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Kindergarten Teacher's Plan of Care (PT Evaluation (Assess ambulation,…
Kindergarten Teacher's Plan of Care
ICF Model
Body function/structure
Lost 18 lbs, BMI now is 21
Anemic
Chills
Chest discomfort
General joint achiness
SOB
Limitations in Activity
Decreased exercise tolerance
Difficulty with bed mobility
Difficulty with stairs
Limitations in Participation
Teaching class
playing with kids at recess
grocery shopping
Personal Factors
38 years old
Kindergarten Teacher
Dx with Lupus erythematosus 3 years ago
Environmental Factors
Lives with Husband and 3 children
Live in two story home
PT Evaluation
Bed Mobility
Transfers
Assess ambulation
device needed?
6 minute walk test
MMT
ROM
Lung and Heart Auscultation
Sensation
Skin Check
Vitals
pt interview
Pain Scale
Quality of Life Assessment
Administer the SF-36 outcome measure
Reliable, valid, easy to use, and acceptable to patients (Brazier et al., 1992)
Additional Recommendations
Discharge plan is home with Home PT
Cardiac/Pulmonary Rehab if pt is not functionally independent at time of discharge from hospital
Pt has support from stay at home dad
Refer to registered dietician
address weight loss
provide dietary recommendations to combat anemia
Recommend/gauge possibility of having a teacher's aide temporarily to decrease workload initially
Continue home walking program
at least 30 minutes per day, 3 times per week
PT Intervention
Chest PT
Percussion, Vibration, and patient positioning to remove secretions
Pt Education
Body positioning
Laying on side of pleural effusion (left side for this pt) worsens hypoxemia (Sonnenblick et al., 1983)
Energy conservation techniques to prevent fatigue
Frequent pt re-positioning to prevent pressure ulcers
Diaphragmatic breathing
Aerobic exercise in the form of walking program
Graded aerobic exercise helps to decrease fatigue in patients with systemic lupus erythematosus (Tench et al., 2003)
"An aerobic exercise training program attenuated the inflammatory milieu in Systemic Lupus Erythematosus women" (Perandini et al., 2014)
This may assist in reducing inflammation of the pericardium as well
Utilize 6 MWT to assess progress in cardiorespiratory endurance
Breathing exercises
Incentive Spirometry to increase inspiratory volume that would be limited due to pleural effusion
Also educate pt on summed breathing to be performed throughout the day