TREATMENT PLAN FOR MR' JESSE

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ADULT REHABILITATION
TREATMENT PLAN FOR MR. JESSE
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DIAGNOSIS

• RIGHT CVA WITH LEFT HEMIPARESIS (WEAKNESS ON THE
  LEFT SIDE OF THE BODY.)
• FEMORAL NECK FRACTURE (BIPOLAR ARTHROPLASTY OF
  THE LEFT HIP.)
• HISTORY OF DVT (DEEP VENOUS THROMBOSIS.)
• END-STAGE RENAL DISEASE.

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PROBLEM LIST

• DECREASED ACTIVE RANGE OF MOTION ON THE LEFT
  UPPER EXTREMITY.
• DECREASED MUSCLE STRENGTH.
• DEPENDENT WITH LOWER EXTREMITY DRESSING.
• UNABLE TO TRANSFER SAFELY (E.G., FROM BED TO
  WHEELCHAIR/ WHEELCHAIR TO TOILET.)

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Mr. Jesses goals will focus in the area of
self-care .
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Long Term Goal (LTG)-Increase active range of
motion and muscle strength of the affected
extremity.

• Short Term Goal (STG) 1 Mr. Jesse will
  increase active range of motion of left shoulder
  flexion and abduction to 90.
• (STG) 2- Client will increase muscle strength of
  the left shoulder to F.
• Functional Outcome- With increased range of
  motion and muscle strength, client will be able
  to perform self-care activities or tasks such as
  dressing and transfers.

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Cont
Rationale- Mr. Jesse will sand and assemble a
simple wood working project while using a
bilateral sander on an inclined plane. The
activity can be graded by adding weights on the
sanding box or by having the client wear a 3 lb.
wrist weight to improve muscle strength. The
client will work on the project for 15 minutes a
day and gradually increase the duration of the
task. Changes in clients position or sanding
direction will facilitate shoulder movements
necessary to carry out tasks of everyday living.
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DRESSING

• LTG- TO PERFORM LOWER BODY DRESSING
  INDEPENDENTLY.
• STG 1 - Client will doff lower body clothing
  independently with the aid of an adaptive device
  while following safety precautions by a week.
• STG 2- Client will don lower body garments
  independently with the aid of an adaptive device
  while following safety precautions by two weeks.

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Dressing

• RATIONALE- The client will use a dressing stick,
  sock aid and a reacher to don and doff lower body
  clothing while following hip precautions.
  Assistive devices will allow the client to
  independently perform lower body dressing while
  reducing the risk of injury.
• ASSISTIVE DEVICES- Hip Kit which includes a
  reacher, shoe horn, sock aid, and dressing stick.

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Dressing precautions and modifications

• Patient should be seated in a chair with arms or
  on the edge of bed.
• Crossing the operated leg over the non-operated
  leg at the knees or ankles should be avoided.

• A reacher or dressing stick should be used for
  pants or shoes.
• When putting on pants, the operated leg is
  dressed first by using the reacher or dressing
  stick to bring pants over the foot and up to the
  knee.

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Dressing( Continued)

• A sock aid may be used to put on socks, while a
  reacher or dressing stick is used to remove them.
• A long-handled shoe horn may be used to put shoes
  on while limiting hip flexion motion.
• Button hook with zipper aid may be used for
  limited range of motion and finger coordination.

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TRANSFER AND MOBILTY
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LTG Resident will independently and safely
ambulate and transfer.

• STG 1- Client will use proper positioning in
  order to safely transfer from bed to wheelchair
  with the use of an assistive device by two weeks.
• STG 2- With the use of transfer techniques,
  client will independently ambulate and transfer
  from bed to wheelchair without the use of an
  assistive device by a month.

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Cont

• Rationale- The goal of the transfer is for the
  person to do the activity safely and
  independently. As Mr. Jesse grows stronger, he
  will require less assistance and will eventually
  be able to ambulate independently. The ability to
  transfer will allow the client to perform
  activities of daily living.

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Positioning
The surfaces for transferring should be
non-movable, firm and well supported and of
similar heights. When transferring from a
wheelchair, the wheelchair should be locked,
should be in a position that allows the client to
use the better side and the footrest should be
out of the way. During transfer from a bed to a
wheelchair, it is often advantageous to position
the wheelchair at a slight angle to the bed, so
that the wheel is not in the way of the
transfer.  It is better if the bed is a little
higher than the wheelchair - to allow for a
downward transfer.  The most common procedure is
for the patient to sit on the edge of the bed and
then slide across to the wheelchair on the
Sliding Board .
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Deep Venous Thrombosis(DVT) Symptoms and
Prevention
Health Management

• leg pain in one leg only
• leg tenderness in one leg only
• swelling (edema) of only one leg
• increased warmth of one leg
• changes in skin color of one leg, redness
• Prevention perform simple exercises during long
  car rides or airplane flightswear elastic
  stockings.

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HOME MODIFICATION
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Bathroom

• Shower Stall Place Non-skid strips or stickers
  in shower stalls or tubs.
• A shower chair with adjustable legs may be
  installed

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Bathroom (cont)

• Patient stands parallel to tub facing shower
  fixtures and using walker or crutches,steps into
  shower sideways while bending at knees not hips.
• Long handled bath sponge may be used to wash legs
  and feet, while a towel wrapped on a reacher may
  be used to dry the legs and feet.

• A tub bench may be used if balance is an issue or
  weight- bearing is to be avoided.

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Bathroom (cont)

• Grab bars should be screwed directly into wall
  studs on either side of the toilet and in the
  bathing area.

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Kitchen

• Adaptive one-handed cutting board,one-handed
  electric can opener,jar openers, and built-up
  handle utensils may be used to compensate for
  limited joint range of motion and muscle
  strength.
• Items in refrigerator and cabinet should be
  arranged so that they are in the most accessible
  place.

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Remember that because of the Fair
Housing Act, it is illegal for a landlord to
outright refuse to make reasonable
accommodations. The tenant pays for these
accommodations. When tenants move out, they must
restore the dwelling to its original condition,
if the landlord desires. Sometimes a landlord
will pay for part of the accommodations because
accessibility features enhance the dwelling. Grab
bars or levered door handles will make a unit
potentially more marketable to more people, such
as elderly tenants or tenants with limited
mobility. The landlord and tenant should be able
to work out the modifications amicably.
Home Modification
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Home Modification
For more information on the Fair Housing Act and
Amendments of 1988, see the U.S. Department of
Housing and Urban Development (HUD) Web site
http//www.hud.gov80/sec8.htmla. HUD also
offers a "Disability" resources page loaded with
helpful information http//www.hud.gov80/disable
d.html
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Support groups for stroke survivors and their
families

• Glen Cove Hospital 3rd Tuesday of every month
  from 2-300pm
• LIJ Medical Center 2nd Tuesday of every month
  from 1-300pm
• North Shore University Hospital every Friday
  from 10-130pm

• Glen Cove Hospital 516 674 7895
• Long Island Jewish Medical Center(LIJ) 718
  470-7706
• North Shore University 516 562-4947

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Renal Disease Support

• National Kidney Foundation30 East 33rd St.,
  Suite 1100New York, NY 10016(800)
  622-9010(212) 889-2210www.kidney.org

• Patient Family Council
• Goals
• Education -- to educate and empower patients and
  families to make informed decisions about the
  quality of care they or their loved ones receive
  http//www.kidney.org/patients/pfc/pfform.cfm

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PRESENTED BY RACHEL DECRESCENZO RACHEL BIANCA
MALLARI