CRYING WOLF

Hello ALL, welcome back to another fun filled month of clinics! Well done everyone thus far!

I have now changed lanes where cardio is my focus. At the moment, I and another colleague are seeing (for identification purposes) a 50-some year old female) post MVA suffering from # ribs and pneumothorax. (NB: pneumo is diminishing.) She has an ‘elevated’ BMI and NIDDM. I feel a bit guilty because when she sees the blue shirts coming, I peak out of the corner of my eye and notice she is either closing her eyes (as if she where sleeping) or starts to moan. We have found one has to be a bit stern with her (your chest may be sore but your legs are just fine, lets have a walk) or distract her (nice tattoo). She does sweat a lot (? due to her weight and the hospital is quite stuffy) but I just want to be sure we’re not pushing her too much. Now I would never put my patient in danger intentionally. I am pretty sure she is capable of a lot more than what we are putting her through. But what if she isn’t just crying out for the attention? I am sure she is in a fair amount of pain (she has oral pain cover), but when we left her on the toilet to ‘take care of business’ she sorted herself out behind closed doors. She can definitely mobilise, but on occasion (off O2) her sats drop…naturally. Now, this could be partially from her constant sighing and not taking deep enough breaths etc. OR I could be horribly wrong. Thus far there are two of us working with her and we/I believe (with my physio student judgement) that she is fine to ambulate but again, I do not want to end up on the chopping block! She is totally fine and very independent, but it just seems she likes to have a bit more care (that is care from others as she may not be getting this much attention whilst at home). Really I’m not a mean person…though this course has taught me I have to be tougher to get what I want!! Our supervisor and nursing staff all agree she is a bit over the top, but I hope I have finally grabbed the bull by the horns and am starting to be reasonably assertive yet still a nice, caring person…hmmm hopefully not a physioterrorist!!! I just don’t want to ignore her if something really is detrimental. Any advice??