Issue with physical therapy..how to handle?

[LizSaRN]

The other day at work I had a strange incident at work that seemed to really upset me and I didn't know how to respond. The PT dept at our hospital always asks us how the patient is doing before they work with the patient, well this particular patient was a recent transfer from our in house rehab dept after the patient had a seizure. The patient had not been witnessed having a seizure until my previous shift where she had what seemed like 3 back to back seizures. That morning the patient had 2 absent seizures, I notified the primary and called the Neuro who came by to see the patient, he changed the meds and told me to call if any more seizures occurred, even said that he believed the patient should go back to rehab since he could follow her there (she was a recent CVA patient with several deficits, but still ambulatory)and there is also nursing staff. This was all first thing as I walked on to my shift. Towards the late afternoon the PT comes and asked me to work with the patient and I stated that was fine. Another PTA that had worked with the patient the previously came up to me and asked me what had happened to the patient, I explained the patient had several seizures the day before, and this morning. He looked at the other PT and made a gesture with his hand as in to say no skip the patient today. The PT stated that I had said it was ok to work with the patient today , the PTA starts talking as if im not right in front of them and states "oh her don't listen to her" in a tone as I didn't know what I was talking about, this made me start feeling very defensive. He then said "Oh Im not trying to kill anyone today", and I told him the patient might even be transferred today, to which he said oh no their not, Im going to go down there and tell them the patient had a seizure they wont accept them. By this point I started to get angry, I understand if you don't feel comfortable working with the patient, just say maybe we will skip them today but he just seem to keep going while his other physical therapy friends were all standing around. I told them the patient has a seizure condition now, what are they going to need to be in the hospital every time she has one? ( I know not the best reply I was starting to feel very hostile), and the other physical therapist just responded by saying," you need to be careful, that might be the last seizure they ever get". At this point I just started ignoring them and continued with my charting.

I just don't know what to make of this situation, I am a newer nurse and this really took a shot at my confidence, maybe I should have told them to skip the patient today but I didn't think it was such a big deal. I think the way he responded in front of the nurses station with several people around made me feel as if they were insinuating that I don't know what I am doing. What do you think of this situation?

[icuRNmaggie, BSN, RN]

I am curious to know if the pt had a new stroke on the MRI /MRA, and if the pt was loaded with IV levetiracetam or fosphenytoin and if the blood level was in the therapeutic range.

The pt had two absence seizures that morning and three seizures on your previous shift, is that correct?

If so, it is not safe for this person to out be out of bed.

Did PT see the patient that day?

If the patient is ambulatory with a self steady gait,

what would be the benefit of PT?

I hope this does not sound argumentative. I am asking to understand your point of view.

[AuDDoc]

I can understand why PT did not want to pick up the patient. Recent seizure activity means the patient most likely was on falls precautions so not a go for PT. Was the PTA being a jerk? Yep. I can understand the being a jerk at times though. I've personally witnessed nurses pass off their normal tasks (ambulation of the patient, repositioning, feeding, toileting, etc.) to OT and PT. Life of an inpatient PT is basically the ortho docs throwing a gazillion consults at you that have to be seen ASAP before they are discharged to rehab houses or sent home. They need to be evaluated and then a plan of care written before they can leave the hospital. The PTA's are often running around like chickens with their heads cut off like many nurses are on the post op floors.

So yes the PTA was being a major jerk. I'm surprised the PT didn't put them in their place.

[MunoRN, RN]

Absence seizures are not considered a contraindication for activity. It's actually pretty rare for a patient to fall while having an absence seizure even while unassisted, if it occurs while working with PT then that's a pretty minimal risk and doesn't outweigh the established benefits of intensive PT/OT post stroke.

[Been there,done that, ASN, RN]

In the future, get a doctor's order to either hold or continue PT on any patient transferred from rehab.

[Libby1987]

You told the PT that the patient was fine for therapy without including the recent seizure activity and med adjustment?