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Ron McDonald's Plan of Care (PT evaluation (Vitals (O2 Saturation,…
Ron McDonald's
Plan of Care
PT evaluation
Interview
Breathing Assessment
Ambulation
Endurance
Motor Control
Functional mobility
Stairs
Transfers
ADL's
Vitals
O2 Saturation
HR
BP
Cough Assessment
Percussion and vibration if neccesary
Ankle Brachial Index (ABI)
Postural assessment
Circulation
Sensation
Skin integrity
ICF Model
Participation
Requires frequent rest breaks which interferes with his work production
Can no longer walk dogs
Can no longer climb into the silo
Activity
Reduced endurance
Difficulty climbing stairs
Body function/structure
SOB
Intermittent claudication of R calf
Personal Factors
Grain farmer
55 years old
Former Smoker
Environmental Factors
Lives on Family Farm
55 acres of land
Lives with wife and 5 children
Family members smoke around him frequently
PT Intervention
Pulmonary rehab
supervised exercise program/walking program
Prescription:
12 weeks
2 times per week,
60 min per session
(Vainshelboim et al., 2017)
improved cardiovascular function (Vainshelboim et al., 2017)
Supervised Walking Program
3 hr/week of treadmill walking at highest speed without claudication for 12 weeks resulted in 74% increase in peak walking time, improvements in VO2max, and Increase in the distance required to experience claudication.
perform with supplemental O2 if cardiovascular endurance is the limiting factor instead of his intermittent claudication
Significantly better results than 12 weeks of LE resistance training or no exercise at all
(Hiatt et al., 1994)
Supervised treadmill training is good for improving walking time and distance in patients with intermittant claudication
(Fokkenrood, 2013)
In a Cochrane review comparing supervised vs. unsupervised exercise, the effect size of the difference in maximal walking distance was 180 m
greater in the supervised exercise group (Walsworth et al., 2017)
16 RCTs demonstrated the effectiveness of exercise in improving maximal walking distance and 12 RCTs demonstrated effectiveness in improving pain-free distance (Walsworth et al., 2017)
Treadmill training increases walking capacity and increased duration of pain-free walking in patients with PVD
(Mannarino, 1989)
Increase QOL and functional capacity (Sharif, 2017)
Improved dyspnea,
pulmonary function,
exercise tolerance,
QOL,
and functional capacity
(Vainshelboim et al., 2014)
Outcome measures that are reliable
and valid for this population
6MW test
(du Bois et al., 2011)
Incremental shuttle walk
(Nolan et al., 2017)
30 second chair stand
(vainshelboim et al., 2014)
Workplace Adaptations from CCOHS-Farmer's Lung
Refer out for fitted respirator for continued farming
Proper Ventilation of Workspace
Wet down grain/hay when cleaning barn areas
Store grain indoors to keep it from drying out
Pre-dry grain/hay before storage (May be expensive)
Pt education
DBE's
Dangers of pressure ulcers
could lead to amputation/infection
Healthy diet
refer to RD if necessary
Stress importance because he is at a higher risk of CVA and MI
Buy a pulse oximeter to monitor oxygen levels on his own
Smoking cessation education for the family
refer to smoking cessation specialist if needed
Education on dangers of second hand smoke to Ron
Education on Influenza and pneumococcal vaccines
Refer to MD for advanced directive
Additional recommendations
Ron could go to a public park once a week with his family
Public park spaces promote wellness
and healthy lifestyle behaviors, especially
for people with cardiovascular disorder
(Arena et al., 2017)
Experience fresher/cleaner air
Discharge to Pulmonary rehab
Ryan Coye,
Lora Kuehn, Megan Madden, Matt Chan, Nick Lacey