Etta Rose: By Valerie Bass; OCT 5425 (Assessments: (Clinical Observations…
Etta Rose: By Valerie Bass; OCT 5425
Strengths: Client is motivated to participate and is willing to participate in OT
Impaired pacing ability
Poor initiation of rest breaks
lack of role fulfillment
Low muscle tone
Hx of smoking
Occupation Based Problem List: Occupations affected due to Etta's diagnosis of Stage III COPD
ADLS: Functional Mobility, Swallowing/Eating
IADS: Driving and community mobility, Health management and maintenance, Home establishment and management, Safety and emergency maintenance, Shopping
Work: Job Performance
Social Participation: community, family, peer/friend
PLOF: independent in shopping and household chores
Current level of function: unable to independently perform IADL's, such as shopping or community mobility, secondary to SOB and overall weakness. Client has been experiencing dysphagia and consistently coughs to "clear her throat".
Client Factors: impaired strength, muscle power/tone/endurance, impaired respiratory system functions, involuntary movement reactions
Clinical Observations: Observe Etta throughout therapy. Be aware of her facial expressions, body language, and reactions to activity. Pay close attention to cues that may indicate dyspnea or other associated problems.
Spirometry: This will aid in assessing Etta's lung capacity and her ability to forcefully exhale. This will give us a baseline of her respiratory ability (COPD Foundation, 2018).
Rate of Perceived Exhaustion: This is a self-rating scale that can be used throughout all activities with Etta to gain a objective measurement of her perceived rate of exhaustion.
6 Minute Walk Test: This is a practical test that will determine the distance Etta can walk in a 6 minute period. The test incorporates responses within the pulmonary, cardiovascular, and muscular systems.
Pulmonary Functional Status & Dyspnea Questionnaire-Modified
Chronic Respiratory Disease Questionnaire (Steidi et al., 2015)
The Mann Assessment of Swallowing (Clayton, Carnaby, Peters, & Ing, 2014)
Videofluroscopic swallow study (VFSS) (Steidi et al., 2015)
Dysphagia Risk Evaluation Protocol (Steidi et al., 2015)
Mini Nutritional Assessment (Steidi et al., 2015)
Education: Educate client on her diagnosis of COPD and the non-pharmacological methods she can take to help manage her symptoms. Increasing her activity level, while focusing on pursed/diaphragmatic breathing techniques, and implementing energy conservation techniques will increase her participation in her valued occupations. Increase Etta's awareness of the risk of aspiration so she becomes more aware of forcefully swallowing and appropriate body positioning during meal time (Migilore, 2004).
Grade Up: Continue educational process by explaining specific exercises she can perform at home through implementation of a HEP. Have client repeat back what you've taught her.
Grade Down: Educate client on one piece at a time. If Etta appears to be overwhelmed or anxious, step back and allow her to absorb a small amount of information at a time. Offer Etta a written copy of anything she needs to remember about her condition and how to implement energy conservation techniques into her daily occupations.
Yoga: Yoga is a very controlled form of strengthening and involves slow effortful stretching while maintaining focus on breathing. This will aid in decreasing anxiety and depression that is commonly associated with stage III COPD and improve her muscle strength and endurance. This will improve her ability to complete ADL and IADL tasks (Soni, Munish, & Singh, 2014).
Grade Up: Have client go into more challenging positions that require increased muscle strength to maintain balance.
Grade Down: Have client implement increased rest breaks and perform yoga positions that require less strength and balance.
Pursed-Lips Breathing: Have client breath in slowly through her nose.. count 1..2. and slowly breath out of her mouth while pursing her lips.. count 1..2..3..4.. Repeat. (COPD Foundation, 2018).
Diaphragmatic Breathing: Have client place one hand over her abdomen and the other on her chest. Instruct her to slowly breathe in through her nose, allowing her abdomen to rise and then breath out through her mouth, allowing her abdomen to draw back down to neutral. Have the client attempt to keep her chest still during the exercise (COPD Foundation, 2018).
Complete grooming/hygiene tasks while standing at the sink while regularly assessing her RPE and educating client on when to take rest breaks.
Grade Up: Have client take less rest breaks and perform more high energy tasks such as blow drying her hair or curling her hair.
Grade Down: Allow Etta to sit in front of the sink while performing her grooming/hygiene tasks. Allow for more frequent rest breaks.
10 minutes of extension exercises in B UE with elastic resistance bands incorporating rest breaks when necessary. Remind client forcefully swallow there is excess saliva sitting in her mouth (Wi, Liu, Li, Li, & Wang, 2018).
Grade Up: Increase the level of of exercise band, increase time
Grade Down: Incorporate more rest breaks
Diet Modification: Using thickit in Etta's liquids may reduce her risk of aspiration (Steidi et al, 2015)
Practice Forceful Swallow: this will help to strengthen the muscles involved in swallowing and help to establish a appropriate muscular rhythm to ensure food/ liquid clearance (Steidi et al., 2015)
Neuromuscular Re-education focusing on balance
Goals: Acute Care Hospital
Short Term Goal: In 2 sessions, client will self initiate pacing strategies throughout meal time, with less than 2 verbal cues, in preparation for safety during meal time.
Long Term Goal: In 5 days, client will modified independently complete 10 minutes of self grooming/hygiene tasks while standing at the sink, with a RPE of less than 5, with use of a visual reminder to take rest breaks, 1x per day.
Long Term Goal: In 5 days, client will independently initiate safe meal time strategies, through demonstration of forceful swallow, upright posture, and pacing strategies, 3 meal times per day.
Short Term Goal: In 2 sessions, client will modified independently complete the self grooming task of blowdrying her hair, while seated in front of the sink with the use of a visual reminder to take rest breaks, 1X per day.
Client Priorities for occupational participation: Client hopes to be fully independent in all ADLs and IADLs. Client hopes to get back to working as a realtor and does not want to go into assisted living.
MD Orders: Assess and address strengthening and balance to maintain patient's independence. Rule out pneumonia.
Caregiver priorities: Clients children want her to be moved into assisted living to ensure safety. Son is worried about his mother possibly having pneumonia due to aspiration during meal time.
Diagnosis: COPD Stage III with pulmonary function of 40%
Doctor Priorities: Medication Management
Current Medications: Albuterol inhaler PRN 2 puffs/ 4hrs,
fluticasone BID, nifedipine XL 30 mg PO daily, triotropim inh 18 mcg/ day, Prilosec OTC 1 tab/day
Current Physical Findings:
Vital Signs: BP 168/70; pulse 110; temp 101.8F; RR 28; O2 86% (room air)
Lungs: Diminished breath sounds, prolonged expiratory time and expiratory wheezing with fine/ coarse rales bilaterally.
Mental Status: moderately anxious and confused
Current living arrangements
Client has lived alone in a 1 story home for the past 6 months, following the passing of her husband.
Breathing exercises and techniques. (2018).
. Retrieved from
Clayton, N., Carnaby, G., Peters, M., & Ing, A. (2014). Impaired laryngopharyngeal sensitivity in patients with
copd: The association with swallow function.
International Journal of Speech-Language Pathology
Make, B., & Martinez, F. (2013). Assessment of patients with chronic obstructive pulmonary disease.
American Thoracic Society
Migilore, A. (2004). Improving dyspnea management in three adults with chronic obstructive pulmonary
The American Journal of Occupational Therapy
, 58, 639-644. Retrieved from
Soni, R., Munish, K., & Singh, S. (2014). Study of the effect of yoga training on diffusion capacity in chronic
obstructive pulmonary disease patients.
International Journal of Yoga
, 5, 123-127.
Steidi, E., Riberio, C., Concalves, B., Fernandes, N., Antunes, V., & Mancopes, R. (2015). Relationship between dysphagia and exacerbations of chronic obstructive pulmonary disease .
US National Library of Medicine National Institutes of Health
Wu, W., Liu, X., Li, P., Li, N., & Wang, Z. (2018). Effect of liuzijue exercise combined with elastic band
resistance exercise on patients with copd.
Evidence-Based Complementary and Alternative Medicine
Discharge Recommendations: Subacute care or home with home health