Lupus Pericarditis

Physical Therapy Treatment

Physical Therapy Evaluation

ICF

Strength Training

Cardiovascular Training

HEP and Discharge Recommendation

Coughing and Breathing Exercises (Valenza et al, 2014)

Limitations in Body Structure/Function

Limitations in Activities

Limitations in Participation

Personal Factors

Environmental Factors

Vitals

Pain

38 y.o. female

Patient Complaints/Subjective Symptoms

Chest discomfort

Joint Aches

SOB

Decreased exercise tolerance

Medications

Corticosteroids

Co-morbidities and Contributing Factors

Anemia

Fever/Chills

Systemic Lupus Erythematosus

Diagnostics

Imaging(CT/MRI/X-ray

L sided pleural effusion

Musculoskeletal (Tench et al, 2002)

ROM

MMT

Functional Mobility

Outcome measures

6 minute walk test

Step test

Lives with family

3 children

Husband(contractor)

Kindergarten Teacher Full-time

2 story home

SLE onset 3 years ago

Decreased endurance

Joint Pain

Group fitness classes with her friends

Mildly Anemic

Normal BMI

Chest Pain

Taking kids to school and extracurricular activities

Going to work as a teacher

Taking vacation with her husband

Walking for prolonged periods

Lab Tests

EKG

Lupus Activity Index

NIH SLE Index Score

Systemic Lupus Activity Measure

CRP

Pt Edu

Diet and Nutrition (Yuen et al, 2014)

Stress Relief and Meditation

Complete Blood Count

Consider Anemia

Stress can induce flare-ups associated with SLE. (Goodman et al, 2009

Skin Assessment

Skin Breakdown for SLE

12 week graded exercise program is more successful at reducing fatigue compared to relaxation techniques or no treatment at all. ((Tench et al, 2003) (Wu et al, 201&)

20-30 minute aerobic training sessions at 70-80% MHR. (Goodman et al, 2009)

3x/week for 50 minute sessions for major muscle groups results in increased isometric strength and functional status. (Goodman et al, 2009)

Energy Conservation Techniques to prevent fatigue

30-50 minute sessions of aerobic training via walking, swimming, or cycling at 60% VO2 max 3x/week. (Tench et al, 2003)

Fatigue Severity Score

Relaxation tape 30 minutes 3x/week in dark room resulted in increased relaxation via self-report measures
(Tench et al, 2003)

Hospital Course (Buppajamrntham et al, 2014)

Lupus-induced pericarditis is an acute exacerbation of SLE that usually are mild to moderate flare ups

Most cases resolve within 14 days, many not requiring medical intervention

Patients with hospital stays are provided anti-inflammatory drugs corresponding to the severity: corticosteroids for more severe cases and NSAIDs for less severe

Physical Therapy in the acute setting is consistent with maintaining mobility through ambulation and ther-ex, proper positioning(limiting supine), breathing exercises, chest physical therapy and education on lifestyle modifications to prevent recurrence.

3 sets of 10 isotonic exercises

60-80% MHR 3x/week for 30-50 minutes each session is effective in reducing fatigue associated with SLE. (Yuen et al, 2014)

Low glycemic Diet

Lower Calorie Diet (not for this pt, however most SLE patients are overweight/obese).

Vit. D supplement

Chest PT to address pleural effusion

Percussion and Vibration(Yernault et al, 1995)

Postural Drainage

Incentive Spirometry(Valenza et al, 2014)

Pt to return home with outpatient rehab to implement cardiovascular exercise plan to be continued as outlined below

Pt has supportive family and was living at home and should be safe and capable of returning to her pervious lifestyle after medically managing acute lupus pericarditis

Assisted and productive cough techniques

Diaphragmatic Breathing

Pursed lip breathing

R Sidelying

Auscultations