Patient monitoring

Can't believe we've survived 2 years...well done guys on finishing placements and good luck on wednesday!

I had a patient (82 year old woman)that was admitted for a ?TIA with minor right sided weakness and the doctors wanted a mobility review. On assessment, the lady presented with decresed muscle strenth (Gr 2+ - 3+) of LL muscles (R = L), no perceptual probs (that I could detect) and poor balance - was unable to bring feet together or tandem stance with EO. Obs were stable, transfers fine, gait - required supervision.

My treatment therefore consited of LL strenthening ex's - bridging, clamshells, IRQ, isometric glut squeezes then progressed on to balance tasks. She appeared fine throughout the session, frustrated at her balance but able to complete tasks. When I left her she was on assumption that she was going home though I told her the doctors would more than likely keep her for observation and was due for a MRI later that day. She felt offended that I wouldn't let her go, but I continued to explain that she was at risk of falling over and it was a safety precaution that she was staying there and "we're just getting you stronger to go home." She continued to pack her bags, claiming she just fainted and didn't have a stroke...we were being silly. Her family later told me her behaviour just wasn't here and very concerned that she had changed.

Half an hour later she had an OT review in which she had a code blue - had 2 episodes of unresponsiveness.

Moral of the story is to keep monitoring your patients even if they seem fairly straight forward, don't push them too hard which may (or may not) have been the cause of this code blue. Can't help but feel it was my fault. I learnt my lesson not to expect your patient to be ok even if they appear ok - continue to look, listen and monitor and observe. There's a reason why they are on a nuero ward.

Fan