Dealing with a non compliant patient
Context and description
This report will outline a personal reflection that occurred during the hospital placement in October. A 78-year-old male patient, a local GP, with a medical history of type II diabete mellitus for thirty years and severe peripheral neuropathy presented at the high-risk foot clinic for a weekly routine treatment. He wears a pair of darco boots and presented with neuroischemic ulcers on both feet. As this patient was allocated for student to treat for the day, and I obtained the patient’s permission before the treatment began.
Left hallux was deteriorated further from last week’s pictures, which required an aspiration from the lesion to investigate further whether this lesion is infected again. Left fourth and fifth inter-digital ulcerations were not improved, and right dorsum of second digit’s ulcerated wound was epithelised. Saline flushed and mildly debride the lesions with blacks file and mosquito forceps. Wound dressed with bactroban, baitain and mefix on left hallux, and baitain with mefix on other
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I was worried about I might cut myself or cut the patient’s toe. The supervisor agreed that the technique is not a safe way, which we all should not do in the normal practical settings. However when there are no equipment is available like the mandrill machine and patients need our care right there, we should provide the best of care where we may possibly can. So this instance, we all know this is inappropriate technique, but find the other way to make patients happy and our work done. As she explained that many podiatrists visiting out service including hospital and nursing home visit, they are not always able to carry machines or other heavy instruments, but we must know how we can utilise with available resources and time for what we have to do the
In her personal essay, Dr. Grant writes that she learned that most cases involving her patients should not be only handled from a doctor’s point of view but also from personal experience that can help her relate to each patient regardless of their background; Dr. Grant was taught this lesson when she came face to face with a unique patient. Throughout her essay, Dr. Grant writes about how she came to contact with a patient she had nicknamed Mr. G. According to Dr. Grant, “Mr. G is the personification of the irate, belligerent patient that you always dread dealing with because he is usually implacable” (181). It is evident that Dr. Grant lets her position as a doctor greatly impact her judgement placed on her patients, this is supported as she nicknamed the current patient Mr.G . To deal with Mr. G, Dr. Grant resorts to using all the skills she
Some may argue that the quality of medical treatment and technology are the most important attributes to a successful recovery. Relman stayed at two hospital facilities during his recovery. The first was Massachusetts General Hospital, and the second was the Spaulding Rehabilitation Hospital in Cambridge. Both facilities belonged to the Partners Health System and, therefore, had similar technologies available. Relman mentions multiple times that his care at Spaulding, as opposed to Massachusetts General, was “sometimes excellent but often inadequate.” (Relman) He came to these conclusions based on how he was personally treated as a patient, rather than based on the quality of the treatments. At Spaulding, multiple physicians treated Relman. His main physician went on vacation so multiple associates stepped in to check up on him throughout his stay. None of these associates made him feel comfortable as a patient. They tended strictly to his dire needs and did not spend much time with him beyond primary...
She later returned to the doctor, the doctor recommended that she undergo some test to find out if there was an underlying cause for the pain in the hallux. The results of the test indicated that she had a condition called Peripheral artery disease (PAD), as a result of this no blood was getting to her hallux. “Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.” (mayoclinic.org)
Something as simple as taking a walk around the facility can prove to be a battle with patient X. From the day I met patient X it was noticeable that she was lacking her memory. Patient X could no longer tell me her name and everyday it would be different struggle, but for that day it was getting her out of bed to take a walk. From the moment I walked in and introduced myself, patient X could not provide me with her name. Patient X constantly asked if I was her baby, and when dealing with an Alzheimer patient, it’s always best to go along with what that patient is saying. As I got patient X up and out of bed, she started to become violent and resistant. Patient X took forty-five minutes to simply get out of bed and dressed, and that was the very beginning of the battle that would consist all day.
During one of my rotations, I was assigned a young adult patient who had run out of insulin and had been admitted to the hospital following a Diabetes Ketoacidosis (DKA) episode. I realized that my patient was probably torn between buying insulin and buying healthy food because her chart showed several admissions in the past following the same problems. This particular patient was in her room, isolated in a corner, and she was irritable. As her student nurse, I was actively involved in her care; I was her advocate for the day. The patient lived with her single mother and worked at a fast food restaurant. Since this was my first time dealing with a patient with DKA, it became a definite challenge for me.
Lastly, and for many professionals, most importantly, further methods engaged with problems of foot constriction and swelling. When the men could not take their boots off, and when they were laced too tight, their feet swelled. This was terrible for their circulation. Sir John French’s dispatch in the BMJ listed in preferential
According to Healthy People 2012 there are more then 800,000 new cases of diabetes each year, with the numbers on the rise. With this in mind, Healthy People 2012 has identified diabetes as their number five focus area. In order to reach their goal of improving the quality of life for people with diabetes they have identified diabetes teaching as their number one objective. Furthermore, in order to reduce the number of complications of diabetes, Healthy People 2012 has identified foot ulcers as their ninth objective. Through patient education Healthy People 2012 hopes to reduce the number of foot ulcers in people with diabetes, as diabetes is the number one cause of nontraumatic amputations in the United States. In order to successfully reduce the number of amputations and diabetic foot ulcers, patient teaching is essential. Patient teaching, as with the nursing process, begins with assessment in order to identify the patients learning needs (Wilkinson & Van Leuven, 2007).
Therapy Analysis The purpose of this paper is to examine the efficacy of my work as a co-therapist during the fifth session with the simulated couple Katy and Michelle. I will discuss our therapy agenda and the goals we hope to attain during the session. It is prudent to begin by giving a brief outline of the couple’s present problem and the patterns of dysfunction that I have identified within their relationship. In my opinion, it is the therapist’s job to recognize patterns and behaviors that disrupt the intimate bond between the partners.
Throughout my final ten weeks at my placement, I have grown and overcome so many obstacles. I have accomplished a wide range of skills since the beginning and have been improving on them as I gained experience. At my placement as a student nurse, I have gained a lot of confidence, skills, knowledge and experiences that have helped me act and work in a professional way. All the experiences I have had during the ten weeks of my student years have helped me in shaping me into a professional.
My experience in mental health clinical was very different from any other clinical I had before. In a mental health clinical setting, I am not only treating client’s mental illnesses, I am also treating their medical problems such as COPD, diabetes, chronic renal failure, etc. Therefore, it is important to prepare for the unexpected events. In this mental health clinical, I learned that the importance of checking on my clients and making sure that they are doing fine by performing a quick head-to toes assessment at the beginning of my shift. I had also learned that client’s mental health illness had a huge impact on their current medical illness.
Then obtained permission from the patient for the next procedure with a number 15 blade to penetrate the left lateral hallux nail. But patient could not tolerate the pain and it interfered me to proceed further and deeper. With a supervisor and the patient permission, I decided to inject a local anaesthetic of Xylocaine 2% on the dorsum of both proximal IPJs of the left hallux to numb the lesion (Watkins, 2010). The patient was become so anxious, and I was also getting nervous by doing an injection itself, then I accidently punctured into my thumb before applying it onto the patient’s. I immediately took off the glove and apply betadine with an appropriate wound dressing. It was a really embarrassing moment, which I became lose of
When it comes to patient care, veracity is a critical component as well as an ethical principle that should be used in every patient interaction. Patients have a right to be able to know all of the details pertaining to their situation and have involvement in the care they receive. These patients are in vulnerable states in their lives and being upfront with compassion is undoubtedly beneficial in the long run, especially in relation to the unequal power relationship that compels unavoidable trust in the nurse. I am able to personally support this issue in relation to both of my brothers being diagnosed with Diabetes Type 1. The honest and open care provided by the nurses in both of their situations greatly helped us overcome it which in turn had a great impact on the adjustment to the new lifestyle they were going to be
My first patient that I started as student nurse on one of the long Rehab Center was a seventy two year old man who had Clostridium difficile (C.diff), Dementia, Hip replacement, and Obesity. Due to the above sickness he had many complications. I can still remember his face suffering from pain. Because of his lack of ambulation and incontinence, he had developed a very serious pressure ulcer under his sacral area. I went through to the room with my instructor and the instructor introduces me for the patient as his student nurse from Towson University and will taking care of him. However the patient was not happy and he becomes a challenging patient in my first experience day. But I may learned more from that challenging patient for my future experience.
Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.
Knowledge is continuously derived and analyzed from the experience of learners validating the truism that experience is the best teacher (Kolb, 1984). The aim of this module was to assist international students improve their communication skills which is key to a successful medical practice. This essay examines my journey through the module, sums up my experience and highlights its relevance to my career.