Imaging/Radiology
This past Tuesday, Wednesday, and Thursday I observed the three doctors that do MRI’s at the hospital. The most common body part I saw was a brain and head because of headaches and memory loss with change in attitude. I think the most interesting MRI I saw, they were looking for acoustic neuroma which is a cancerous tumor in the ear. While looking at the results, there was a small white spot between the midline and ear. To get a better look and make sure the results were correct an injection of dye was put into the ear. These results came back positive again so the radiologists said that surgery will follow and the patient will lose hearing in the ear. There were several other MRI’s on the head and brain but not many came back positive. The other MRI that came back positive was an epidural hematoma where there was an obvious enlarged spot right under the skull. This patient was referred for immediate surgery and had only a matter of time till serious symptoms occurred. Another common spot patients had to get an MRI on was there knee. The injured cartilage the radiologist had to primarily look for was the meniscus and looking for tears and degeneration of it. Several came back positive but when looking at the anterior cruciate ligament (ACL) the MRI results came back negative. Throughout my time there, some MRI’s took longer than supposed to because patient’s movement in the machine would blur the results causing them hard for the doctor to read. Another problem the radiologists ran into was missed appointments because of the inclement weather going on during the week. When the weather was nice the schedule was full all day and some immediate patients had to be taken but Thursday was slow because of snow.
It was a great experience and met some educated individuals that helped me a lot with understanding the MRI since it was my first time in the setting. I realized the job radiologists do may look simple because it is looking at a computer most of the time but a lot of precautions need to be taken with the magnetic. There were two patients that could not get an MRI after waiting for the whole process do to implants and physical conditions. Radiologists need to know what to look for which I learned can be very difficult depending on the size and severity of the injury.
It was a great experience and met some educated individuals that helped me a lot with understanding the MRI since it was my first time in the setting. I realized the job radiologists do may look simple because it is looking at a computer most of the time but a lot of precautions need to be taken with the magnetic. There were two patients that could not get an MRI after waiting for the whole process do to implants and physical conditions. Radiologists need to know what to look for which I learned can be very difficult depending on the size and severity of the injury.
Outpatient PT Clinic
On Monday, Wednesday, and Friday I went to the physical therapy outpatient clinic and observed Matt Harris two weeks ago. I had to observe on Wednesday the following week to get my full requirement of hours. Every time I went, I was there from 3 pm to 5 and saw most of the same patients every time. I saw two elderly ladies with knee replacements and we worked on getting their full range of motion back. They were both about a month out of surgery so we used manual massage to move the swelling out of the area and of the thigh. We also did a manual stretch to gain flexion and extension back while the leg was elevated. Also, she would ride a seated bike for ten min each treatment and would practice walking up and down the steps to gain weight bearing and balance. Then the treatment would end with PRICE for ten minutes before the patient would leave.
The other patient I saw was in a car accident two months ago and had muscle spasms and soreness on the left side of her neck. Her treatment always started with a twenty minute heat with pre-mod e-stim on her neck and then use isokinetic exercise machine for 10 min. It would end window wipes to stretch her neck and shoulder muscles causing the soreness and some manual stretching. Another patient had a shoulder impingement of the supraspinatus tendon and was a very busy employee at the hospital doing a lot of over the head activities. To release some pain Matt did joint mobilizations to relieve the stress on the tendon. She also used dumbbells and did over the shoulder press exercises and the bike elliptical for shoulder range of motion.
The last patient I saw was a middle aged man in his 50s with a hip replacement. He was about three weeks out of surgery and was doing well with rehab until he slipped on some ice the day before I saw him. Luckily his hip was strong enough to stay in place but he was very sore the next day. The patient was having trouble walking up the steps with his bad right hip. Also, when he was doing active range of motion such as marching (hip flexion) to gain range of motion and push the swelling out, he could not bring his hip to ninety degrees. It was a great experience to get to know these patients as you talk to them while going through their rehabilitation. What I saw at the rehab center was similar to what we were going over in class so it was great to see it in the clinic.
The other patient I saw was in a car accident two months ago and had muscle spasms and soreness on the left side of her neck. Her treatment always started with a twenty minute heat with pre-mod e-stim on her neck and then use isokinetic exercise machine for 10 min. It would end window wipes to stretch her neck and shoulder muscles causing the soreness and some manual stretching. Another patient had a shoulder impingement of the supraspinatus tendon and was a very busy employee at the hospital doing a lot of over the head activities. To release some pain Matt did joint mobilizations to relieve the stress on the tendon. She also used dumbbells and did over the shoulder press exercises and the bike elliptical for shoulder range of motion.
The last patient I saw was a middle aged man in his 50s with a hip replacement. He was about three weeks out of surgery and was doing well with rehab until he slipped on some ice the day before I saw him. Luckily his hip was strong enough to stay in place but he was very sore the next day. The patient was having trouble walking up the steps with his bad right hip. Also, when he was doing active range of motion such as marching (hip flexion) to gain range of motion and push the swelling out, he could not bring his hip to ninety degrees. It was a great experience to get to know these patients as you talk to them while going through their rehabilitation. What I saw at the rehab center was similar to what we were going over in class so it was great to see it in the clinic.
Emergency Department Observation
Luckily my first time in an emergency room was for observation instead of being patient. During the four hours I was at Johnston Memorial Hospital last Thursday I saw many different patients with an assortment of problems. When I first got there the nurse I observed showed me how the system works so they know who needs assistance and what room to go to. First we had to discharge a patient with a bruised sacrum but the patient was convinced it was broken because he had a baseball sized knot that formed three days after the incident. Once he left, two children around 9-13 years old came in from football practice with a hairline fracture in his wrist and the other broke his thumb. The child with a fractured wrist got a cast wrapped in an ace wrap and his arm in a sling. The nurse put a thumb spica cast on the other child with a broken thumb. A lot of patients were coming in with apparent chest pain so they would take their vitals and put them in a room to run further tests on which I was unable to watch. I did see the nurse have to take blood samples from a patient who had been a smoker and came in with chest pain. The biggest emergency of Thursday night was an inmate came in with EMS from the jail that had been having a lot of trouble breathing and showed signs of a heart attack. I got to step in the room while they were analyzing his heart and pulse. The nurses outside the room showed me his pulse and what to look for in rhythms. His showed that he had signs of heart problems from years ago. The patient was 500+ pounds at a time in his life then lost over 200 pounds years ago but began using street drugs which lead to more heart problems. During this emergency, another patient in the other room was getting frustrated they were not being helped so they wanted to leave Against Medical Advice. The patient thought she was being treated rude and unfairly because the patient that came from the EMS was more important. These people refused to sign the form but the nurse I was observing handled the situation properly and documented the patients AMA form. To end Thursday night a patient came in with a broken foot, I was not told where the break was exactly in the foot. The nurse gave the patient some ibuprofen to help the pain and a walking boot with crutches. Sunday night I observed a nurse who was in charge of triage but the night was slow so we did not see many patients. I saw her take vitals of incoming patients and put them in a room most of the night. The biggest emergency was a woman came in with handcuffs that had abrasions on her neck from a noose but other than the pulse analyzing and blood work they did on her, I was unable to see any further diagnosis or tests performed on the patient. Overall I learned a lot from my first experience in an emergency room and realized how different an athletic trainer treats athletes medically on the field then how a nurse treats a patient at the hospital.
Wound Care Observation
The week of November 13th I did my clinical rotation observing wound care at Johnston Memorial Hospital. I went on Monday for four hours in which I saw a lot of venous ulcers and only a few diabetic ulcers as well. Then I went again Thursday morning for two hours before class. Every wound I saw was either on the foot or lower leg and had complications healing over a long time. There were a couple people that came in with calluses on the pad of the great toe that needed to be cut down. I observed four different registered nurses throughout my time there and I went with whoever had a patient since there were not that many appointments. On Thursday, there were often two nurses in the room so one would be on the computer while the other is checking/cleaning the wound. Monday afternoon was when I saw some interesting cases such as an elderly woman who had been bitten by a brown recluse spider. Her wound has been on her medial calf for several months now which has made a lot of progress from what it looked like right after she was bit. The nurse applied a PICO devise that looked like a gauze pad that gets vacuum sealed so all sides of the bandage must be taped down and secured so the wound can properly heal. The PICO device was used so that the wound would not scab over. Another patient that came in was diabetic and he had stepped on a nail between his 2nd and 3rd metatarsals. He came in with his foot and leg all bandaged up from the last visit. His wound had actually became worse because of his toes would rub together causing irritation between the toes and the wound had grown to the bone. Once the nurse bandaged it up again after applying many antibiotic creams and ointments, the patient was sent to get an MRI on his foot because there is a possibility that he will have to get his foot amputated now that the wound is infected. Lastly, there was a retired coal miner that had his lower leg compressed when he was working. He will be a lifelong patient because he gets venous ulcers randomly along his lower leg since there is a lack of blood flow from the compressed veins. The patient has a sleeve he wears for blood flow and a bandage over any ulcers that he has. When I saw the patient there was one on his lateral side and another that had just healed on his medial side.
My visit went very well at wound care because I learned a lot about chronic wounds and the complications of wound healing. All the nurses new most of the patients from past visits so they would let me know what happened and how the wound was caused. It was a good experience to see what many people have to take care of on a daily basis and see how common or uncommon some of these wounds are such as the brown recluse spider bite.
My visit went very well at wound care because I learned a lot about chronic wounds and the complications of wound healing. All the nurses new most of the patients from past visits so they would let me know what happened and how the wound was caused. It was a good experience to see what many people have to take care of on a daily basis and see how common or uncommon some of these wounds are such as the brown recluse spider bite.