While on placement in a general surgery ward earlier this year, i was treating patients who were placed in a special observations area. One particular patient was a 23 yr old guy from up north who was addmitted with pancreatitis due to alcohol abuse. After 1 wk in this ward, he was transferred to ICU as his condition became critical due to the fact that his stomach was so distended that he basically could hardly breathe. After 5 days in ICU he began to improve and came back to the ward, very lucky to have survived. My supervisor at the time told me that the survival rate for severe alcoholic pancreatitis is extremely low, especially if the pt ends up in ICU, as there is no treatment other than waiting for the pancreas to being to heal on its own.
As this pt lives and works up north, he is part of a community where socialising means drinking. All people his age head to the local pub each day after work for a 'few' beers, and on weekends do the same. This guy originally told myself and his doctors that he was consuming aound 4 beers every weeknight and up to 30 every friday or saturday night. Considerng his condition was so extreme, this didnt sound like the whole story, and only after his stint in ICU did he confess to drinking nearly a carton of beer every night of the week, which is masssive!
During his entire stay in hospital, just over 1 month, he was very non-compliant when it came to any physio input, and basically just wanted to stay in bed and not move. It was really difficult to get him to take a few deep breaths let alone get up for a walk around the ward, and this contributed to his slow recovery.
All of the medical team were having difficulty convincing this guy that he had to quit drinking if he wanted to get better, and all basically gave up on him because he was ignoring their input.
What i am asking you all is how do you make a 23yr old guy realise just how serious this situation is, and prevent him from going back to his social ways and becoming what the docors call a 'frequent flyer' in and out of hospital for the rest of his life? or is this just one of thise times when you say that you have tried everything and its just up to him to make his own decisions about his life?
2 comments:
hey stace
yeh that is definately a difficult situation especially when you have exhausted all your possible options. I do think it comes down to him to make the decision about his health.It sounds like the helath professionals have tried all they can. From previous pracs where i have had very similar patients, anything you do or say has no effect. Its especially difficult for this patients as that lifestyle is all they know and it would be so hard for them to change when they are surrounded by it 24/7. I think you should keep trying what your already doing: daily visits for ambulation, deep breathing etc. Keep up with the education ++ about effects on decreased mobility and relate back to his condition. Keep liasing with staff about encouragement for amb and SOOB. Even if he's unreceptive to your treatment, you still need to have some input with him. Perhaps see if you (or social worker) can get in touch with family (and emphasise compliance with Rx) or organise the aboriginal liasion worker to visit.
Hi Stace,
I agree with Hollie, I think you should continue with your daily regular treatment and urge him to participate, i find that telling pts that they can't go home until they are fit to walk around and get in and out of bed on their own is a good motivation to do their Physio. I would also consider probably as a student having a supervisor with you, but sit him down for a serious chat and i guess sort of tell him once and for all that he almost died this time and if he doesn't change his lifestyle, he might not be so lucky next time! Sit him down for one last serious chat and if he doesn't listen after that then you have really done all you can do!
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