Running Hours Total: 51 hours April 11: 12-4pm (Mother/Infant) I was unable to make it to my physical therapy shift this

week because of a family emergency, but I did, however, go to my Mother/Infant shift this Friday. On my shift, I assembled packets again for another couple hours and then I restocked the nursery linens and made more cribs for the newborns. We had some nurses in training come in and shadow the Cottage nurses on different procedures, so it was fun to connect with them and find out what they are learning. One student nurse got to draw a newborns blood for the first time and also print the babys feet on the birth certificate. I would have loved to be able to do that, but it was thrilling, nonethe-less, to watch a student similar in age to me perform these things. Also, on the job, I transported a mother and her newborn down to their car to go home. This was an enjoyable experience for me because I got to interact with both of the parents and ask them a bunch of questions. The mother showed me a book that her six-year old daughters first-grade class had made for her. Each student, including her daughter, had drawn a picture and written a piece of advice for how to care for a new baby. Some of the responses I read were hilarious and it was fun to joke and laugh with this mother as we waited for her husband to pull the car around. I enjoy these moments like this a lot because I am able to connect with the people I meet on a more genuine level.

i. Research one topic related to your internship and summarize here. Use this opportunity to add to your knowledge base.

Response: At the Cottage Hospitals Outpatient Physical Therapy Rehabilitation Facility, I have observed quite a number of patients with a condition called adhesive capsulitis, or frozen shoulder. In the last few weeks, I have shadowed a particular therapist that has four clients with this condition, so I thought it would be a great topic for me to research. According to the Mayo Clinic Health Letter, adhesive capsulitis happens when the shoulder capsule thickens and tightens around the shoulder joints (Mayo Clinic Health Letter, 2013, Vol. 31, Issue 8, p7-7). In my observation experience, this normally happens to people recovering from rotator cuff surgery. Three of the four patients with frozen shoulder that the therapist had were due to previous surgery, however, the fourth was a diabetic middle-aged man who had no record of surgery. The therapist I was shadowing said that she had had a couple of diabetic patients like this with frozen shoulder over the years, and upon her research, she found that there was a link between diabetes and adhesive capsulitis. Upon my own research on this topic, I found that it is true that people who have diabetes appear to be predisposed to develop frozen shoulder, but the cause of why this is the case is still unknown (Mayo Clinic, 2011). Adhesive capsulitis causes pain and significantly reduces shoulder range of motion, especially in shoulder flexion (Sandor, Rick, 2000). It typically has three stages in its progression: the Painful stage, the Frozen stage, and the Thawing stage. Stage 1; The freezing stage that may last six weeks to nine months. Pain develops. As it worsens, the shoulder loses motion. Stage2; The frozen stage may last four to nine months. Pain fades, but the stiffness remains. Stage 3; The thawing stage may last five to 26 months. Shoulder motion gradually returns toward normal (Hagen,

Patricia, 2008, p62-64). For some people, like the therapists diabetic patient, the pain worsens at night and can even disturb normal sleeping patterns (Mayo Clinic, 2011). The diabetic patient that I was observing seemed to be in Stage 3, or the Thawing stage because he was gaining significant improvements on range of motion every time he came back. Upon researching common treatments and therapies to combat frozen shoulder, I found that conservative health care professionals seem to recommend rest, analgesia (pain control) with the use of NSAIDs, and range of motion exercises (Sandor, Rick, 2000). The therapist I observed said that these methods are what she uses on all her patients. Sometimes, though, for extreme patients, she might recommend other therapies such as corticosteroid injections, capsular distention to stretch the joint, manipulation under anesthesia, or even surgical capsular release (Sandor, Rick, 2000). Apparently, treatment is a controversial topic because not all doctors believe a patient should rush into treatment (Hagen, Patricia, 2008). In terms of lifestyle for a patient with frozen shoulder, Mayo Clinic advocates for continued use of the shoulder and extremity in as many ADLs (activities of daily living) as possible (Mayo Clinic, 2011). This means that patients with adhesive capsulitis should keep living their normal lives within the limits of their pain and range-of-motion constraints. It is also encouraged highly that to prevent frozen shoulder, especially after surgery, the patient needs to increase their range of motion and stray away from immobility and the best way to do this is through physical therapy (Mayo Clinic, 2011). References

1. Frozen shoulder. (2013). Mayo Clinic Health Letter, 31(8), 7. 2. Hagen, Patricia. 2008. "Thawing Out Frozen Shoulder." Saturday Evening Post 280, no. 5: 62-64. 3. Mayo Clinic Staff. (2011). Frozen Shoulder. Retrieved from: http://www.mayoclinic.org/diseases-conditions/frozenshoulder/basics/definition/con-20022510. 4. Sandor, R. (2000). Adhesive capsulitis. Optimal treatment for 'frozen shoulder'. Physician & Sportsmedicine, 28(9), 23-29.