PTA 230 Clinical Applications Across the Lifespan. Cardiopulmonary Stent Placement

Transcription

1 PTA 230 Clinical Applications Across the Lifespan Content & Format Case studies will be presented by groups of five people. Groups and clinical cases will be randomly assigned. Please carefully read the patient case study and respond to all questions as thoroughly as possible. Though it is important to be succinct in your writing, beware not to exclude any important details. Be sure to include a rationale for your answers where it is asked. You should work together as a group. Many of the questions have several possible correct answers. Sometimes a correct answer is not readily apparent. Use your best judgment, and openly discuss all ideas and options before deciding on a response. For every answer you give, you should always ask yourselves Why is this the best answer? You will submit your answers on a separate sheet of paper. Answers will be typed, double-spaced, with a minimum of 11 point type. Selected groups will present their patient to the class each week. A class discussion will follow. The presenting group can compare their ideas and answers with those of the class. HOMEWORK ASSIGNMENT: Entire class will be required to answer questions pertaining to the presentation. In order receive full credit for the homework assignment, questions will need to be answered accurately, thoroughly, and provide a rationale for the answer. Grading Each case study is graded on a 150 point scale. Format 25 All format criteria are followed according to established guidelines 20 Most format criteria are followed according to established guidelines 15 Some format criteria are followed according to established guidelines 10 Few format criteria are followed according to established guidelines 5 Little to no format criteria are followed according to established guidelines

2 Focus and Purpose of Narrative 25 Well developed and clear, relevant statements that engage the reader 20 Well developed ideas in narrative 15 Mostly good ideas, but expression is weak 10 Mostly simplistic, unfocused ideas. Little or no sense of overall purpose 5 Ideas are extremely simplistic, showing signs of confusion and lack of purpose Writing Mechanics 25 Virtually free of punctuation, grammatical and spelling errors. Formatting is appropriate 20 Occasional punctuation, grammatical, spelling, and/or formatting errors 15 Contains a moderate amount of punctuation, grammatical, spelling, and/or formatting errors 10 Contains several punctuation, grammatical, spelling, and/or formatting errors 5 Contains serious errors in punctuation, grammar, spelling, and/or formatting Response to Questions 25 Answers all questions accurately and thoroughly. Provides a rationale for answers, when requested 20 Answers all questions thoroughly, though accuracy and/or rationale may contain some errors 15 Answers all questions. Responses are not thorough. Contains a moderate amount of errors or misjudgments 10 Does not answer all questions and is not thorough or accurate. 5 Minimal effort in responses. Contains significant errors or misjudgments

3 Homework Assignment - Summary of Presentation 50 Answers questions accurately and thoroughly. Provides a rationale for answers, when requested 40 Answers questions thoroughly, though accuracy and/or rationale may contain some errors 20 Answers questions. Responses are not thorough. Contains a moderate amount of errors or misjudgments 30 Does not answer all questions and is not thorough or accurate 10 Minimal effort in responses. Contains significant errors or misjudgments Total Points: /150

4 Patient Scenario Your patient is a 56 year old unemployed male admitted for chest pain. An angiogram revealed 85% blockage of the left circumflex coronary artery. He had a small stent implanted in the artery two days ago. The patient is in a regular room in the surgical unit. The patient has a 34 year pack/day smoking history. Subjective Report Patient reports feeling tired most of the time prior to being admitted to the hospital. He complains of mild discomfort around the incision site, but is otherwise without complaint of pain. Patient notes SOB with getting up to use the bathroom. Patient has been otherwise lying in bed for two days. Patient s plan is to return home where he lives with his wife. Patient s home is a single level home with four steps up to front door. Objective findings Observation: Pt. is morbidly obese. He is lying in bed in a semi-reclined position and appears alert and oriented Pulse = 115; Regular rhythm BP = 162/94 Temperature = F SaO 2 = 92%, room air Respiration: 20; Shallow; Breath sounds are diminished; Occasional weak, non-productive cough Baseline Dyspnea Index: Functional Impairment: Grade 1 Magnitude of Task: Grade 3 Magnitude of Effort: Grade 2 Transfers & Bed Mobility Sit to stand, MIN A Supine to si, MOD A Ambulation Pt. ambulates 20 feet with a FWW walker for balance, CGA Pt. experiences SOB after walking for 20 feet Pt. s BP measures 138/89 after walking 20 feet Pt. s HR measures 105 after walking 20 feet Pt. s RPE after walking 50 ft. is 13 (Borg RPE Scale) Neurologic Screening Cranial nerves are intact Peripheral sensation is intact to light touch DTR s are symmetric B UE, LE and trunk muscle tone is normal

5 MMT Shoulder flex = 4/5 B Shoulder abduction = 4/5 B Biceps = 4-/5 B Triceps = 4/5 L, 4+/5 R Wrist flex/ext = 4/5 B Hip flexors = 4-/5 B Quadriceps = 4-/5 B Hamstrings = 4/5 B Ankle DF = 4/5 B Assessment Pt. is two days s/p implantation of coronary stent. Pt. presents with morbid obesity. He exhibits poor pulmonary function and poor endurance. Safety is compromised due to poor endurance and balance. STG: Pt. will ambulate 75 feet with a quad cane SBA within 3 days STG: Pt. will transfer supine to sit, MIN A STG: Pt. wil transfer sit to stand, SBA LTG: Pt will transfer supine to sit, SUPV LTG: Pt will ambulate 100 ft with with quad cane, SUPV LTG: Pt. will climb four steps with handrail in order to enter home with or without the use of an assistive device, SUPV Plan of Care 1. Gait training 2. Endurance training 3. Breathing and coughing exercises to improve pulmonary function 4. UE and LE resisted exercises 5. Balance training 6. Training with the use of a walker, progressing to a quad cane 7. Bed mobility exercises

6 Precautions Monitor HR, BP, and RPE during activity Please answer the following questions regarding this patient: 1. Describe two exercises you could have the patient perform in bed to prepare for bed mobility activities. Provide a rationale for the exercises you have chosen. 2. Describe the gait training activities you would perform on the first treatment with the patient. Outline periods of activity and rest while you gait train with this patient. Keep in mind the patient s STG and LTG as you devise your treatment. Provide a rationale for the gait training activities you have chosen. 3. How would you determine periods of activity and rest for this patient during gait training activities? 4. What two interventions could you provide to this patient to assist with his pulmonary function? Provide a rationale for the interventions you have chosen. On the second day gait training with this patient, he appears to have greater difficulty walking. You measure his HR, which is 130 BPM. You measure his BP, which is 172/88; his RPE is What is your course of action based upon these measurements? 6. Which, if any, of the above measurements preclude the patient from engaging in physical activity? The patient has been treated by the physical therapy staff in his room and on the surgical floor twice a day for three days. The patient is now able to come to sitting MIN A, but has difficulty rolling to his side. He is able to walk 75 feet with a FWW, SBA. The patient states that he feels his balance has improved, and that he would like to try walking with the quad cane. Both the supervising physical therapist and you agree that this is an appropriate progression. 7. Describe one exercise that will help this patient to roll more easily to his side in bed. This should be a different exercise than what you had previously shown the patient. Provide a rationale for the exercise you have chosen. 8. While walking with the quad cane, the patient tenses up, and requires MIN A for balance. What is your course of action? The patient has been in the hospital for six days, and the attending physician is looking to discharge him. The patient is now able to walk 75 feet with a quad cane over level ground, SBA. Following gait training, his last measured HR was 104, and his BP was 142/88. His RPE was 12. He is able to step up onto one step while holding a hand railing, SBA. He experiences a minor LOB with trying to climb more than one step.

7 9. What factor(s) do you feel are preventing the patient from achieving his LTG? Provide a rationale for your answer. 10. What additional treatment interventions might you recommend to the supervising physical therapist so that this patient might achieve his LTG? 11. In your opinion, should the patient be discharged from physical therapy if he hasn t yet achieved his LTG? Provide a rationale for your answer. The patient is about to be discharged from the hospital. He has met his STG but not his LTG. The supervising physical therapist asks you to speak at the team meeting regarding this patient. 12. What suggestions do you have for this patient as regarding discharge location, so that he might be more independent?