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Plan of care (Pericarditis/Arthralgia) (Evaluation (Lung ascultation…
Plan of care (Pericarditis/Arthralgia)
Evaluation
Vitals
Clinical Signs and symptoms
MMT
Lung ascultation
Decreased or absent breath sounds
Pain Scale
Sitting balance
Functional mobility/transfers
intervention (vitals are monitored at all times)
ambulation/ gait trianing
aerobic fitness should be considered in treatment of fatigue and disability in SLE (Tench, et al 2002)
controls patients with SLE had significantly reduced levels of aerobic fitness compared to sedentary controls (Tench, et al 2002)
patient education
Education of changing positions, to prevent compression of the lung tissue due to pleural effusion and absorb the fluid
In pleural effusions, fluid builds up in the space between the layers of pleura. the fluid can compress the lung tissue, which results in SOB (Mount Sinai Beth Israel, 2017)
light body weight exercises
mini squats at bed side, marching x10 reps
Plueritis is a contraindication for resistant training ( Meka, Katragadda, Cherian & Arora, 2008)
Gross Active ROM
Segmental breathing exercises
18-20 breaths in one session(6 breaths/min) with rest interval after 6 breaths for a total 0f 10-15 mints (Gunjal, Shinde, Kazi, & Mahajan, 2015
Segmental breathing exercises have better effect on chest expansion and pulmonary function than deep breathing exercises in those individuals with pleural effusion (Gunjal, Shinde, Kazi, &Mahajan, 2015)
Incentive Spirometer
A physical therapy program that includes the incentive spirometer and mobilization improves spirometric paramters and reduces hospital stay in patients with pleural effusion (Valenz-Demet, Valenza, Cabrera-Martos, Torres-Sanchez, & Revelles-Moyano, 2014)
transfer training / Bed Mobility
Stair training
ICF
Body Function and Structure
fever anc chills
mild chest discomfort
mildly anemic
arthralgia
Restriction in Participation
Unable to take kids to school
Unable to work
Unable to attend fitness classes
Limitations in Activity
Unable to play with the kids due fatigue
Unable to perform household chores due to SOB
SOB/ fatigue and decreased aerobic endurance during exercise
Personal factors
38 y.o. female
BMI of 21
has systemic lupus erythematosus
Full time Kindergarten teacher
Environmental factors
lives with husband and threes kids
Lives in a two story home
Discharge
Outpatient PT
12 weeks of aerobic exercises by a supervised health professional 3x per week could reduce fatigue and increase fatigue for patients with SLE (Wu, Yu, & Tsai 2017)
walking program
one hour walking session three times per week for 16 weeks
this program showed improved endothelial function and aerobic capacity without worsening disease activity in SLE patients (Reis-Neto, Da Silva, Monteiro, de camargo, & Saro, 2013)
Referal
psychologist
Depression and Poor sleep quality are significantly greater in SLE patients (Tench, et al 2002)
Hospital/medical course
admitted to hospital with pericarditis and Arthralgia
pleural effusion develops on left side
began course of corticosteroids
Outcome measure
systemic Lupus Erythematosus Activity questionnaire
SLAQ is reliable, valid (Yazdany, 2007)
6 minute wak test
HEP in hospital room
Ankle pumps
Hospital confinement is a risk factor for DVTs (Heit, et al 2000)
ROM of motion exercises