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Home Care Physical Therapy Plan of care (Evaluation (Assessment of risk…
Home Care Physical Therapy Plan of care
Intervention
Education
Modifying Risk Factors
reduce time around those who smoke
Wear mask to protect airways during farming
Energy Conservation Strategies
Nutrition
Eat a healthy diet
Foods low in saturated fat
help control cholesterol levels and blood pressure
(The Mayo Clinic)
less damage to the arteries
dust from moldy crops should be wetted down before being swept to prevent it from becoming airborne (Canadian Centre for Occupational Health and Safety, 2016)
Ambulation for intermittent claudication
treadmill training
Improved quality of life and functional capacity one year post intervention
(Guidon & McGee 2013)
monitor symptoms
Treadmill training to onset of claudication pain/max claudication pain
Improved distance of ambulation
(Gardner et al., 2001)
Breathing exercises
pursed lip breathing
tissue blowing
Resistance Training
Lower Extremity Resistance Training
Improved functional performance in men with PVD and IC with regards to treadmill walking, stair climbing and quality of life (McDermott et al., 2009.)
Endurance Training (Cycling/Walking) + LE Strengthening
Improvement in functional exercise capacity evident by increase of 35m on 6MWT (Holland, Hill, Conron, Munro, & Mcdonald, 2008)
Stress Management
Emotional stress causes peripheral vasoconstriction, which is detrimental to a patient whose circulation is already compromised (Linton, 2016).
Relaxation helps restore normalcy in blood pressure through vasodilation
Relaxation Techniques
Massage
Imagery
Deep breathing exercises
Meditation
Yoga
modified to match functional level of patient
Recreational Activity
Avoidance of known stressors
Outcome Measures
Modified Physical Performance Test
This is an appropriate and more sensitive measure than the Short Physical Performance Battery in predicting global disability in patients with PVD (Addision et al., 2017).
6MWT
6MWT is negatively associated with endothelial inflammation,
ABI and CAD. It seems that improving this score will help protect patients from the deleterious effects of PVD (Gardner et al., 2017).
Measure of cardiovascular endurance. Suitable for this population due to the short duration of this assessment
SF-36
Edinburgh Claudication Questionnaire
Walking Impairment Questionnaire
Low scores on stair climbing portion of WIQ is a high predictor of mortality. Therefore, we can use this as an assessment tool and to guide our intervention. (Jain et al., 2012)
Measures self-reported performance on walking speed, walking distance and stair climbing
ICF
Body Structure & Function
SOB
FEV1= 2.8L (60% predicted)
FVC= 3.0L (64% predicted)
FEV1/FVC= 93%
Diffusing Capacity= 47% of predicted
Chest Tightness
Intermittent Claudication in R calf
Decreased Endurance
Activities
Difficulty walking
Difficulty ascending/descending stairs
Participation
Unable to work on the farm
Unable to participate in sport/recreation
Personal Factors
55 y.o. male
Works as grain farmer
Lives with wife and 5 kids
Gave up smoking years ago
H/o respiratory allergies
Environmental Factors
Lives on Farm
Family members smoke
Evaluation
Edinburgh Claudication
Questionnaire
Clinical signs and symtpoms
Skin integrity
Peripheral pulses
Pain scale
Assessment of risk factors
HTN
Smoking
Occupation
Vascular History
Past cardiac issues
50 y/o
AODM
HLD
Diminished kidney function
Breathing
Hospital course
admitted to the hospital in acute distress
Oxygen and pulmonary vasodilator administered
discharged with immunosuppressive therapy and corticosteroids
Claudication Differential Diagnosis
Chronic compartments syndrome
LE arthritis
Nerve root compression
Spinal stenosis
Venous claudication
Baker Cyst
DVT
referrals
Nutritionist
Respiratory Therapy
Fitted Respiratory (Canadian Centre for Occupational Health and Safety, 2016)
exercise stress test
HEP
Breathing exercises improve 6MWT and QOL in restrictive lung disease (Kagaya et al., 2009)
Pursed Lip Breathing
Diaphragmatic Breathing
Slow Deep Breathing
walking program
moderate intensity exercise 30 minutes/day
monitor vitals
monitor onset of claudication
gradually increase walking distance
Postural exercises
Promote efficiency of breathing
increase oxygen delivery to tissues
discharge from homecare
pulmonary rehab
Pulmonary rehabilitation is effective in improving exercise endurance and the quality of life and in reducing hospital admissions in patients with significant restrictive lung disease (Naji, Connor, Donnelly, & McDonnell, 2006)
Joseph Dubato
Jessica Nguyen Leticia Antunes Aubrey Elstad Neil Toussaint