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OAS Case Study: Mrs. K


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OAS Case Study: Mrs. K

  2. 2. WHO is MRS. K?• 63 y/o woman.• Married• Lives with husband• Works part time (clerical work) & babysits grandchildren.• Independent w/self-care & work tasks.• Enjoys: gardening, knitting, quilting.• Used to attend weekly luncheons w/her friends.
  3. 3. Nature ofREFERRAL Arthritis Insulin-dependent OT evaluation for diabetes tx, pain at R thumb OCD Relevant Medical HISTORY
  4. 4. OT  EVALUATION• Pain Scale • Reported 9/10 initial evaluation• ROM • Bilateral shoulder/elbow ROM are WNL• Grip/Pinch Strength • Weak hand grasp, especially in pinches • Instability of CMC & MCP, limited R thumb opposition
  5. 5. OT  Evalua)on  Ccontinued OT   EVALUATION ont.• Sensory Assessments (Pin Stick & Temperature) • Impaired sensation for light touch, sharp/ dull, hot/cold in both hands• Arthritic Deformities • Multiple swan neck: L hand digits 2 & 4, R hand digits 3-5 • Multiple RA nodules on both hands
  6. 6. Func)onal  Problems Functional  PROBLEMS1 Pt. is always tired & depressed2 Unable to bathe & perform self-groom tasks3 Unable to carry out household chores4 Difficulty preparing meals5 No longer attends weekly luncheon with her friends
  7. 7. Long-Term  GGoal  #1 Long  Term   OAL #1Client will be independent with all hygiene/self-care activities in own home, using A/Eand energy conservation strategies with afatigue level of 5 or less in 4 weeks toincrease functional independence anddecrease fatigue.
  8. 8. Short-term  GOAL 1a Short  Term  Goal   1aClient will tolerate 20 minutes of ADLactivity, taking 2-minute breaks every 10minutes with 0/10 pain in R and L upperextremities during rest and activity, 3x/weekfor 3 weeks.
  9. 9. Short-term  GOAL 1b Short  Term  Goal   1bClient will demonstrate independence withbrushing hair and teeth using built-uphandles on her hairbrush and toothbrush tocompensate for weakened grasp aftereducation for five minutes, 2x/week for 2weeks.
  10. 10. Long-term  GOAL #2 Long  Term  Goal   #2Client will be able to independently self-feedfor 15 minutes, using built-up utensils,compensatory movements, and UE jointprotection strategies without VCs 1x/weekfor 4 weeks to increase functionalindependence.
  11. 11. Short-term  GOAL 2a Short  Term  Goal  2aClient will independently self-feed usingbuilt-up utensils for 10 minutes afterinstruction 1x/week for 2 weeks to increasefunctional independence.
  12. 12. Short-term  GOAL 2b Short  Term  Goal  2bClient will tolerate 10 minutes of wrist andhand exercises to increase strength, ROM,and endurance, which will improve feedingand other ADLs, 3x/week for 3 weeks.
  13. 13. OT  Treatment  Plan OT  TREATMENT PLAN• Educate client: • Energy conservation & ECWS techniques • Fall risk & prevention strategies • Joint protection • Stress management & relaxation techniques
  14. 14. OT  Treatment  Plan OT  TREATMENT PLAN continued• ADL/IADL training • A/E to improve grasp & compensate for muscle atrophy • Pain management techniques • Train in safe/efficient transfers
  15. 15. OT  Treatment  Plan OT  TREATMENT PLAN continued• Splints: • Rest/working hand splint • Wrist cock-up • Finger splint • Ulnar deviation splint • Tri-point splint • Thumb Spica
  16. 16. Frames  of  References Frames of  REFERENCEMOHO Understanding her habits according to her roles. Looking at her volition to make her more self-sufficient in her daily tasks.PEO Changing the environment to create a greater fit w/the client & occupation to improve occupational performance.EHP Establish/restore intervention addresses inability to self- feed. Adapting/modifying the above task addressed by adding built up handles. Prevent/create intervention will be addressed by the home exercise program.
  17. 17. the  ACTIVITYClient will work on multi-step food preparation in own kitchen by participating in graded cooking tasks to improve safety and independence in meal preparation. Client will prepare dinner for two (her and her husband) using pre-prepared meals. Client will prepare dinner for two using pre-cut vegetables and meat. Client will prepare dinner for two with only one pre-prepared item, utilizing A/E (e.g. rocking knife) to cut vegetables. 17
  18. 18. Home  Program Home  PROGRAM• Practice energy conservation, work simplification, & safety techniques• Wear working splints during day activities & resting splint at night.• Use built up padding for tools during ADL’s.
  19. 19. Discharge  Summary Discharge  SUMMARYClient achieved all long & short term goals.Pain reduced from 9/10 to 2/10 &occasionally 7/10.Fatigue level decreased from 10/10 to 5/10.Grip strength improved from 42lbs to 50lbson the R hand and 50lbs to 51lbs on L hand.
  20. 20. THE END 20