake (“not really”), but in conversation re Admission mentioned “hot whiskey” Patient understands reason for admission, aware of treatment and compliant Good family support, socialises in family owned Pub (everyday from lunch time till evening), dependent on care through family
- 9. Medical Examination Blood culture and sensitivities, lactic acid Ultrasound abdomen Observation of BP, RR, Temp, Pulse 3 hourly Check AVPU, GCS Check Blood sugar Input/output chart Assist with ADL’s Document
- 10. Physiotherapy Initial assessment: ROM, Strength, Sensation, Neurological assessment for Parkinson's, Respiratory assessment for pneumonia. Treatment: Mobilisation, ADL, Balance, Coordination and Strengthening Outcome measure: Berg Balance scale. 48/56. Deemed low falls risk
- 11. Discharge Planning Involve family/Medical professionals in holistic care for patient Involve Public Health Nurse Diabetes CareSpecialist Parkinson’s DiseaseNeurologist, GP OT?stair lift already installed, possibility to move bedroom downstairs? Physiotherapy: Berg Balance, can carry out ADLs, mobilisation independently and chest is clear with stable SpO2 levels.
- 12. Varicose veins Enlarged and twisted veins, usually in the leg more common in women than men Cause: heredity, pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining. Varicose veins, less common post phlebitic obstruction or incontinence, venous and arteriovenous malformations cosmetic problem, painful, especially when standing Severe long-standing varicose veins can lead to leg swelling, venous eczema, skin thickening and ulceration Life-threatening complications uncommon Non-surgical treatments include sclerotherapy, elastic stockings, leg elevation and exercise traditional surgical treatment: vein stripping to remove affected veins
- 13. Pneumonia Inflamed infection of the alveoli in one or both lungs. Alveoli filled with purulent material (bacteria, viruses, pus, fungi) CAP: Streptococcus Pneumoniae Symptoms: SOB, Cough with sputum, fever, chills and pleuritic chest pain. Smoking is a major risk factor Outcome measure: Pneumonia Severity Index or CRB-65
- 14. Parkinson’s Disease Progressive disorder of the nervous system Caused by breakdown of neurons in the brain. Dopamine levels decrease and cause abnormal brain activity leading to signs of the disease In early stages: masked expression, slowed movement, shuffling gait, impaired posture and balance.
- 15. Septicaemia Life threatening condition Immune response triggered by infection Signs: fever, increased HR, RR, Confusion Diagnosis: Blood test Treatment antibiotics, fluids, O2 take 3 and give 3
- 16. Diabetes Diabetes I and II Metabolic illness, either insulin deficiency or inability to use produced Insulin Type I Diabetic Novorapid Bolus with Meals Bloodsugar levels checked with every meal (between 4-8 mmols) Controlled by diet and insulin Diabetic meals from kitchen Sees specialist in Bons Secours Hospital Monitor complication
- 17. Interprofessional Education Experience Difficult as we are not yet used to assess a patient unsupervised. MDT work very important as it can save time and is less stressful for patients and care team involved. Good communication skills are necessary as well as a plan before assessing the patient Difficult to gain all necessary information in 1 interview. Difficult to read Doctor notes, medication prescription chart, have access to medical chart, patient etc.. Working with peers at same point in training