Physiotherapy Case Study. A patients prognosis may be greatly enhanced if serious or life threatening conditions may be diagnosed early (Greenhalgh & Selfe 2006). This is particularly true of a Deep Vein Thrombosis (DVT), which involves a clot or thro

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SCHOOL OF HEALTH AND REHABILITATION

NAME OF COURSE:         physiotherapy

MODULE TITLE: PPD/PBL 3

ASSIGNMENT TITLE: PPD/PBL 3:  Reflections

WORD COUNT: 1487 (495, 496, 496)

Please note that the stated word count for each piece of course work is an ABSOLUTE MAXIMUM 

N.B. tables, diagrams, figures, text boxes all count as 100 words (Unless stated different by module leader)

HAND IN DATE: 21/06/10

COMPLETE COPY                                                                    yes

(INC DECLARATION OF OWN WORK, APPENDICES ETC)                                                                        

I have read the relevant information in the handbook relating to coursework requirements and have complied with these.                                yes


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Essay 1:  Patient

A patient’s prognosis may be greatly enhanced if serious or life threatening conditions may be diagnosed early  (Greenhalgh & Selfe 2006). This is particularly true of a Deep Vein Thrombosis (DVT), which involves a clot or thrombus forming in a deep vein. This condition if left untreated carries a high risk of a pulmonary embolism (Kumar & Clark 2009) and highlights why awareness, attention and  suspicion are just as important in clinical reasoning as structured protocol (greenhalgh & Selfe 2006)

A patient presented, as a fracture clinic referral, with a diagnosis of an avulsion fracture to the tibial spine. On observation, there was clear, but minimal swelling around the patella. Range of movement and isometric quadriceps exercise were prescribed and a physiotherapy appointment for two weeks later was arranged. On the second presentation the swelling was still uni-lateral but much more widespread, covering most of the upper thigh and some of the lower limb, and the tenderness had moved from the patella to the medial aspect of the upper thigh. Observation is a major tool in the physiotherapists armour (Petty 2006) not only in terms of posture, symmetry and muscle form but also of more localised physiological changes (Hengeveld & Banks 2005). I observed and recognised these changes, and although the exact diagnosis eluded me I intuitively felt something was wrong. Thus as a student I felt it best to consult my clinical educator, where it was decided to

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refer the patient to the Accident and emergency department on the suspicion of a DVT, which was subsequently diagnosed.

On reflection I feel that overall my performance was at least adequate and efficient. I correctly observed and highlighted signs and symptoms which were not expected as a progression of the original diagnosis and was aware enough of contraindications to be alerted.  Thus my clinical reasoning had to be adapted to the patient presentation. (Hengeveld & Banks 2005).  In addition I correctly concluded that it was in the patient’s better interests and my duty of care to alert my clinical educator to something that was beyond my scope (CSP 2005). However my inability to specifically diagnose the condition highlighted a lack of knowledge, which is essential for reasoned decisions (Higgs & Jones 2000). It also helped to emphasise the embryonic stage of my professional career, and that physiotherapy is a profession encompassing life-long learning that has no room for complacency and only accurate clinical reasoning. (Hengeveld & Banks 2005). In addition it re-focused the need to be clinically suspicious with regard to contra-indications and red flags as critical clinical markers. (grenhalgh & Selfe 2006)

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Going forward, I feel it is important to keep an open mind when assessing patients, many signs and symptoms do not sit squarely within classic patterns (Maitland 2006) or protocols, echoing the CSP (2005) guidelines of not assuming with regard to physiotherapy delivery.  Furthermore, clinical

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reasoning should never be complacent, the physiotherapy path is one of life long learning not of dogma. (Higgs & Jones 2000)

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Essay 2:  communication

With regards to ...

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