MHKH 2/13/15 and GC

MHKH 2/13/15

Responsibilities:

• Find and follow a physical therapist.
• Observe a patient receiving physical therapy.
• Get equipment for the physical therapist.

New Knowledge/Skills:

• Learned what a physical therapist does
• What a whirlpool is used for
• Learned that some of the staff are students in training
• There is an on-site interpreter for patients

Best Thing(s):

• Getting to see therapy be done
• Actually doing something after having done nothing
• Being the interpreter for a patient while the on-site interpreter was on their way.

Worst Thing(s):

• Had to wait for the physical therapist to show up
• All other therapists were busy or students
• Not being able to see the finish of a procedure.

Overall:

The rotation got off to a rocky start as most of the therapists were busy but once the head therapist cleared up I got to see a procedure be done.

Technology:

The physical therapy room has many different machines for exercise and therapy. There are treadmills, elliptical machines, dumbbells, and other equipment. There is also a whirlpool bath for wound and burn care so that blood gets flowing and infections are prevented.

Diagnostic:

The physical therapy room performs a lot of diagnostic procedures to make sure a patient is making progress. Therapists will check on a patient's level of pain, chart any progress they've made, keep track of recommended exercises, and other things. Therapists will also check for certain vital signs like pule and respirations.

Therapeutic:

since it's the physical therapy department there is a lot of therapies going on. There is strength training using dumbbells, treadmills, and gait belts. There is speech therapy that goes on in another area of the room and next to that is training in doing simple ADL's. The whirlpool helps treat burn/wound care victims.

Diseases/Disorders:

The therapy department deals with a lot of different diseases and disorders and I got to observe some. As I was entering there was a burn care patient who was just finishing therapy with the whirlpool. There was also a patient who come in with a broken  leg who was doing some gait training and crutch exercises.

Med Terms/Abbreviations:

The therapy department doesn't really use that many med terms or abbreviations but there were a few I heard here and there. Supine- laying on the back. Abduction- laying on the side and lifting arm and leg. Brachial Plexus- a network of nerves that runs from the spine and when injured can cause shoulder disabling injury.

I.Environmental Assessment:

The therapy room is a rather large one with a lot of exercise machines around the room. It smells quite clean and there is a faint sound of music coming from the therapist desk in the center of the room. There are windows in the room to let natural light in and make the atmosphere less like a hospital. The staff is rather unresponsive to me entering as they are either busy or telling me to look for the head therapist. There are a lot of treadmills, elliptical machines, dumbbells, and a whirlpool.

II. Observation:

The staff is pretty busy but for the longest while they kind of just shrugged me off. As a unit, everyone works well together from what I observed. The room is sized just enough that therapists can communicate back and forth without phones. There are a lot of safety precautions like a fire exit and extinguisher, safety releases on certain machines, and therapists making sure a patient doesn't get hurt. Therapeutic services offered are strength training and muscle reconditioning, gait and crutch training, speech therapy, and ADL therapy. Diagnostic procedures taken are charting and checking a patient's progress in therapy, taking Vital signs like pulse and respiration.

III. Knowledge:

While in the unit there wasn't much hands-on things I could do. I was able to get some equipment for therapy though. A few words I learned were, supine, abduction, and brachial plexus. Supine- laying on the back. Abduction- laying on the side and lifting arm and leg. Brachial Plexus- a network of nerves that runs from the spine and when injured can cause shoulder disabling injury.

IV. Evaluation:

I personally feel that the department has it's work cut out, but it should really be more student friendly. I get that the therapists are at work but I'd at least like to follow someone. The professional experience that can be gained here is extensive as one can learn how to communicate with both patient and coworker. For someone interested in becoming a physical therapist, this is the place to go.

GC

Social workers handle a lot of the behind-the-scenes work at the nursing home and are constantly being called about some kind of complaint that arises. Gerontology- the study of the aging population and physical, psychological, and environmental factors that affect them. Geriatrics is the work that is done on the aging population in the medical field. Geriatric medicine looks to treat the elderly and research on factors that cause faster aging in one person than the other. The scope of work that can be done in geriatrics is very large as it encompasses many fields of study and medicine.

MHKH 2/6/15 and GC 2/9/15 and 2/12/15

MHKH 2/6/15- Pharmacy Department

Responsibilities:

• Go to the Pharmacy and learn from a pharmacist.
• Followed a pharmacist around and learned different sections of medications.
• Had to help label and seal insulin pens.
• Had to help package some Ipratropium Bromide to send to other departments.

Knowledge/Skills:

• Where certain medications are located based on department and use.
• Certain medicines are marked with stickers to indicate their use and department.
• Learned how to identify the stickers.
• Learned how a pharmaceutical dispenser works.

Best Thing(s):

• Got to help around the pharmacy.
• Got to see different medications.
• Got a chance to get some questions answered.

Worst Thing(s):

• Things slowed down after a bit and there wasn't much to do.
• The first pharmacist I was with was rather unresponsive to me being there and asking questions.

Overall:

This week was pretty good, the rotation itself went smoothly and I got to learn some stuff while there.

Technology:

Some of the technology I observed in the pharmacy was a pyxis cube which dispenses the needed medications into a sealed tray and can be delivered afterwards. Another was a fridge that keeps certain medications cold so that their effectiveness doesn't ware off. They have a lot of computers and printers that receive orders and are used for charting  medications.

Diagnostic:

Some diagnostic procedures that the pharmacy department engages in is taking inventory of medications and filing them in the appropriate section. They also have to fill out orders and keep track of what comes in and goes out. They also check that orders are correct before sending them out.

Therapeutic:

The pharmacy provides medications that are used in the therapeutic treatment of a patient. They provide pain relievers that are self explanatory and are used on many departments. They also provide tranquilizers that will help keep a restless and aggravated patient calm.

Diseases/Disorders:

The pharmacy has a wide variety of medications for patients with different diseases and disorders. One of the most common orders received is for insulin which helps diabetics control their blood sugar. Another is anti-depressants for patients who suffer from depression. And another is nitroglycerin for heart problems.

Med Terms/Abbreviations:

Rx- this is a symbol for the Latin word recipe, which means to take. Ipratropium Bromide- a nasal decongestant that is used to relieve a runny nose. Albuterol-used to treat and decrease asthma and increase airway volume.

I. Environmental Assessment:

The pharmacy is a well sized and very clean. It's kind of quiet here all the time. It smells like Lysol and other nice smelling things. There are shelves stacked high with medications of all sorts, each put into a section that corresponds to it's use. Everyone here is hard at work but they all take some time to joke around and there is a feel of friendliness. Some of the technology used here is a fridge to keep medications like insulin cold, there is a pyxis cube to dispense medications to be sent to other floors, and a crash cart with emergency medications. There are also computers everywhere to chart medications coming in and out and receiving orders.

II. Observation:

Everyone in the pharmacy is on their feet and working all the time. They will definitely talk and joke and gossip but they do it while working. The size of the department makes it easy for them to communicate without need of a phone. Diagnostic procedures that are performed are checking inventory, stocking shelves, checking and delivering medications, and keeping records of what comes in and goes out. Therapeutic procedures that some of these medications are used for is treating allergies and cold-like symptoms, treating high BP, using nitroglycerin to treat heart problems, and using insulin on diabetic patients.

III. Knowledge:

I learned about the organizational system that the pharmacy uses. I also learned how to label certain medications with a sticker when it is outgoing. The abbreviation Rx is short for the Latin word "recipe" which means "to take". Ipratropium Bromide is a drug that treats allergies and a runny nose. Sucralfate is a drug that treats ulcers and other stomach issues.

IV. Evaluation:

I personally think that this department is a great place to learn more about what medications are used to treat patients and their conditions. The department is a paradise for anyone who is OCD with all the strict organization that goes on. I also feel that the pharmacy offers an inside glimpse into what it's like to some of the most needed people in the hospital. I feel that it is a good rotation to go on.

GC 2/9/15 and 2/12/15

This week I rotated back to LTAC to do some activities with some of the residents, but first of all we had some work to take care of. After that we got right to spending time with patients. The patients and us students feel that these activities help us all bond and become closer, I just hope we can do this again some time.

MHKH 1/30/15 and GC 1/29/15

MHKH Report

Responsibilities:

• Go to Cardiopulmonary Dept. and follow a nurse or respiratory therapist.
• Went to ICU with RT, was instructed to take a few vital signs.
• Learned about ventilators and different types.
• No more to do with RT after a few patients so I went with another ICU nurse.
• Nurse had me check if feeding tubes were working.

New Knowledge/Skills:

• Learned about a CBC or complete blood count.
• Learned that Cardiopulmonary Dept. works very close with ICU.
• Learned how to check if a feeding tube and ventilator are working and it was freaky.
• Learned about an ethics case in ICU.

Best Thing(s):

• Got to take some vital signs.
• Learned how to check feeding tubes and ventilators.
• Got to see an x-ray of a patient.

Worst Thing(s):

• The RT had nothing else to do so I couldn't keep learning from him.
• Seeing the ethics case.

Overall:

The rotation was pretty awesome because of all that a person gets to see and learn from both Cardiopulmonary and ICU. It was a great week.

Technology:
The ICU has a lot of ventilators and feeding tubes that are going on  most of the patients. There is a crash cart that is in the center nurse station just in case a patient flat-lines. There is a plethora of EKG's all around the department. There was a portable x-ray machine on the department.
Diagnostics:
The RT deals with a lot of ventilators and making sure that they work and that they are used properly. He and the nurses monitor vital signs, check medications, and constantly check up on the patients.

Therapeutics:
If a patient gets restless or agitated when a ventilator is being put in they will be given sedatives. Medications are also drip fed to patients who are asleep or sedated. If a patient is about to pass away then the nurses make sure they are as comfortable as possible.
Diseases/Disorders:
There was a patient who was a long time smoker who just happened to have contracted pneumonia. There was also a patient who was in the ICU with COPD or chronic obstructive pulmonary disease.
Med Terms/Abbreviations:
A few that I heard were  CBC or complete blood count which counts all white blood cells, red blood cells, and platelets in the body as a test to see if there is an infection due to higher white blood cell count. Another I encountered was a PEG or percutaneous endoscopic gastrostomy which is pretty much a feeding tube for a patient.

I. Environmental Assessment:
The Cardiology Dept. on 1st floor seems kind of small but it feels comfortable. There is the hustle and bustle of some nurses here and there. The nurse I talked to said that the department was actually really slow and since RT's work under the CP department I was sent to an RT in the ICU. The whole ICU was alive with electronic buzzing from EKG"s and ventilators.The place smelled of sanitizer. There is a cleaning crew around the clock to ensure that the environment remains sterile. The RT was really cool and nice and the nurses were also great. ICU provides care for patients in critical condition, keeps them under close surveillance, and checks on patients every 15 minutes to an hour. The ICU uses EKG's, ventilators, feeding tubes, drip feeds, and crash carts just in case.
II. Observation:
The RT and Nurses are rather formal people, but nice nonetheless. They get in, work on a patient and then they are out. New machines and equipment is coming in and the whole department is excited. The staff is quiet but they all work very well together. Phones are used often if something is needed from pharmacy or any other department. There is a fire door just in case and an extinguisher. There is a crash cart within the vicinity of every room if it's needed. Therapeutic services offered are sedation for restless and agitated patients, medications to stop pain, and a patient who is close to passing will be made as comfortable as possible. Diagnostics that are performed are checking ventilators and feeding tubes to make sure they all work properly, taking vital signs on patients every 15 minutes to an hour, and check medications.
III. Knowledge:
On the unit I actually learned a lot about ventilators, what they're used for and when. I learned how to check if a ventilator and feeding tube are in properly by using a stethoscope to check if the ventilator can be heard in the body and the feeding tube as well. Some abbreviations  learned were CBC or complete blood count that measures both white and red blood cells and platelets and how white blood cell count indicates an infection. There was also PEG or percutaneous endoscopic gastrostomy which is a feeding tube. New learned skills were learning how to check that a ventilator and feeding tube were all in place.
IV. Evaluation:
Overall this unit was a really cool and educational unit that was pretty hands on with the RT.I think that the way that CP works closely with ICU is a great thing because it gives us more options on who to follow and what we can learn. This unit is an awesome place to learn how to deal with certain patients, their needs, end of life needs, and ethical cases.

GC 1/29/15

The LTAC is associated with several Federal Government programs like the Older American Act which made the government put some more focus on the aging and elderly community to comprehensively provide care and other services. There was also the Omnibus Budget Reconciliation Act of 1987 which was also known as The Federal Nursing Home Reform Act that was to provide protection of patient's rights in a nursing facility and regulated Medicare's participation in the nursing home. It makes sure that no patient is given more medication than needed and that anti-psychotic medications are given to patients who truly need them. In some cases an ombudsman is assigned as a public advocate who is assigned by the federal government to seek out instances of maladministration and violation of patient's rights.