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Systemic Lupus Erythematosus (PT Evaluation (Vitals (Blood pressure, Heart…
Systemic Lupus Erythematosus
ICF
Activity limitation
Difficulty ambulating long distances(endurance)
Difficulty negotiating stairs(endurance and joint pain)
Decreased ability to perform ADL's
Body structure
SOB
Reduced exercise tolerance
Joint achiness
chest discomfort
fever and chills
mildly anemic
Pericarditis
Pleural effusion
Participation
Difficulty working as teacher/keeping up with kids
Decreased family involvement
Difficulty attending and participating in community activities
Physical factors
Lost about 18 pounds
BMI=21
38 year old female
Environmental factors
Married to building contractor
Teacher
Has three children
Lives in a two story home
PT Evaluation
Chart review
Sensation/skin check
Patient history and chief complaint
Proprioception
Vitals
Blood pressure
Heart rate
Respiratory Rate
SaO2
Auscultation
Systemic Lupus Erythematosus Disease Activity Index [SLEDAI]),
Overall measure of activity specifically for patients with Lupus. (Diaz et al,2011)
6 minute walk test
Bed mobility and transfer assessment
AX0X3
Gait assessment
Balance
Stairs
Hospital anxiety and depression scale
MMT and ROM
PT treatment
Deep breathing exercise
High quality of evidence demonstrating positive effects of controlled breathing exercises on breathlessness and quality of life. (Borge et al, 2014)
Pursed lip breathing, diaphragmatic breathing, glossopharyngeal breathing
Incentive spirometry
Significant improvement in vital capacity and chest wall expansion in incentive spirometry group vs control. (Kotani et al, 2015)
Gait training with breathing exerxises
To reduce effects of immobility while promoting efficient breathing while ambulating.
Patient education on energy conservation
Patients who received patient education on energy conservation reported decreased fatigue at 1 year follow up. (Ahn, Goldman, 2015)
Upper and lower extremity strengthening
"Findings suggest that improving muscle strength may reduce physical disability among women with SLE." (Andrews et al, 2015)
Exercises could include mini squats, long arc squats, resisted walking, step ups etc.with close monitoring of vitals, and patient response.
Aerobic training
15 minutes of bicycle ergometer 3x per week for 6 weeks showed significant improvement in SF-36 scores and decrease in depression in patients with SLE. (Bogdanovic et al,2015)
Discharge plan
Home with recommended outpatient PT
Patient education
On importance of frequent position changes to minimize risk of developing further respiratory conditions such as atelectasis.
HEP
Initiate walking program and continue with deep breathing exercises
"Therapeutic exercise programmes appear safe, and do not adversely affect disease activity." (Dwyer, Duncan,Watson,2017)