Betty
Tier 1
Tier 2
Tier 4
Tier 5
Tier 3
Occupational Deficits
Problem Statements
Difficulty completing ADLs due to fatigue and pain
Inability to cook/clean/perform other IADLs due to fatigue and wheelchair/walker use
Lack of social participation and motivation due to depression
Client has difficulty completing ADLs such as bathing and dressing due to her fatigue and lack of mobility outside of bed.
Client does not perform IADLs such as cooking and cleaning due to fatigue and inability to move around without the assistance of a wheelchair or walker.
Client will have difficulty participating in her typical roles as a wife and friend due to her depression.
Evaluations Tools
Beck Depression Inventory
Fatigue Assessment Scale
Modified Functional Reach Test
Clinical Observation
Intervention Approaches
Preparatory Methods and Tasks: utilization of wheelchair to use for mobility, strengthening exercises to improve muscle weakness
Occupations: start with simple ADL/IADLS tasks at bedside and progress from there, main focus is grooming and dressing, provide adaptations and modifications as needed
Education: bed positioning to prevent further sores and bed mobility education
Depression is a psychiatric comorbidity that develops at different stages of lupus (Moustafa et al., 2019, p. 2). Lupus can have a significant impact on a client's health related quality of life as well as satisfaction (Moustafa et al., 2019, p. 2).
Fatigue is a major complaint of individuals with lupus and is often reported as a debilitating feature of the disease (Horisberger, Courvoisier & Ribi, 2019, p. 1).
In order for the client to perform her ADLs in a safe manner, especially reaching for needed objects in multiple directions, it is important for her to have a good level of stability to engage in her daily activities (Rosa, Perracini & Ricci, 2019, p.149).
As the client is currently in a wheelchair, the modified functional reach test would be beneficial to perform with the client as it can be performed with the client seated. This will help showcase the client’s functional abilities within her current method of mobility.
Observation will occur during every step of evaluation and treatment. Observation of the client will allow the therapist to better understand how she performs her occupations and provides information regarding what adaptations would be beneficial to increase her independence and function.
The Fatigue Assessment Scale, FAS, is a 10-item self-reported questionnaire that is used to assess the fatigue that individuals feel. Answer choices range from 1-5, 1 being never and 5 being always.
Examples of questions include: "I get tired very quickly" and "I have problems thinking clearly".
Client Overview/Diagnoses
Pneumonia
Depression
Lupus
Incidence: The CDC estimates concluded that lupus is much more common in African Americans than Caucasians and higher for women than men.
Prevalence: Recent prevalence is unavailable because Lupus is relatively uncommon and difficult to diagnose.
Symptoms: Fatigue, muscle and joint pain, general pain, fever, swelling of joints
Incidence: Women are almost twice as likely as men to have depression. It is also more common in families with lower income levels.
Prevalence: The CDC reported 8.1% of American adults aged 20 or over had depression between 2013 and 2016.
Symptoms: Social isolation, lack of occupational performance, feelings of sadness/hopelessness
Prevalence: Approximately 257,000 cases reported as the primary diagnosis upon arrival to emergency departments
Symptoms: Fever, mucus-producing cough, shortness of breath, chest pain, fatigue, nausea
Incidence: Affects all individuals equally. However, it is more serious in children and older adults.
References
Prevalence of Depression. (2018). Retrieved from https://www.cdc.gov/nchs/products/databriefs/db303.htm
Systemic Lupus Erythematosus (SLE)- CDC. (2018). Retrieved from https://www.cdc.gov/lupus/facts/detailed.html
FastStats-Pneumonia. (2017). Retrieved from https://www.cdc.gov/nchs/fastats/pneumonia.htm
Horisberger, A., Courvoisier, D., & Ribi, C. (2019). The fatigue assessment scale as a simple and reliable tool in systemic lupus erythematosus: a cross-sectional study. Arthritis Research & Therapy, (1), 1. https://doi.org/10.1186/s13075-019-1864-4
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl.), S1-S48. http:dx.doi.org/10.5014/ajot.2014.682006
Moustafa, A. T., Moazzami, M., Engel, L., Bangert, E., Hassanein, M., Marzouk, S., … Touma, Z. (2019). Prevalence and metric of depression and anxiety in systemic lupus erythematosus: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism. https://doi.org/10.1016/j.semarthrit.2019.06.017
Rosa, M. V., Perracini, M. R., & Ricci, N. A. (2019). Usefulness, assessment and normative data of the functional reach test in older adults: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics. https://doi.org/10.1016/j.archger.2018.11.015
McAllister, L., & Lewis, C. (2019). Bed Mobility: More Than Min, Mod, or Max Assist. GeriNotes, 26(3), 23–24. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=137269467&site=eds-live
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
"Getting out of bed is an essential daily life task. Difficulty with bed mobility has been reported to be 27.6% in a survey of adults over 65 years of age and as high as 63% in older adults residing in nursing homes" (McAllister & Lewis, 2019, p. 23).
"Occupational therapy practitioners could encourage people with SLE to include physical activity as part of their daily routine, such as aerobic exercise to improve function, fatigue, pain and depression" (Poole, Bradford & Siegel, 2019, p. 7).
"Occupational therapy practitioners should identify client-centered goals with people with SLE and help modify tasks or provide adaptive skills training to best meet their goals" (Poole, Bradford & Siegel, 2019, p. 7).
Limited resources and limited time in rehab will minimize her ability to improve her occupational performance in inpatient setting
Outcomes
Increased Bed Mobility
Increased Muscle Strength
Decreased Fatigue
Increased Social Participation
LTG: Client will complete grooming tasks with modified independence using 2 rest breaks in 12 weeks.
LTG: Client will demonstrate bed mobility techniques independently in hospital bed in 12 weeks.
LTG: Client will transfer out of bed with modified independence using a walker in 12 weeks.
LTG: Client will independently participate in 2 social activities per week based on her daily schedule in 12 weeks.