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Ms. Mercury (References (Google Images ([Photograph of adaptive equipment]…
Ms. Mercury
References
Majnemer, A. (2010). Balancing the boat: Enabling an ocean of possibilities.
The Canadian Journal of Occupational Therapy, 77
(4), 198-208. Retrieved from
https://search.proquest.com/docview/762450065?accountid=158603
Misko, A. N., Nelson, D. L., & Duggan, J. M. (2015). Three Case Studies of Community Occupational Therapy for Individuals with Human Immunodeficiency Virus.
Occupational Therapy in Health Care, 29
(1), 11–26. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=100006508&site=eds-live
HIV/AIDS. (2019, April 24). Retrieved from
https://www.cdc.gov/hiv/basics/whatishiv.html
Cohen, H. S., Burkhardt, A., Cronin, G. W., & McGuire, M. J. (2006). Specialized knowledge and skills in adult vestibular rehabilitation for occupational therapy practice.
The American Journal of Occupational Therapy, 60(
6), 669-68. doi:
http://dx.doi.org/10.5014/ajot.60.6.669
Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach.
Thorofare, NJ: Slack, Inc.
Oʼconnor, A. R., Birch, E. E., Anderson, S., & Draper, H. (2010). Relationship between Binocular Vision, Visual Acuity, and Fine Motor Skills.
Optometry and Vision Science, 87(
12), 942-947. doi:10.1097/opx.0b013e3181fd132e
Occupational Therapy Practice Framework: Domain & Process. (2014). Bethesda, MD: AOTA Press/American Occupational Therapy Association.
Pizzi, M. (1990). The Model of Human Occupation and Adults With HIV Infection and AIDS.
American Journal of Occupational Therapy. 44
(3):257-264. doi: 10.5014/ajot.44.3.257.
Sharmin, R., Jung, B., Shimmell, L., & Solomon, P. (2016). Benefits and challenges of role-emerging placements of student occupational therapists in HIV service organisations.
International Journal of Therapy and Rehabilitation, 23(
12), 574-582. doi:10.12968/ijtr.2016.23.12.574
Google Images
[Photograph of adaptive equipment] (2018). Retrieved from:
https://www.google.com/search?rlz=1C1CHBF_enUS796US796&biw=1366&bih=625&tbm=isch&sa=1&ei=KxxcXayUNInisAXozYeAAg&q=OT+using+adaptive+equipment+&oq=OT+using+adaptive+equipment+&gs_l=img.3...5008.23508..23706...0.0..0.167.1242.15j1......0....1..gws-wiz-img.......35i39.uusA9TZsIM8&ved=0ahUKEwjs1fDm65HkAhUJMawKHejmASAQ4dUDCAY&uact=5#imgrc=_
[Photograph of before and after hospital room] (2018). Retrieved from:
https://www.google.com/search?q=before+and+after+hospital+room&rlz=1C1CHBF_enUS796US796&tbm=isch&source=iu&ictx=1&fir=fHXDQSnobZT6SM%253A%252CuURimMXMXDVDJM%252C_&vet=1&usg=AI4_-kSPkE9b0ez8J4QGd_sIUg81GME3vg&sa=X&ved=2ahUKEwj_griM9JHkAhVJKawKHdOVBB4Q9QEwAHoECAQQBg#imgrc=fHXDQSnobZT6SM
:
[Photograph of pill organizer] (2018). Retrieved from:
https://www.google.com/search?q=pill+organizer+with+different+colored+pills&rlz=1C1CHBF_enUS796US796&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjTsr3T9JHkAhVNHqwKHSmsCq4Q_AUIEigC&biw=1366&bih=625#imgrc=7XQ2YP5Uh5Gj0M
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Occupational Deficits
Environment
Lives with partner and 2 children
Context
Alcohol and drug dependancy
Client Factors
Decreased sensation in hands and feet due to neuropathy
HIV/AIDS, weakness, pneumonia
Hx of alcohol and drug abuse and chronic liver failure
Performance Patterns
Alcohol and drug dependence
Unemployed
Relies heavily on others help in order to complete activities of daily living
Performance Skills
Unemployed, unbalanced, medication management
CDC
Prevelance
Gay and bisexual men are the population most affected by HIV. In 2017, gay and bisexual men accounted for 66% (25,748) of all HIV diagnoses and 82% of diagnoses among males
Prognosis
Today, someone diagnosed with HIV and treated before the disease is far advanced can live nearly as long as someone who does not have HIV.
AIDS is the most severe phase of HIV infection. People with AIDS have such badly
Incidence
An estimated 1.1 million people in the United States had HIV at the end of 2016, the most recent year for which this information is available. Of those people, about 14%, or 1 in 7, did not know they had HIV
Symptoms
Common symptoms of AIDS include chills, fever, sweats, swollen lymph glands, weakness, and weight loss
Interventions
OT will place multiple colored beads on the table top and request Ms. Mercury to retrieve them one at a time and place them into a pill organizing box. This will work on fine motor skills necessary to complete medication management. Additionally, this intervention can be used as an assessment to evaluate her vision, processing skills, and cognitive ability required to complete a fine motor task. This intervention can be upgraded and downgraded based on performance starting with retrieving five small beads of the same color and repeated three total times.
The therapist will collaborate with the patient in order to adapt to her environment while she is hospitalized. This can include placing personal items, pictures, music, and specific scents around the room. Additionally, it needs to be a priority of the therapist to remove any negative stimuli that trigger her negative dependence that correlates with drug and alcohol abuse and hinders her progress in therapy. Research has found that by adapting the environment, clients suffering from HIV/AIDS are far more likely and motivated to participate in therapy (Pizzi, 1990)
OT will provide adaptive equipment to aid Ms. Mercury in bathing, grooming, and toileting to help promote independence with ADL tasks. OT will also provide detailed instructions on how to efficiently and effectively use the tools. This intervention can be worked on daily for the entirety of her hospitalization stay after the FIM evaluation has been complete.
Client goals
LTG #2:Client will complete morning routine including medication management independently within 4 weeks.
LTG #3: Client will develop a daily schedule to manage time and conserve energy independently for tasks required to take care of self and children in 4 weeks.
LTG #1: Client will transfer on to shower chair and bath herself using modified-independence within 2 weeks.
Evaluation Tools
COPM
Relating it back to the client: Due to Ms. Mercury’s complex health ailments, she has lost motivations and desire to find meaning in daily occupations. She relies heavily on her partner to care for children’s needs. She has recently started neglecting her self-care activities. This assessment tool will help her identify which tasks she finds the most meaningful and help build upon the skills necessary to accomplish these tasks as independently as possible (Majnemer, 2010)
Clinical Reasoning: The COPM is an individualized, client-centered outcome measure designed to capture a client’s self-perception of performance in everyday living and ability to care for oneself. Helps identify which occupations the client feels are the most important; what they feel they can do, what they can’t do, and what they would like to be able to do. Targets a wide range of activities starting with ADLs like self-care skills and concluding with productivity and leisure during IADLs and social interaction. Client can then rate the importance of each occupation giving the OT can good base to formulate a client-centered and individualized treatment plan (Majnemer, 2010).
Berg Balance Assessment
Clinical Reasoning: The Berg Balance assessment is an objective assessment used to identify the patient’s ability/inability with balance while sitting, standing, and ambulating. Because this client has such unsteadiness while standing, she was will at an increased risk for falling while participating in rehabilitation. Therefore, the Berg balance assessment is a perfect evaluation tool that can be used to identify a baseline in static balance (Majnemer, 2010).
Relating it back to the client: As stated previously, Ms. Mercury has neglected her self-care ADLs. One cause that can be expected to have caused this is her unsteadiness while standing. The Berg Balance assessment will be appropriate to identify what kind of fall risk Ms. Mercury is as well as assesses overall static balance. When collaborating with physical therapy, therapeutic intervention plans can be designed to target improving her balance in order to encourage her to engage in ADLs for herself and possibly her children.
Functional Independence Measure (FIM)
Clinical Reasoning: assessment is used to measure physical, psychological, and social functioning. The assessment helps practitioners identify the level of assistance required by the client to complete all ADL tasks. It can be expected that this client will need increased assistance will all ADLs/IADLs because the client is suffering from generalized weakness, neuropathy, unbalanced/unsteady gait, and chronic liver failure secondary to a complex diagnosis of HIV/AIDs & pneumonia. This initial assessment provides a starting point for the OT to measure progress throughout her hospitalization (Majnemer, 2010).
Relating it back to the client: Ms. Mercury has poor self-care skills brought on by her generalized weakness and her lack of motivation. This assessment tool will serve as a baseline for self-care skills. The therapeutic intervention approaches can be used to target increasing FIM scores, therefore, increasing her abilities to care for herself following discharge.
Theoretical Framework/Model
Model of Human Occupations
Function and disability
A person displays function when he or she is able to choose, organize, and perform occupations that are personally meaningful. Through the MOHO, a person experiences optimal functioning when a person demonstrates a sense of competence and role fulfillment. Disability or dysfunction is defined as a disorder, or the inability to perform occupation, an interruption in-role performance, and an inability to meet role responsibilities. These people experiencing disability can not meet the needs of societal expectations (Cole, Tufano, 2008).
Motivation
Influenced by a person’s interests, values, and a sense of personal causation. All aspects of a person’s life in which they think are important. The volitional subsystem becomes a significant focus are for motivation and change (Cole, Tufano, 2008).
Focus of this model
The framework of the Model of Human Occupation spans the entirety of life, offering a universal and complete approach. Human occupation is described as the ‘doing’ of work, play or ADL’s within a temporal, physical, and sociocultural context. the major focus is on the person and how his environment plays a role in motivation, patterns of behavior, and performance. The driving force behind this model is the idea that there are three interrelated parts that exist within each person which include volition, habituation, and performance capacity. The degree to which one sustains a pattern of occupational participation that represents one’s occupational identity (Cole, Tufano, 2008).
Cognitive Behavioral Frame of Reference
Function & Disability
Functional individuals can control and manage their own thoughts, feelings, and behavior to cope with stress, manage time, and balance their life roles and occupations. In OT, we look at how cognitive limitations affect one’s occupations and identify the specific problems that cause occupational disruption. This FOR defines both function and disability in terms of characteristics of the person, task, and environment that can be observed and measured (Cole, Tufano, 2008).
Motivation
Person’s are motivated by their wish to fulfill their obligations or to meet the expectations of others, or conversely, by the wish to avoid social sanctions. Motivations work best when clients have internalized the personal satisfaction that comes with mastery and achievement of occupational goals (Cole, Tufano, 2008).
Focus of this FOR
Under the domain of occupational performance patterns, the framework discusses domination habits as so demanding that they interfere with daily life. The cognitive-behavioral FOR offers useful techniques for self-management that OT’s can use in addressing these barriers to occupational performance. Self-efficacy refers to the belief in one’s own ability to interact effectively with the environment. Self-efficacy involves the cognitive ability to anticipate consequences. Self-efficacy changes with each situation, and may involve the observation of others, coaching, or demonstration (modeling) to learn what skills or behaviors might be needed or expected when facing unfamiliar tasks or situation. Self-awareness is another important concept in several FOR. In the cognitive-behavioral FOR, self-awareness involves a realistic understanding of one’s strengths and weaknesses and the realization of the effect of one’s own behavior on others. Self-awareness also serves as the basis for insight (Cole, Tufano, 2008).
Overview & Problem Statement
Complication of HIV resulting in generalized weakness. She has also been diagnosed with pneumonia, chronic liver failure, neuropathy in bilateral feet, and is very unbalanced. Additionally, she has a history of ETOH and drug use.
Problem Statement: Generalized weakness secondary to HIV/AIDS that has now affected work (unemployed), child rearing, medication management, and navigating home and community.
