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2010 ADHB Case Study 1

Neurosurgery placement block
by

Angela McGregor

on 22 April 2010

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Transcript of 2010 ADHB Case Study 1

Patient introduction Medical SMART Goals MDT Physiotherapy assessment Physiotherapy Intervention References Neurosurgical
Case Study admission: 29 Mar
surgery: 30 Mar
PT 1: 31 Mar
PT 2: 1 Apr
discharge: 3 Apr
Stealth guided craniotomy
e/o large R) temporal meningioma
Buetow, M. P., Buetow, P.C., & Smirniotopoulos, J.G. (1991). Typical, atypical and misleading features in meningioma. Radiographics, 11(6), 1087-1106. Relevant SHx:
Previously high ETOH intake
Ex-smoker
Sister died of C in 50's PMHx:
Hypertension
Cholecystectomy (2001) Informed consent 62yo
Lives alone
Independent
computer specialist Activity
Mr X moving in bed and
eating independently

Function of body/impairment
(S) no dizziness, nauseousness
(O) sensation, ROM, strength of UL
& LL bilaterally normal
Cognitively intact
obs stable Short term:
Mr X will walk 10m from bed to shower and back with Ax1, and will wash himself while seated in shower today (1/7). needed confidence and encouragement ankle paddles
knee flex/ext
hip flexion exercises... Sykes, C. (2008). The international classification of functioning, disability and health: Relevance and applicability to physiotherapy. Advances in Physiotherapy, 10, 110-118. ICF model Le Lievre, D. & Knox, M. (2005). ADHB Neurosurgery guidelines. N.p:n.p Health and Disability Commissioner. (2004). The code of health and disability services consumers' rights. Retrieved from http://www.hdc.org.nz/theact/theact-thecode on April 18, 2010. Long term:
Mr X will reattain his pre-morbid level of independence in 6 months, including;
living safely and (I) in his flat
working 30-40hr week as a computer specialist
excl

Precautions (60/d for 20y=60 pack yrs) informed
consent (Health and Disability Commissioner, 2004) (Health and Disability Commissioner, 2004) (Sykes, 2008) epileptic
seizure
community health services:
- doctor for F/U, medications,
- professionals for financial, emotional, physical concerns
short stride with R) foot stairs + railing
(at home) Berg balance:
55/56
advice:
shower- bathmat, inform friend
progress activity wrt safety, fatigue

SW - transport
assistance OT - cognitive fatigue (computer) D/C from
PT service mobilised
progressively post-surgical HYPOtension:
(no food, dehydrated, meds withheld) distress?
R/R, sweating, pale neck weakness
when unsupported lines limiting movement Reflection Ideal 'routine' pt
-quick D/C if no complicn
-majority progress similarly Psychological
-confidence
-reassurance
-security Proprioceptive & sensation testing ! CVL through muscles
Support head & trunk when sitting
Roll to side (sore side down) then sit
Very assertive RR= 16, O2 sats= 97% o/a, SBP <160mmHg Medications Analgesia Anti-inflammatory Insomnia Hypertension Paracetamol
Codeine
Morphine Dexamethasone Zopiclone Hydralazine
(smooth muscle relaxant) Mobilise POD1
(Le Lievre & Knox, 2005) Policies and procedures (2009). MIMS new ethicals (10th ed.). Auckland, New Zealand:CMP Medica remove TEDs
Ax2 advice...
supervision
Full transcript