Sunday, 27 May 2007
Unmotivated patient
I am currently on my cardio placement on SCGH in the medical respiratory ward and have encountered a difficult patient. This patient was admitted to the ward with increasing shortness of breath with mild exertion and a suspected exacerbation of asthma & query COPD diagnosis. On reviewing the pts medical notes (analyzing her PFT’s, chest X-ray ect.) I found that this pt does not actually have any signs of respiratory pathology and she has never actually been diagnosed with asthma by a Dr. The reason she was experiencing dyspnoea & displays a restrictive pattern on a PFT is simply because she is obese. This individual had a BMI of over 50 and as a result suffers from sleep apnoea and obese hypoventilation syndrome. Obviously this pt needs to make some major changes to her lifestyle in order to improve her symptoms however she is very unmotivated to do so. I focused my treatment on improving the pts exercise tolerance. I did a six minute walk test on the pt and unfortunately due to her lack of motivation her results were not very good. She was not even close to reaching her target heart rate and her 20minute walk distance only worked out to 400m when in my opinion & my supervisors opinion she could walk a lot further in that time. I also prescribed the pt with a home exercise program, which included UL & LL strengthening exercises. I gave the pt a table to record the exercises she completes every day and suggested that she put it somewhere handy (e.g. on the fridge) & hopefully it will keep her motivated to do them every day. However she was not very receptive to this idea & I was not convinced she would stick to the program even though I explained to her the benefits of exercising regularly. I also requested that the dietician see the pt & she later informed me that she offered the pt a strict low kj diet that is available through the hospital but the pt declined. This pts attitude really frustrated me as there are so many very sick pts on the ward with conditions such as CF, COPD ect who are unable to reverse the damage that has been done whereas she can improve her condition by putting in some hard work. My question is what else could I do or say to convince this pt that she needs to take control of her life or her health will continue to suffer without getting her offside & pushing her further away?
Subscribe to:
Post Comments (Atom)
2 comments:
hey kayla, sounds like a tough one but nothing you cant handle i'm sure. Maybe get the social worker involved or take some time to have a chat to the lady about the reasoning behind her obesity and why she doesn't want to help herself. She might be depressed and not be at the stage of acknowledging that she herself needs to do something about it. What did Tom always say: "You cant help someone unless they WANT to be helped otherwise you are wasting your time!!" Maybe you have done all you can here and you might just have to wait until the patient is ready and willing to take control of her life. Then, and only then will you be able to take part in this ladies future.
I agree with Suanne, there is really only so much you can do. I came across a similar patient at RITH who was so unmotivated that he was having all his meals on bed and ignored an OT's presence while talking on the phone. And I agree with you that the patient is definitely someone of less priority (compared to other patients) at the moment unless she takes up her own responsibility of getting herself healthy!! I would probably include education+++ and motivation into my treatment session. Other than social worker, I reckon you can possibly try to involve family members who are often more pursuasive which I did with my pt and it worked well!!
Post a Comment