Question

E was playing bridge with their friends, when they experienced SOB and tightness in their back. The friends called EMT and E was admitted to the hospital. A CABG was conducted soon after arrival. At discharge, E would like to return to their prior activities and apartment in the independent senior living community.

Prior level of function ( PLOF):

El is a 82 year old person that lives in a senior community which provides multiple levels of care. The patient lives by themself in a one-bedroom apartment. The apartment has a bathroom with tub seat and grab bars. These are the only modifications in the apartment. The community provides breakfast and dinner daily in a community dining room, as well as assists with cleaning tasks. The patient must be able to get themself to and from the dining room upon return to apartments. The dining room is 1000 feet away from the patient’s apartment. E was independent with all B ADL and I ADL tasks. E did not use AD for functional mobility prior. They worked part-time as a piano teacher and volunteered as a ‘Reading Grandparent at a local Head Start Preschool.

Utilize universal precautions at all times

Precautions: Sternal, O2 at 3 L at all times

PMH: HTN, elective hysterectomy 2010, smoked 1 pack/day until cessation in 1995, COPD

Current Level of Function (CLOF):  

ADL & Functional mobility

Feeding - independent (GG 6)

Grooming - independent (GG 6)

UE Dressing - Mod A (GG 3)

LE dressing - Mod A (GG 3)

Bathing - S (GG 4)

Transfers - S (GG 4)

PT has provided a rollator for mobility

Activity tolerance:

Poor with 3 L of O2

Balance:

Sitting balance - 3+ on KU

Standing balance - 3+ on KU

Cognition:

OT has assessed the patient using the Allen lacing test - score of 4.8

Assessments week 1 = ADL (LB dressing with pants) & transfer (wc to bed with rollator)

Assessments week 2 = BORG during ADL task (get clothing out of closet and put on sweatshirt) & Pain scale

Assessments week 3 = tub transfer (wc to tub with rollator)

• 1. Assessment & Intervention

     1. Which areas of occupation could be impacted?

     2. List reasons why (ie what assessments led you to these reasons?)

     3. Which areas would you/should the OT practitioner address in the setting from the case study (focus of intervention varies by setting & diagnosis)

• 2. Intervention & Implementation (Activity Analysis/Grading Activity)

     1. Which client factors could impact participation in occupation? How or why?

     2. Which performance factors could impact participation in occupation? How or why?

     3. Which performance patterns could impact participation in occupation? How or why?

     4. Which context or environments could impact participation in occupation? How or why?

3. Review the educational material or manual for the assessments that you will give week one. Then, answer the following questions:

• 3. What areas do these assessments assess?

  4. Who is qualified to administer these assessments

  5. What is the age range that these assessments can be utilized with?

  6. How long does it take to administer?

  7. What kind of scores does it provide?

Answer 1

Greetings of the day!

Answer:

Which areas of occupation could be impacted?

• can't stand or sit in the same spot for too long. Move around a little bit.
• can walk but slowly.
• Climbing stairs with resting halfway up the stairs if needed.
• Light household chores, such as setting the table, folding clothes, walking, and climbing stairs can be done.
• Slowly increase the amount and intensity of your activities over the first 3 months.
• can't exercise outside when it is too cold or too hot.
• Stop if you feel short of breath, dizzy, or any pain in your chest. DO NOT do any activity or exercise that causes pulling or pain across your chest, such as using a rowing machine or weight lifting.
• Keep your incision areas protected from the sun to avoid sunburn.
• can't drive for at least 4 to 6 weeks after your surgery. The twisting involved in turning the steering wheel may pull on the incision.
• can't travel for at least 2 to 4 weeks. Ask your provider when travel is OK. Also ask your provider before starting sexual activity again. Most of the time it is OK after 4 weeks.

List reasons why (ie what assessments led you to these reasons?)

Assessments week 1 = ADL (LB dressing with pants) & transfer (wc to bed with rollator)

UE Dressing - Mod A (GG 3)

LE dressing - Mod A (GG 3)

Grooming - independent (GG 6)

Assessments week 2 = BORG during ADL task (get clothing out of closet and put on sweatshirt) & Pain scale

ADL & Functional mobility

Feeding - independent (GG 6)

Pain scale

Assessments week 3 = tub transfer (wc to tub with rollator)

Bathing - S (GG 4)

Transfers - S (GG 4)

PT has provided a rollator for mobility

Poor with 3 L of O2

Sitting balance - 3+ on KU

Standing balance - 3+ on KU

Which areas would you/should the OT practitioner address in the setting from the case study (focus of intervention varies by setting & diagnosis) Intervention & Implementation (Activity Analysis/Grading Activity)

Occupational Therapists (OT’s) are experts in “functional cognition”, or in other words, how a person’s thinking skills affects their performance in daily tasks.

Current Level of Function (CLOF):  

ADL & Functional mobility

Cognition:

OT has assessed the patient using the Allen lacing test - score of 4.8