Case Study #5: Motor Vehicle Collision (MVC)
Place: Surgical Ward
“Good morning, Aaron. My name is Jeremy and I’ll be the nurse caring for you this fine morning. How are you doing?”
“I guess I’m doing better,” Aaron whispers. “My throat is still sore and my voice doesn’t sound like my own.”
“Yeah, that will go away in time. You have had a tough go of it for the last 24 hours.”
“Any information on my girlfriend?”
“Sorry, I don’t know anything. I just came on. I would ask your Mom when she comes in.”
Looking disappointed, Aaron nods.
“I know this is tough. Let’s focus on you. Today will be a bit action-packed for you. Bloodwork today, probably in a couple of minutes. Then Physio is going to see you and get you up and about. Dr. Labinski will come in, and together we are going to change that dressing. If you can tolerate more than a few sips of water, we will see if I can get you something a little more like jello.”
“Can I have a milkshake?”
“Sure, whatever. The tube that is down there, you know…”
“That’s called a foley catheter and it goes through your penis to your bladder. It drains your urine out and allows me to see if you are drinking enough or not. If things keep going well today and you are able to tolerate an increase in fluids, I’ll remove the catheter. Sound ok?”
Aaron leans back, closes his eyes and nods.
Jeremy efficiently completes his assessment and moves outside the room to record his findings.
Jeremy feels a light touch on his shoulder and turns away from the computer where he is charting to see a very fit young man in street clothes. “Can I help you?”
“Sorry to disturb you. My name is Chin and I’m the physiotherapist today. Just started here a couple of weeks ago.”
“Oh, hi.” Jeremy looks down to see an ID tag dangling from Chin’s right front pocket.
“I’m here to check on a patient from last night. Mr. Knoll?”
“Yes, he’s one of my patients. Doing quite well and is probably ready to get out of bed and begin moving around.”
“That’s excellent. Can you tell me more about him?”
“Sure, come closer and I’ll pull his chart up on this computer and we’ll go through the history together.”
“Thank you, Jeremy, for walking me through the chart,” says Chin. “Are you able to assist me with mobilizing Aaron?”
“Yes, let’s go see him and see if he wants to get up.”
Walking into the room, they find Aaron and Mrs. Knoll talking.
“Hi, Aaron, Mrs. Knoll. This is Chin. He’s a physiotherapist, and he’s going to help me get Aaron out of bed and learn how to move around with the large incision that he has.”
“Do I have to leave?” Mrs. Knoll asks.
Chin shakes his head. “Definitely not. I would actually like you to stay and see how we assist Aaron. That way, if he wants to move or needs help, you can provide that assistance.”
“Oh, I would like that,” says Mrs. Knoll, smiling.
Jeremy moves to the opposite side of the bed to arranges the IV pumps and untangles the nasal prongs tubing in order to give Chin and Aaron enough room.
Chin then moves to beside Jeremy and sits on the edge of the bed. “Ok, Aaron, we are going to get you standing and maybe taking a couple of steps. Not much activity in comparison to what you were able to do two days ago. It will be uncomfortable and I want you to press your PCA if you’re having pain. We need to get you up or you’ll get stiff and your lungs will accumulate fluid.”
Aaron looks around at his mother and she nods to him but looks concerned.
“Jeremy is going to help me. We’re going to roll you onto your side. Jeremy will lift you to a sitting position and I will slide your legs off the bed so you are sitting on the edge of the bed. Then we will let you relax and get used to sitting. If things are ok, then we will help you stand. At any point in time, you let us know if this is too much or to keep going.”
Chin stands up and asks Mrs. Knoll to come and stand behind them so she can see what they do to sit Aaron up and to get him to stand.
Moving slowly, both Jeremy and Chin get Aaron sitting up on the side of the bed.
“How do you feel?” asks Chin.
“Very dizzy and can’t believe I’m so weak.”
“Yes, it will take awhile to get your strength back.”
Aaron reaches for the PCA remote and presses the button once.
A few minutes go by, with everyone talking about the weather. During a break in the conversation, Chin asks, “You ready to stand, Aaron?”
“I think so.”
Jeremy stands close to Aaron’s right side and Chin stands on the left. Both assist Aaron to wiggle a bit forward to the very edge of the bed so he can place his feet flat on the floor.
“Ok. Jeremy and I will take some of the weight by holding your arms and shoulders. If at any time you don’t feel well, just sit back down.”
Aaron nods that he understands.
Moving quite slowly, Chin and Jeremy get Aaron standing upright. Legs shaking but holding, Aaron looks around and weakly smiles at his mother.
“Wow, that is awesome. You are up out of bed.” Mrs. Knolls smiles and clasps her hands together. “Oh, I’m going to have to tell everyone that you are doing so well.”
“Yeah? If this is well, I’ll have to lower my standards.”
Chin laughs. “Aaron, it’s going to take time for you to get better. You’re young and will probably get better faster than other patients. It’s important, though, that as you feel better, you don’t overdo it. I’m going to create an activity plan for you and post it by your bed and on your chart, so that everyone knows and you know what your activity is.”
Chin continues. “Ok, let’s take two small steps.”
Aaron shuffles two steps forward, then stumbles.
“All right then, Aaron. Let’s get you back to bed.”
Jeremy and Chin help Aaron back to bed and settle him in.
“Very good, Aaron. I’ll come back this afternoon and see if you’re ready to sit in a lazy boy chair.”
Aaron just nods and closes his eyes. “So tired,” he says.
Jeremy checks the IVs and then leaves the room with Chin. “Thanks for your help, Jeremy,” Chin says.
“No problem. If you want help this afternoon, I’m around.”
“Excellent. If Mrs. Knoll is around, I may see if she can help so she can learn how to assist Aaron when he goes home.”
Dr. Labinski enters Aaron’s room to find Aaron sitting in a large grey chair and Mrs. Knoll sitting beside him holding his hand.
“Good afternoon, Mrs. Knoll and to you, Aaron. Not sure you remember me. I am Dr. Labinski. I operated on you last night.”
Aaron looks up. “I can’t remember anything except having dinner with my girlfriend then going to the library.”
“Not surprising. Your surgery went well and I expect you will make a full recovery in time.”
Dr. Labiniski then explains the surgery and how he expects the next few days to go. “Do you have any questions, Aaron?”
“Just one, my girlfriend. What happened to her?”
Dr. Labinski leans forward. “Aaron, both you and your girlfriend were in a serious accident that required cutting you out of the car. Your girlfriend was brought to the hospital before you.”
Dr. Labinski goes on to explain what happened to Aaron’s girlfriend.