Client is a 55 year old woman diagnosed with Lupus.

Tier 1: Diagnoses

Incidence

Prevalence

Symptoms

Prognosis

Tier 2: Occupational Deficits & Problem Statements

Performance Skills

Client Factors

Context and Environment

Performance Patterns

Tier 3: Evaluation Tools

Tier 4: Intervention Approaches

Tier 5: Outcomes

Occupational Model: Occupational Adaptation

Occupational Frame of Reference: CBT

References

Depression Anxiety Stress Scale

Clinical Observation

Borg Rating Scale of Perceived Exertion

MMT

Prevent: Client and caregiver education on positioning (AOTA, in press)

Modify: Client education on energy conservation principles and compensatory strategies to manage fatigue and cognitive deficits (O'Riordoran, Doran, & Connelly, 2017)

Establish/Restore: CBT techniques for mindfulness to increase coping skills and self-efficacy (Poole, Bradford, & Siegel, 2019)

Promote: Encourage healthy lifestyle through a home exercise program and nutrition (Poole, Bradford, & Siegel, 2019)

Decreased risk of pressure ulcers

Increased functional ADL performance

Increased social participation

Increased independence in bed transfers

LTG: Client will participate in 1 social outing per week with her husband within 90 days.

LTG: Client will demonstrate proper positioning techniques while seated and lying down to decrease risk of pressure ulcers within 90 days.

LTG: Client will engage in 30 minutes of ADL participation with compensatory strategies within 90 days.

LTG: Client will complete bed transfers with moderate assistance within 90 days.

CBT uses cognitive techniques to help people become more aware of negative thinking and respond to challenging situations more effectively (Cole & Tufano, 2008). By helping the client change her negative thinking patterns, this frame of reference can help her get out of bed in the morning and engage in meaningful occupations.

Poole, J. L., Bradford, J. D., & Siegel, P. (2019). Effectiveness of Occupational Therapy Interventions for AdultsWith Systemic Lupus Erythematosus: A Systematic Review. American Journal of Occupational Therapy, 73(4), 1–20. https://doi.org/10.5014/ajot.2019.030619


Klein, A., Polliack, A., & Gafter-Gvili, A. (2018). Systemic lupus erythematosus and lymphoma: Incidence, pathogenesis and biology. Leukemia Research, 75, 45–49. https://doi.org/10.1016/j.leukres.2018.11.004


Fava, A., & Petri, M. (2019). Systemic lupus erythematosus: Diagnosis and clinical management. Journal of Autoimmunity, 96, 1–13. https://doi.org/10.1016/j.jaut.2018.11.001

Extreme fatigue

80% have cognitive impairments

Arthralgia/ musculoskeletal pain

Photosensitive rash or rosacea

Increased risk of coronary artery disease and infection

Depression

Renal involvement in 50% of patients

Swollen joints

Mostly affects women of childbearing age, (Klein, Polliack, & Gafter-Gvili, 2018).

African-American women are about 3 times more likely to have lupus and suffer greater mortality compared to Caucasian, (Fava & Petri, 2019).

Lupus is a multi-system auto-immune inflammatory disease, ranging from 20 to 150 cases per 100,000 population, (Klein, Polliack, & Gafter-Gvili, 2018).

The clinical onset requires an interaction of genetic predisposition, environmental triggers, and immunological and hormonal factors. Environmental triggers are considered: Ultraviolet light (the most recognized), drugs/supplements (echinacea, trimethoprim/sulfamethoxazole), smoking, infections (Epstein-Barr virus in particular, silica, mercury. Psychological stress has also been linked to a 50% increase risk of developing lupus, (Fava & Petri, 2019).

In women between the age of 15 and 44 years, the female to male ratio is up to 13:1 while it is only 2:1 in children and in the elderly, (Fava & Petri, 2019).

80-90% of people with lupus can expect to live a normal life span, (Help Us Solve The Cruel Mystery, 2019).

The effects of lupus depends on the severity of the disease. Some people who have severe flare-ups could be at greater risk of their lupus being life-threatening, (Help Us Solve The Cruel Mystery, 2019).

Help Us Solve The Cruel Mystery. (2019). Retrieved from https://www.lupus.org/

This will help understand the client's perceived energy expenditure and fatigue level during physical activity.

This evaluation tool will provide therapist and patient with the severity of depressive symptoms through patient-reported outcomes.

This evaluation will measure the strength and function of the client's current physical level of fitness. The results will help establish goals with transfers and functional mobility in ADLs.

Because the client spends so much time in bed, it is important to evaluate her skin integrity and signs for pressure ulcers. The small wound on her sacrum is concerning and needs to be addressed before getting worse. It also indicates there could be more pressure ulcers developing, which is why this assessment is necessary.

She is lacking in desire for mastery to pursue occupations due to depression. However, the demand and press for mastery in her environment is apparent in her declining functional status. She isn’t able to successfully fulfill her roles. Creating personal goals and evaluating her relative mastery in tasks will help her be successful. (Cole & Tufano, 2008)

Pressure ulcers result in client obtaining less than 3 hours of sleep nightly.

Client requires max assist in bed transfers due to size and muscle strength of 2-/5. She is unable to endure the transfers.

Client is uninterested in social participation due to symptoms of depression.

Client is unable to engage in weekly routine of going to the store due to immobility.

Client is unable to engage in less than 10 minutes of ADL participation due to chronic fatigue and pain.

Client is unable to successfully fulfill role as wife due to depression.

Cole, M.B., & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: SLACK Incorporated.

American Occupational Therapy Association. (in press). The role of occupational therapy in wound management. American Journal of Occupational Therapy, 72 (Suppl.2)

O’Riordan, R., Doran, M., & Connolly, D. (2017). Fatigue and activity management education for individuals with systemic lupus erythematosus. Occupational Therapy International, 24(1), 1–11. https://doi.org/10.1155/2017/4530104