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All Biology seniors complete a capstone experience by doing independent research or an internship for a minimum of 8-10 hours/week throughout the senior year. The students who have internship placements keep a journal of their experience. Check out these sample journal entries for 2008!
Date: 2/8/08 (1 Session Than Strobes)
Hours on site: 10 Hours
Patient 1: She is an articulation patient. Her mom said that she is noticing less problem words and sees improvement. She has trouble with pronouns and mixing up his and he and hers and she. Used a book to perform conversational tasks. Sometimes /0/ or /d/ become /d/ and /g/ becomes /d/ (fronting) these two mix-ups are not concerning because of her age. Sometimes she eliminated /0/ or /d/, which is much more concerning because she is no longer marking a sound she does not have with another sound, but eliminating it all together.
Patient 2: She has been experiencing hoarseness, bronchitis, dismotility, and acid reflux (probably from osteoporosis medication). Strobe showed hyperfunctioning with a little loss of superficial lamina propia. It appears that the superficial lamina propia is receding causing vocal fold bowing.
Patient 3: She has been experiencing pitch breaks, shakiness in her voice, and voice cracks. When she talks it sounds like she is about to cry. She says nervousness makes her symptoms even worse. She has been experiencing these symptoms for a little over 20 years. Sometimes her head nods when she is trying to hold a pitch. Appears to be adducting spasmodic dysphonia with vocal tremor.
Patient 4: She experiences hoarseness which gets worse when she speaks often and she experiences a little pain when speaking over long periods of time. The strobe exam showed a large amount of mucous that keeps collecting in the same area. There is also premature contact caused by edema on the left vocal fold possibly pre-nodular swelling.
Patient 5: She is experiencing hoarseness thought it was because of bronchitis. She uses a steroid inhaler to control her asthma. Strobe exam showed fungal infection of laryngeal candidaisis. Her treatment will probably be Diflucam and re-strobe.
Patient 6: Voice therapy session. She thinks her voice sounded awful all week. She feels dry and thinks it might be the wrong time of the year to try to fix her voice because the air is so dry. She tried not to yell and scream but she talked over a lot of background noise when she went to watch the super bowl. She is using a steamer and drinking a lot of water and has gotten rid of alcohol, chocolate, and mint from her diet; however she still drinks 2 cups of coffee a day. She is taking protonix to help control her acid reflux. She hyperfunctions and has a gravelly voice which sometimes cracks. She has been using resonant voice therapy and the next step is taking the phrases and sentences that she has been practicing with and make them more conversational. She struggles to maintain air and breath control. She sometimes has hard glottal attacks.
Wrote the SOAP note for the last patient.
Fronting: When a sound that is supposed to be produces in the throat ends up being produced in the front of the mouth ex: /g/ becomes /d/ and /k/ becomes /t/
Dismotility: swallowing muscles broaden
The vocal fold is comprised of 3 layers: 1st, the superficial lamina propia (what vibrates), 2nd, the intermediate vocal ligament and 3rd, the deep vocal ligament.
Anterior commissure: where the two vocal folds meet (anterior)
Spasmotic Dysphonia: abduction: vocal folds are coming apart too much. Adduction: the vocal folds are coming together too much. The muscle spasms interrupt the flow of air causing pitchbreaks. It is neurogenic. Therapy is not effective but an effective treatment is Botox.
Muscle tension dysphonia: functional problem. Patient will have problem saying voice and unvoiced sounds (Spasmotic dysphonia only have problems with voiced sounds)
Hemorrhagic: blood filled (Happens with polyps)
Nodules: usually occur bilaterally
Cyst: appears to have a capsule around it
Reactive lesion: lesion that occurs because of another
Larangeal Candidaisis: happens a lot when mixing steroid inhalers and antibiotics. Tends to spread to the arytenoids cartilage and the false vocal folds.
Hard glottal attack: too much emphasis is put on the initial sound, which causes strain.
Look up voice disorders seen on the strobe.
Seeing the strobe exams is always helpful because I get to physically see what is causing the sound to be produced a certain way. With each strobe I see I get better and better at being able to tell by myself what is wrong and the name for what is wrong. This time I guessed before we talked about what the diagnosis was for each one, which helped me force myself to think critically about what I saw and what I heard.
Reading Understanding Voice Disorders (1 Hour)
Hours on site: 8 Hours
I was with T. again this week and we worked on the newsletters for an extended period of time. I have them and will try to attach a copy of the ones that I develop to this paper. I learned alot in their development. I am much excited to help the hospital as I produce these. T. told me that S. wants to include these in the employee paychecks each week for a series of weeks with the intention of helping to let the employees know about some important issues at the facility. I am very interested in getting my products to the employees and seeing what they think of them. Today I worked on the Ventilation Associated Pneumonia newsletter which was something S. recommended we work on as it has been a national issue lately as it is a very preventable disease. I will also write more about these issues in my paper and try to include a copy of my newsletters there.
This was pretty much all I did today as I was using the computer in an office away from T. when she went to see the patients. I hope to be able to see some of the patients the next time I am here. I enjoy working with them and seeing the clinical side of things as this is what I want to go into when I graduate Simmons whether it be Nursing or P.A.
VAP - Ventilator Associated Pneumonia is a sub-type of hospital-acquired pneumonia (HAP) which occurs in people who are on mechanical ventilation through an endotracheal or tracheostomy tube for at least 48 hours. VAP is a medical condition that results from infection which floods the small, air-filled sacs (alveoli) in the lung responsible for absorbing oxygen from the atmosphere. (Kollef, MH 2005."What is ventilator-associated pneumonia and why is it important?". Respir Care 50: 714-21; discussion 721-4)
I really enjoyed working on the newsletters and will share more about them next week.
Hours on site: 4 Hours
Current Events, Physical therapy
Questions- Does bilingualism delay the onset on dementia?
References to be accessed: bilingualism and dementia, vascular dementia
Today I met J. J is a polish immigrant who lived in Lawrence all his life. He sang me a few songs in polish and then would translate them line by line into English. My supervisor told me that a lot of studies show that people who are bilingual often delay their onset on dementia. I found this very interesting and a good reason to learn another language.
J seems to be as sharp as a tack, so I went to grab his chart to look. J is here only for dehydration, there is no past medical history. Dementia is listed as a symptom of dehydration.
Today in group C didn't get her hearing aids back from the nursing staff so I had to yell and repeat myself a million times. One of the other new patients E finds this ordeal quite amusing and can't help herself from bursting out laughing. When C answers wrong and says something unrelated to the topic, E laughs even harder.
My supervisor told me that C and her husband owned a hotel. With this in mind I tried to get her to tell the group. She denied this information. She agreed that she did work in a hotel and her job was to "be a lady"
My supervisor began to read the current events and we began to discuss the Filenes's basement wedding dress sale. C stated that she wore a red and blue wedding dress. I immediately noted this as wrong, but my supervisor pulled me aside to tell me that before WW2 they didn't wear wedding gowns because no one could afford them. I guess you have to be very careful what you write off as confused statements.
C left in the middle of the group to go for an MRI. She does have delirium secondary to previous surgery. Antibiotics have not helped improve her mental status. It was confirmed later in the day that C has vascular dementia. The changes in her brain lie in the frontal lobe, which gives her an intact personality. She is prone to the same outbursts and changes that Phineas Gage experienced.