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Andrea (Client history (Chronic liver failure, Generalized weakness, 36…
Andrea
Client history
Chronic liver failure
Generalized weakness
36 years old
Complications from HIV
Pneumonia
Drug and alcohol use
Non-compliant with medications
Neuropathy in bilateral LE
Balance issues when standing
Problem List
Medication non-adherence
Generalized weakness
Symptoms of HIV/AIDS: fatigue, fever, loss of appetite, discomfort, night sweats, or sweating
Impaired balanced
Neuropathy in feet
Pneumonia
Individuals with HIV experience not only their physical symptoms as a challenge but stigma as well (Moyo & Perumal, 2019).
Intervention approaches
Establish/Restore: Client will restore standing balance by working on weight shifting and strengthening of muscles.
"Regular and moderate physical activity has been shown to positively affect the quality of life of HIV‐positive people, for example, reducing acute fatigue, muscular weakness or pain..." (Bergamaschi et al., 2019, p. 2148).
Create/Promote: Create an informative class on medication management in order to increase client's awareness in adherence
Established and Restore: Restore Client's strength in extremities to address generalized weakness.
Modify: Create a visual and auditory schedule to promote medication adherence and establish a routine.
Maintain: Client will maintain energy through out everyday activities with learned energy conservation techniques.
"...55%–65% of HIV‐infected people attributed a primary role to fatigue in their daily lives" (Bergamaschi et al., 2019, p. 2148).
Performance patterns
Habits
Automatically snoozes alarm in the morning
Looking both way before crossing the street when dropping her children off on the school bus.
Routines
Follows a morning sequence in completing ADLs for children
Follows a morning sequence for self care
Putting the kids on the bus for school every morning
Rituals
Drinking 5 glasses of wine every night to relive stress
Roles
Significant other
Mother of two children
Unemployed
Friend
Daughter
Context
Cultural
Motherhood
Date night every friday
Weekend partying
German
Temporal
Fundraising for kids school
Celebrates mothers day
Celebrates kids birthdays
Personal
Has her highschool diploma
36 years old
Female
Unemployed
Low middle class
Poor access to health care
Volunteers at her kids school once a month
Virtual
Texting friends
Texting significant other
Using computer for lesuire
Uses computer to track kids education
Client factors
Body structures
Fluid filled air sacs
Ulcers in mouth or white tongue
Inflammation and scar tissue of the liver
Minor inflammation of LE
Values/Beliefs/Spirituality
She is committed to her family
Attends church irregularly with children
Not committed to a medication schedule
Trying to commit to sobriety
Body functions
Lack muscle endurance
Pain and tinging in LE
Low muscle tone
Emotions are irregular
Difficulty with memory and attention
Difficulty breathing
Has fatigue
Occupations
IADLs
Prepping meals for children
Night showering routine for kids
Child rearing
Paying bills
Looking for work
Home maintenance
Applying to higher education
Needing to adhere to medication
Rest and Sleep
Night sweats
Irregular sleeping times
Unable to get full night of sleep
Takes frequents naps while children are at school
ADLs
Feelings of fatigue after showering
Feelings of fatigue when washing hair
Having trouble safely going in and out of the tub
Feeling tried when engaging in sexual activity
Performance Skills
Motor Skills
Weak power grasp due to low muscle tone
Has slow movements with manipulating objects when cooking
Requires a few break when completing high energy tasks due to physical fatigue
Persistent leaning on counter when standing
Process skills
Runs through tasks very quickly causing fatigue
Starts many tasks without completion
Social interaction skills
Has trouble communicating to her significant other
Evaluation tools
Berg Balance
In order to measure the risks for falls due to weakness and fatigue.
COPM
In order to measure Andrea's perceptions of her everyday activities and defining the activities that cause her the most difficulty.
DASS
This is to measure the symptoms of depression, anxiety and tension/stress
Outcomes
Well being: Through client education of diagnoses client will better understand and be able to imbed a routine that will impact their overall well being.
Goal
LTG: Client will verbally say 5/5 safety awareness tips for her diagnoses within 4 weeks
STG: Client will verbally say 3/5 safety awareness tips for diagnoses within 2 weeks.
Occupational performance: Through modifications and energy conservation techniques client will be able to better engage in occupations.
Goal
LTG: Client will learn energy conservation techniques within 4 weeks.
STG: Client will learn energy conservation techniques within 2 weeks.
Quality of life: Client will increase participation in ADLs and IDALs in-turn improving overall quality of life.
Goal
LTG: Client will be independent in all ADLs and IDALs with visual cues within 4 weeks.
STG: Client will be independent in 3/5 ADLs and IDALs with visual cues within 4 weeks.
Frames of Reference/Practice Models
Biomechinical
In order to be used as preparatory therapy for strengthening Andrea's muscles and to gain endurance in her everyday activities.
MOHO
In order to explore the volition, habituation, and performances in Andrea's life. Applying this FOR can be useful in helping Andrea find motivation and being able to identify healthy and unhealthy habits.
Service Delivery Model
This model entails various features of HIV, different environments and how the client interacts in each in order to promote participation (Restall et al., 2017).
Environment
Physical
Lives on the third floor of her apartment complex
Uses elevator to get to apartment
Many kids toys and plants in apartment
Social
Parting with friend on the weekend
Spending time with her significant other
Spending time with children before bed time
Going to church on Sundays
References
Restall, G., Sullivan, T., Carnochan, T., Etcheverry, E., Roger, K., & Roddy, P. (2017). A Service Delivery Model for Addressing Activity and Social Participation Needs of People Living with HIV.
Open Journal of Occupational Therapy, 5(2),
1–16.
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.).
American Journal of Occupational Therapy,
68(Suppl . 1), S1– S48.
http://dx
.doi .org/10 .5014/ajot .2014 .682006
Moyo, Z., & Perumal, J. (2019). Challenges Faced by Teachers Living with HIV. South African Journal of Education, 39(1). Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1210341&site=eds-live
Bergamaschi, A., d’Arripe-Longueville, F., Gray, L. L., Colson, S. S., Goujard, C., Ferez, S., … Schuft, L. (2019). Perceived HIV-related physical fatigue, sociodemographic characteristics and physical activity: A cross-sectional study. Journal of Clinical Nursing, (11–12), 2147.
https://doi.org/10.1111/jocn.14793
Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: Slack, Inc.
Meriano, C., & Latella, D. (2016). Occupational Therapy Interventions : Function and Occupations, Second Edition (Vol.
Second edition). Thorofare, NJ: SLACK Incorporated. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1241589&site=eds-live