7/31 pratice daily

周業太 yehtai.office@gmail.com
if PDA connection didnt have any problems,but still can't access Stream Management or Stream-CAT , just call the name above sentences.

IADL
The patient who is total dependent in his daily activities, he didn't do activities that he like after stroke because of depression mood.According to the p't mood, make him didn't have any mood to do meaningful activities. It doubt me that this situation of patient had change totally after stroke .how we can do to change his quality of life.
Item 41 others: p't do said he 隨意欣賞風景,散步


Thusday 8/2
From 2 pm to 4pm have patient to practice some assessment, for example BI,BIB,Stream-cat and others.

7/30 pratice BI,Stream-CAT,BADL

BADL:
IADL need to plan to take examination on patient in other days.
Stream-CAT(paper sheet) :
in the item of M2(hip elevation on lying ),her leg are deviated from midline,need one people to hold it.if someone help her ,is it the point will given 1 or 2?
And the hip are not symmetrical (no assisstant at her foot), and also cant maintain longer.
-U10 thumb and index finger tipinch,use the thumb nail to touch the pad of index-->wrong ,just can give with one mark!
-M4(sit to stand) can use hand to support on the bed.
BI : need to exclude the patient who has aphasia syndrome?
if we met some patient who are total independent, still need to consider in? or just exclude from our examination.
next plan: find OPD for training stream -cat with PDA and include paper sheet.

7/27 pratice BIB and BI (morning)

BIB
1.Before assess patient's sit to lay, need to remember remove their shoes ,and wear it back before exam the item of standing(sitting).
-must lying straight in midline
2. If the patient is prone(wrong position), this result that may be her concious not clear about our commands, and too many commands will confuse her.
-at the item of taking a pen infront of him, if the p't can't recognize the direction(left or right), that's fine ,we can give them a sign where the pen need to put on.
-at the ietm of taking a pen from floor ,never mind with her leg move back !
3.Arteriovenous malformation( 動靜脈畸形) s/p op(AVM) is include in CVA criterion?
Answer:

• 747.81 Anomalies of cerebrovascular system
  - Arteriovenous malformation of brain
  - Cerebral arteriovenous aneurysm, congenital
  -Congenital anomalies of cerebral vessels
  Excludes:ruptured cerebral (arteriovenous) aneurysm (430)
• reference from: http://icd9cm.chrisendres.com/

4. The mark of BI is a little bit large to determine p't ability in their meaningful daylife, for example bathing, hygiene,wearing and etc. even though, we are difficult to judge the independence level of client.

7/26 pratice BIB & BI

In BI assessment ,when we met some patient who are talking not so fluent , or aphasia ,is it we won't choose them for a exam ? In my opinion,if the patient doesn't understand or comman ,that's difficult for determine which answer he give is right, there have too wide indefinite rank to consider.

BIB, got one item that tip to toe and two legs be a line, but if the line is not so straight, are this item going to give him a point or 0. There are too many item need to remember comman ,so need some time to remember it.

tuberculosis meningocephalitis(結核症狀腦膜炎) can include in CVA criterion?
Answer :not include in CVA criterion.
reference from: http://icd9cm.chrisendres.com/

7/25 a mistake i need to pay attention

Mission: BI assessment ,BIB, BADL,Stream-CAT "Practice"

Interview skills need to improve!!! today I met one p't who was sensitive(direct) about her disease's history , after that she came to find me twice for saying about the interview skills need to be pay attention!

Review:
1After this matter happened, how i'm going to solve it ? if after I had apologized to her ,( phone her on everning to calming down her feelings?--not suitable).what else i can do afterwards?
2.Before do any assessment, I need to look through the p't minute book, make sure which p't can agree or suitable to take the assessments.
3. After sieving unsuitable p't, that will avoind same matter happen.
4.Interview skills need to improve, for example
if i met some familiar p't again ,what interview skills i can use?

• 婉轉的方式: 不知道你現在願不願意接受問幾個問題, 不知你方便告訴我你為何要來復健?發生了什麼事情?
• 請問妳現在有時間願意接受我們的測驗嗎? 我們現在要做一些跟中風病人相關的評量,想要瞭解您目前的動作和日常生活功能的程度!

7/24 clinical practice

Today mission:succed assess one p't with BIB and BADL, but got one p't can't take in because unsuitable time for arrange an assessment.
After that, i went to bedside office wrote down the details of p't . I got a curios about the explaination of the year p't get stroke,the information of the chart is not clear. so i decided find student chart look through it, but teacher need to disscuss with student ,and i will look through it tomorrow.
Got one question is about all the assessment for stroke p't need one criterion is one side is parethesis ,that have a difference with the good limbs? Because today i met a p't who just got hand function prechesion problem only. is it still can include in this case?
Answer: i dont think so .

7/23 pratice stream-CAT(with PDA)

Today, go to clinical practice, but few patient can we have to test because no new CVA patient.
But i had practiced the STREAM-CAT paper sheet and PDA to one p't. Unbelievable PDA waste the time is shorter than paper sheet did, but the position change is more often, need to be suitable for p't who have more endurance!!

7/20 pratice stream-cat

A point for attention: we must pay an attention on patient's safety for example when p't is doing position become side-lying, or go downstairs and side walking. we must stand close to the patient in 2 steps distance to give him/ her protection.

Second, when giving them an assessment ,the item of Mobility do not need assisstant ,but U/L extremities need to determine to p't ability that they either need assisstant , or no assisstant.

Third,when p't do bilateral movement ,we cmay need caregiver sit beside(患側) p't to protect him/her, then only we can confirm the correct motion(symmetrical motion) infront of him(in the middle) .

Another BIB, precautions same with front ,there are more dangerous positions,for example when in standingr ,or squat and others positions change.we need to protect p't for falling down or other causes, like isn't after he squat ,he get the ability to stand up again.

Last, asking about BADL is need some time to find out interview skills ,for example how to ask and how can i save the time .

In this item, we need to know,did they do after sick(within two days for inward p't and one weeks for OPD p't ) . sometimes, need to ask the p't or caregiver more clearly about how they drink ,not did you do it ;amd separate the item of wearing clothes and pants ,shoes and socks,etc.