Thursday, November 08, 2012

Keeping Life at a 3

"Ambulation" is the medical term for walking.  After surgery, it is important to ambulate at least once on the day of surgery (usually) and then 3-4 times a day every day after that.    If you don't walk, your cells won't get the oxygen they need for healing; your lungs won't be expanding all the way, so fluid could collect in the bases causing pneumonia; and the blood could pool in your legs, giving you a blood clot that could break off and give you a heart attack or stroke; and your bowels won't "wake up" fast enough, possibly giving you an ileus. Ambulating patients drives most of what I do as a nurse.  I need to keep you rested, pain-medicated, cleaned up, and happy enough to get those walks in.

I try to keep my patients at a "3" on a 0-to-10 pain scale.  No pain is unrealistic because 1. you just had surgery and 2. if I give you enough pain medication to erase your pain, you will also stop breathing.  But a 3 you can work through and get your walk in.

Last night, I was reading my first How-To parenting book: Smart But Scattered.  It's all about "executive skills" and how to teach them to your child.  Executive skills are skills needed to execute tasks and be successful.  Lillian has problems with sustained attention, task initiation, and time management.  (I don't know where she got that from: my assessment said my weaknesses were in sustained attention, organization, and time management.)

Anyway, one of the Principles for Improving Executive Skills is to "Modify tasks to match your child's capacity to exert effort."  The authors suggest modifying tasks so that they feel like a "3" on a 1-to-10 effort scale.  This can be accomplished by breaking down the task into smaller pieces (clean just this room, instead of the whole house), decreasing the time spent on the task (clean for 5 minutes instead of 20), or increasing the reward so the task feels like less work.

I've been trying to force Lillian to sit for 3 hours and get all her homework done (because she doesn't do her work in school, we get to do school work AND homework), when for her, that feels like a 10 on the effort scale.  This is why it's not working.  Duh, Amanda!  This is why she flops around and can't concentrate and "forgets" how to do math even though we just went over it 10 times! I don't make my patients ambulate when they have a 10 on the pain scale... I give them morphine and then come back in 30 minutes.

I'm only about 100 pages into the book, so I don't know all the tips and tricks, but I'll keep you posted on how we do.

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