P4R5W4: Used with good effect.

The third week on the wards rolled around pretty quickly. I've listened to some interesting sounds through my stethoscope, including wheeze, creps, heart murmurs, people talking to me whilst I try to listen to their lungs, as well as the rare burp & hick-up that coincidentally occurred whilst auscultating! I am more often finding myself excited for my patients when they clear secretions from their lungs. I even had an exciting conversation with an older lady who, after a few days, had finally passed some wind. The excitement continued later in the week when she had a bowel motion. Exciting stuff!

There are some great patient attitudes out there. One patient stopped me in passing to tell me a joke. I was somewhat busy, but I stopped to listen (who wouldn't pass up an opportunity to share a laugh). The joke was about an elderly person who took their neighbors 'dog' for a walk down the street when a passerby asked why the person had a cabbage on the leash, to which the elderly person retorted that they would go back to their neighbor to apologise for not walking their colly.

On the ward I've had the opportunity to perform a bit of chest physio, there have been a range of patients with a range of conditions; post-abdominal surgery under local and general anaesthetics (some following the ERAS enhanced recovery after surgery protocol... different booklet to that of normal notes), traumatic injury (mountain bikers beware, your sport is dangerous!), pneumonia and upper respiratory tract infections. Incentive spirometers seem to be the flavour of the month - from my short experience, these devices really do motivate people to breathe deeper more often each hour! I've had many patients demonstrate their improvement with such pride. I've also made some DIY bubble PEP devices out of unused saline bottles (rinsed and filled with tap water) and unused catheter tubing (cut to size!) stuck together with some sellotape, with a post-it note covering the saline bottle label (instead showing instructions for bubble PEP). Bubble PEP is not just for paediatrics... geriatric patients enjoy it too.

There are plenty of wound drains, IV lines, PCA (personal controlled analgesia) line, catheters, telemetry lines, nurse-buzzer button, SCDs (sequential compression device i.e. calf pump machine), Airvo/nasal oxygen tubes, blood pressure cuffs + pulse oximeter lines etc to be cautious of and searching for. I have noticed that patients are often put on supplementary O2 via nasal prongs by the nursing staff on their arrival, this is something that physios commonly remove from the patients soon after they are assessed and deemed safe to have the oxygen removed (these patients are relieved, as the oxygen nasal prongs reportedly dry out their throat). 

I had some friends visit over the weekend, so we made a day trip into Abel Tasman national park!