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COMPLEX CASE
36 yr old Female, Inpatient Rehab
HIV/AIDS, Generalized…
COMPLEX CASE
36 yr old Female, Inpatient Rehab
HIV/AIDS, Generalized Weakness, Pneumonia, Chronic Liver Failure, & Neuropathy
COMPLEX DIAGNOSIS
HIV/AIDS
- 1.1 million people diagnosed with HIV in the U.S, in 2015 (CDC, 2018)
- 38,500 new HIV cases reported in the U.S, in 2015 (CDC, 2018)
- Symptoms consists of: fever, chills, muscle aches, soreness in throat, swollen lymph nodes, pain in joints, night sweats, fatigue, weakness and tiredness, and weight loss (Times of India, 2017).
- Prognosis consists of three phases, they are called Acute infection, Asymptomatic HIV and AIDS, and Late stage HIV (Times of India, 2017).
- Acute phase includes influenza-like symptoms which last for 2 - 6 weeks. Asymptomatic HIV and AIDS present with no symptoms after the acute phase, for many years. During this phase, the body's immune system keeps getting damaged by the HIV strain and attacks the organs (Times of India, 2017).
- The Late stage of HIV is the most severe phase of the infection with T cell count below 200 cells and multiple diseases occur in relation to this stage of HIV (Times of India, 2017).
GENERALIZED WEAKNESS
- The prevalence of reduced muscle strength increases with age while the prevalence of normal muscle strength decreases with age (CDC, 2015).
- Generalized weakness and fatigue occur as an underlying symptom of other conditions which require medical treatment (Mayo Clinic, 2018).
PNEUMONIA
- Number of deaths reported in 2015 is 51,811 (CDC, 2017)
- Symptoms consist of: chest pain during breathing or coughing, confusion or changes in mental awareness, fever, fatigue, sweating and shaking chills, nausea, vomiting, and shortness of breath (Mayo Clinic, 2018).
CHRONIC LIVER FAILURE
- Number of adults diagnosed with liver disease: 3.9 million (CDC, 2016).
- Number of deaths: 40,326 (CDC, 2016).
- Symptoms consist of: Jaundice, abdominal pain and swelling, itchy skin, dark urine color, swelling in the legs and ankles, chronic fatigue, loss of appetite, nausea, vomiting, and tendency to bruise easily (Mayo Clinic, 2018).
NEUROPATHY
- Symptoms consist of: gradual onset of numbness, prickling or tingling in the feet or hands. Extreme sensitivity to touch, lack of coordination and falling, muscle weakness (Mayo Clinic, 2017).
- Prognosis varies, if symptoms are treated neuropathy will improve with medication management, if not treated, it will worsen over time (Mayo Clinic, 2017).
OT EVALUATION/ASSESSMENT
COPM
- This assessment is suitable for our client because it will help built patient therapist rapport and also keep it client centered to understand what her goals are and to help improve her occupational performance while be treated for her medical conditions.
- The COPM helps identify and prioritize patient-specific occupational problems and evaluate changes in these problems. It is a feasible and helpful clinical assessment within the therapeutic process (Nieuwenhuizen, de Groot, Janssen, Maas, & Beckerman, 2014).
Semmes-Weinstein Assessment
- This assessment is appropriate for our client to test for sensation in her hands and feet as she suffers from neuropathy in her legs.
- Research states the Semmes - Weinstein is a noninvasive, low cost, rapid, and easy to apply test often used in clinical testing and routine to detect neuropathy (Feng, Schlosser, & Sumpio, 2009).
Berg Balance Test
- The client currently is experiencing balance problem and unsteady gait due to neuropathy in her feet. The Berg Balance Test will help assess her balance while determining her walking speed and functional walking ability. (Makoto, Hiroyuki,Yooichiro, & Shin, 2013).
FIM
- The FIM will help to understand where the client is at functionally at the moment and how much assistance they do and don't require when performing daily tasks and occupations.
- FIM can be utilized to assess movements along with mobility and transfer capabilities at home and other settings (Toyama, Sawada, Ueshima, Mikami, Mori, Takamuku, & Takahashi, 2018).
MMT/ROM
- ROM and MMT can be performed to assess muscle strength and joint stability of our patient.
- Staying in the hospital for an extended period of time can lead to muscle decondition and hospital acquired weakness as well.
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INTERVENTIONS
IADL: Health Maintenance. Medication Management-Promote:The client will follow a routine based medication management program. The partnership with the client and occupational therapist will develop a client-centered plan to improve the client's performance of medication management (Siebert, Schwartz, & Kannenberg, 2017).
ADL: Functional Mobility. Balance-Restore: The client will perform 10 reps and 2 sets of sit to stand exercises each day to improve her balance. Functional mobility activities may be used by leveling up from bed mobility to functional transfers (Amini, Lieberman, & Hunter, 2018). The client will be supported by a gait belt and will walk for 15-30 minutes each day in rehab to improve balance while walking. The client will use proper techniques and posture while positioned at a table when performing ADLs.
IADL: Safety and Emergency Maintenance. Safety-Prevent: Precautions need to be addressed for the client to help reduce the risk of infection such as pneumonia. Interventions that teach the client to adjust and examine her environment for safety hazards that can cause illness, teach about good hand hygiene and contact with large groups or sick people (Stark, Keglovits, Arbesman, & Lieberman, 2017).
Sleep and Rest: Rest. Energy conservation techniques- Modify: Work simplification techniques and appropriate body posture will be used to educate the client on how to position the body when lifting and carrying objects (Denton, 1987). The client’s bio-mechanics will be adjusted to help reduce overuse of type-II muscle fibers and taking breaks to prevent overuse of muscles.
ADL: Functional Mobility. Strengthening/conditioning-Restore: The client may use a structured aerobic program to reduce fatigue and increase endurance. The client may use a stationary bike program for 20 minutes 3-4 times per week or swimming exercises may be implemented (Hardison & Roll, 2017).
IADL: Home Establishment and Management. Routine/schedule-Create: The client will set a timer to take breaks when appropriate when she is performing occupations and implement routine exercises (Misko, Nelson, & Duggan, 2015).
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