CASE STUDY S F Level II Fieldwork Baptist

CASE STUDY : S. F. Level II Fieldwork: Baptist Memorial Hospital

BACKGROUND Name: S. F. Sex: Female Age: 80 y/o Reason for Admit: o Pneumonia o SOB for one month o Recent fall PMHx: A-fib, breast cancer, CHF, COPD, RA, emphysema, B pleural effusion

PRIOR LEVEL OF FUNCTION Living Environment: o Assisted Living Facility (Independent side), lives alone o 3 rd floor (uses elevator) o Walk-in shower with grab bars and a shower bench o Pt uses RW, WC, electric scooter, and O 2. Uses RW the most. ADLs: I/mod I with all ADLs

EVALUATION AROM: WFL Strength: 4/5 I Evaluation Goals Transfer to toilet/tub/WC : SBA, Mod Static sit balance: good- Bathing: SBA , Mod I Dynamic sit balance: fair + Dressing: SBA, Mod I Standing static/dynamic : Fair Toileting: SBA, Mod I Bed mobility: CGA/Min A Sit to stand: CGA with HHA Assist needed with ADLs: Min/Mod A Sitting EOB ADL: 10 min, 20 min

PROGRESSION 11/2 11/6 11/7 11/9 11/14 Sit balance: good- Decline in respiratory status, RN hold Sit balance: good- Dynamic balance: fair/fair- Dynamic stand: did not stand Dynamic stand: fair- Dynamic stand: poor Supine to sit : Min A Supine to sit: Min A Sit to supine: Mod A Grooming: Min A Grooming: CGA Sit to stand: Min A, stood 5 sec Transfer to BSC: Max x 2 Toileting: Mod A UB bathing: set-up 2 x 10 large circles Toileting: Max A Ther. Act: 3 x 5 shoulder raises, midline punches 2 x 10 cross midline punches 2 x 5 shoulder raises Respiratory status: Unable to stand, fair Respiratory status: Increased RB’s, 4 L Respiratory status: Pt with C-diff, decreased Respiratory status: 4 BNC

CHALLENGES Decreased respiratory status with movement Constant oxygen monitoring Increased RB’s to recover to 90’s Hard to keep medically stable when sitting up in chair Anxious with movement Constant reinforcement that oxygen is within limits >75 Encouragement needed to sit EOB, increased agitation when pushed to do more Limited motivation to do activities, due to the discomfort of being SOB Can lead to depression

BENEFICIAL INTERVENTIONS Pursed-lip breathing exercises and techniques Start by practicing technique at rest Practice in sitting while playing a board game or activity with limited movement Upper extremity activity, such as donning a shirt or brushing hair Standing static activity Brushing teeth at sink, putting on make-up, etc, . Dynamic standing activity IADLs, such as cooking or cleaning the house

BENEFICIAL INTERVENTIONS Upper Extremity Strengthening Pt’s with COPD often use accessory muscles of the shoulder girdle to help them breath Using these muscles make it harder to engage in unsupported UE activities UE strengthening by theraband, free weights, etc will: Increase capacity and endurance to perform ADLs Reducing oxygen requirement of UE activity Overall improve quality of life due to participating in ADLs more easily

BENEFICIAL INTERVENTIONS Modifying the task or environment to fit needs Schedule activities that require more energy expenditure early in the day Schedule activities right after bronchodilator use to decrease SOB/fatigue Support arms during UE activities, such as combing hair, brushing teeth, etc. Using adaptive equipment or DME if needed Shower chair in the bathroom Reacher, sock aide, and shoe horn to donn/doff clothing Stress Management Visualization relaxation technique Well-practiced plan of action if they have a panic attack, so they feel like they have some control Pursed lip-breathing

INTERVENTIONS IN ACUTE CARE Educate client on breathing techniques Have them demonstrate at rest and with activity UE strengthening Theraband exercises Seated UE aerobic exercise, while using breathing technique ADL’s with using a modified technique Seated grooming, bathing, and dressing Supporting UE’s while performing activity Teaching them how to use AE if needed

RECOMMENDATIONS FOR DISCHARGE Discharge to assisted living facility Utilize energy conservation techniques Use WC on days when feeling SOB Shower in a seated position and use AE when needed Use BSC at night or as needed for energy conservation Continue to be social and participate in activities offered

LEARNED EXPERIENCE With pts who are in respiratory distress you must… Keep oxygen line connected at all times and monitor closely Slightest change of position cause decrease in sats The pt usually knows their own tolerance, going above that can cause panic/anxiety When performing transfers pt’s can become dizzy and very SOB Rest breaks are needed frequently Make sure the pt utilizes correct breathing techniques, when SOB it is easy to start hyperventilating

REFERENCES Radomski, M. and Trombly, C. (2014). Occupational Therapy for Physical Dysfunction. Philadelphia: Wolters Kluwer Health; Lippincott Williams &Williams.