Charles is a 78-year-old man with COPD, chronic renal failure, and depression who wants to remain independent in his home. He fatigues easily when performing self-care tasks like toileting, dressing, and shaving. His goals are to complete these tasks without fatigue and be able to visit his daughter upstairs. The OT will work on techniques to reduce fatigue like pursed lip breathing and use of adaptive equipment to help Charles meet his goals and maintain independence.

1. Lexi Amici

2. OT Profile
 Charles is a 78 year old African American male with a
primary diagnosis of chronic obstructive pulmonary
disease, or COPD, and a secondary diagnosis of
chronic renal failure and depression.
 Charles lives on the first floor of a two story house
with his wife, Bessie. His daughter, who he adores
seeing, lives on the second floor with her husband and
two children.
 Charles does not wish to enter a nursing home and
wants to stay as independent as he can.

3. Profile Continued
 Charles spends his day watching TV and reading
newspapers. Occasionally, a friend from his lodge
comes by for short visits.
 Charles does not have a good relationship with his
wife, but loves seeing his daughter and grandchildren.
However, he cannot make it up the stairs because he
does not have the endurance and the oxygen tubing
does not reach this far.

4. Background
 Charles was recently admitted into the hospital for his
chronic renal failure. Although physicians maintained
control of the disease, it has taken a toll on Charles.
Charles is now depressed due to his condition.
 His prior level of function was independent in all self
care tasks but slowly.
 Client is now receiving home health care 5 days a
week.

5. Assessment
 Charles has no sensory deficits except for wearing glasses
for vision. His judgment and memory is minorly impaired.
 Charles has AROM WFL but has very poor endurance
making any activity difficult to perform. Charles can
complete independent bed transfers.
 Client is easily fatigued when performing toileting and
dressing. For toileting, he cannot raise himself off the toilet
without assistance. He also cannot get his socks on.
 Charles is afraid of getting out of breath for any activity. His
goal is to be able to shower, shave, and dress without
fatigue. He really wishes to be able to see his daughter. He
is not currently doing any pursed lip breathing.

6. Long term Goals
 1. Client will perform lower body dressing under
supervision with the use of a sockaid in 4 weeks.
 2. Client will perform self care task of shaving with 2 or
fewer verbal cues while standing at sink and utlizing
position that reduces shortness of breath in 4 weeks
 3. Client will complete toileting modified independent
with us of a commode and proper sitting technique in
4 weeks.
 4. Client will perform pursed lip breathing technique
under supervision to increase endurance in all
activities and to ascend the stairs in 5 weeks.

7. Short term Goals
 1. Client will perform lower body dressing with min
assist utilizing a sock aid in 2 weeks.
 2. Client will perform self care task of shaving with 4-5
verbal cues while sitting at sink with proper technique
in 2 weeks.
 3. Client will perform toileting with 2-3 verbal cues
utilizing a commode in 2 weeks.
 4. Client will perform pursed lip breathing with 2-3
verbal cues to increase endurance and activity
tolerance in 2 weeks.

8. Interventions
 For Goal 1- Collaborate with client on use of sock aid to
help establish skill of donning and doffing socks.
Practice twice a day.
 For Goal 2- Client will be educated on sitting and
standing techniques that reduce shortness of breath.
Client will wash face using these techniques to prepare
for the complex task of shaving.
 For Goal 3-Client will complete 5 sit to stands on new
commode to increase UE strength and establish skill
of utilizing commode correctly while toileting.

9. Goals 4-Pursed lip breathing
technique
 Breathe in through your nose (as if you are smelling
something) for about 2 seconds.
 Pucker your lips like you're getting ready to blow out
candles on a birthday cake.
 Breathe out very slowly through pursed-lips, two to
three times as long as you breathed in.
 Repeat. (Kane 2016)

10. Downgrade/upgrade technique
 Upgrade- if client’s breathing seems great for the day,
only perform pursed lip breathing technique a few
times instead of more. This can also be performed
standing if at rest sitting it is too easy
 Downgrade- sit down, repeat technique as many
times as needed if you lose breath during an activity
 Client may feel weaker that day and the need to perform
more times appears

11. Outcomes
 I focused on that intervention and goal because proper
breathing is needed to complete any activity, not just
visit his daughter. Increased endurance can make
client independent as possible.
 Pursed lip breathing will increase activity tolerance
and overall breathing pathway for client. It improves
COPD symptoms.
 When Charles reaches the goal of ascending the stairs
to see his daughter, it will help with his depression as
well, as she makes him very happy.

12. References
 Kam, K.(2016). Breathing with COPD. WebMD.
Retrieved from
http://www.webmd.com/lung/copd/features/breat
hing-copd?page=2