DIAGNOSIS RIGHT CVA WITH LEFT HEMIPARESIS (WEAKNESS ON THE LEFT SIDE OF THE BODY.) FEMORAL NECK FRACTURE (BIPOLAR ARTHROPLASTY OF THE LEFT HIP.) HISTORY.

DIAGNOSIS RIGHT CVA WITH LEFT HEMIPARESIS

(WEAKNESS ON THE LEFT SIDE OF THE BODY.)

FEMORAL NECK FRACTURE (BIPOLAR ARTHROPLASTY OF THE LEFT HIP.)

HISTORY OF DVT (DEEP VENOUS THROMBOSIS.)

END-STAGE RENAL DISEASE.

PROBLEM LISTDECREASED ACTIVE RANGE OF

MOTION ON THE LEFT UPPER EXTREMITY.

DECREASED MUSCLE STRENGTH.DEPENDENT WITH LOWER EXTREMITY

DRESSING.UNABLE TO TRANSFER SAFELY (E.G.,

FROM BED TO WHEELCHAIR/ WHEELCHAIR TO TOILET.)

Mr. Jesse’s goals will focus in the Mr. Jesse’s goals will focus in the area of self-care .area of self-care .

Long Term Goal (LTG)-Increase active range Long Term Goal (LTG)-Increase active range of motion and muscle strength of the of motion and muscle strength of the

affected extremityaffected extremity..Short Term Goal (STG) #1 – Mr. Jesse will Short Term Goal (STG) #1 – Mr. Jesse will

increase active range of motion of left shoulder increase active range of motion of left shoulder flexion and abduction to 90flexion and abduction to 90˚.˚.

(STG) #2- Client will increase muscle strength of (STG) #2- Client will increase muscle strength of the left shoulder to F+.the left shoulder to F+.

Functional Outcome- With increased range of Functional Outcome- With increased range of motion and muscle strength, client will be able to motion and muscle strength, client will be able to perform self-care activities or tasks such as perform self-care activities or tasks such as dressing and transfers.dressing and transfers.

Con’t…Con’t…

Rationale- Mr. Jesse will sand and assemble a simple wood working project while using a bilateral sander on an inclined plane. The activity can be graded by adding weights on the sanding box or by having the client wear a 3 lb. wrist weight to improve muscle strength. The client will work on the project for 15 minutes a day and gradually increase the duration of the task. Changes in client’s position or sanding direction will facilitate shoulder movements necessary to carry out tasks of everyday living.

DRESSINGDRESSING

LTG- TO PERFORM LOWER BODY DRESSING INDEPENDENTLY.

STG #1 - Client will doff lower body clothing independently with the aid of an adaptive device while following safety precautions by a week.

STG #2- Client will don lower body garments independently with the aid of an adaptive device while following safety precautions by two weeks.

Dressing

RATIONALE- The client will use a dressing stick, sock aid and a reacher to don and doff lower body clothing while following hip precautions. Assistive devices will allow the client to independently perform lower body dressing while reducing the risk of injury.

ASSISTIVE DEVICES- “Hip Kit” which includes a reacher, shoe horn, sock aid, and dressing stick.

Dressing precautions and modifications Patient should be

seated in a chair with arms or on the edge of bed.

Crossing the operated leg over the non-operated leg at the knees or ankles should be avoided.

A reacher or dressing stick should be used for pants or shoes.

When putting on pants, the operated leg is dressed first by using the reacher or dressing stick to bring pants over the foot and up to the knee.

Dressing( Continued)

A sock aid may be used to put on socks, while a reacher or dressing stick is used to remove them.

A long-handled shoe horn may be used to put shoes on while limiting hip flexion motion.

Button hook with zipper aid may be used for limited range of motion and finger coordination.

TRANSFER AND TRANSFER AND MOBILTYMOBILTY

LTG: Resident will LTG: Resident will independently and safely independently and safely ambulate and transfer.ambulate and transfer.

• STG #1- Client will use proper STG #1- Client will use proper positioning in order to safely transfer positioning in order to safely transfer from bed to wheelchair with the use from bed to wheelchair with the use of an assistive device by two weeks.of an assistive device by two weeks.

• STG #2- With the use of transfer STG #2- With the use of transfer techniques, client will independently techniques, client will independently ambulate and transfer from bed to ambulate and transfer from bed to wheelchair without the use of an wheelchair without the use of an assistive device by a month.assistive device by a month.

Con’t… • Rationale- The goal of the transfer is Rationale- The goal of the transfer is

for the person to do the activity for the person to do the activity safely and independently. As Mr. safely and independently. As Mr. Jesse grows stronger, he will require Jesse grows stronger, he will require less assistance and will eventually be less assistance and will eventually be able to ambulate independently. The able to ambulate independently. The ability to transfer will allow the ability to transfer will allow the client to perform activities of daily client to perform activities of daily living.living.

PositioninPositioninggThe surfaces for transferring should be non-

movable, firm and well supported and of similar heights.

When transferring from a wheelchair, the wheelchair should be locked, should be in a position that allows the client to use the better side and the footrest should be out of the way.

During transfer from a bed to a wheelchair, it is often advantageous to position the wheelchair at a slight angle to the bed, so that the wheel is not in the way of the transfer.  It is better if the bed is a little higher than the wheelchair - to allow for a downward transfer.  The most common procedure is for the patient to sit on the edge of the bed and then slide across to the wheelchair on the Sliding Board .

Deep Venous Thrombosis(DVT) Symptoms and Prevention

leg pain in one leg only leg tenderness in one leg only swelling (edema) of only one leg increased warmth of one leg changes in skin color of one leg, redness Prevention: perform simple exercises

during long car rides or airplane flights;wear elastic stockings.

Health Management

HOME MODIFICATIONHOME MODIFICATION

BathroomBathroom

Shower Stall: Shower Stall: Place Non-skid Place Non-skid strips or stickers strips or stickers in shower stalls in shower stalls or tubs.or tubs.

A shower chair A shower chair with adjustable with adjustable legs may be legs may be installed installed

Bathroom (cont)Bathroom (cont)

Patient stands parallel Patient stands parallel to tub facing shower to tub facing shower fixtures and using fixtures and using walker or crutches,steps walker or crutches,steps into shower sideways into shower sideways while bending at knees while bending at knees not hips.not hips.

Long handled bath Long handled bath sponge may be used to sponge may be used to wash legs and feet, wash legs and feet, while a towel wrapped while a towel wrapped on a reacher may be on a reacher may be used to dry the legs and used to dry the legs and feet.feet.

A tub bench may A tub bench may be used if be used if balance is an balance is an issue or weight- issue or weight- bearing is to be bearing is to be avoided.avoided.

Bathroom (con’t…)Bathroom (con’t…)

Grab barsGrab bars should be should be screwed directly screwed directly into wall studs on into wall studs on either side of the either side of the toilet and in the toilet and in the bathing area.bathing area.

KitchenKitchen Adaptive one-handed Adaptive one-handed

cutting board,one-cutting board,one-handed electric can handed electric can opener,jar openers, opener,jar openers, and built-up handle and built-up handle utensils may be used utensils may be used to compensate for to compensate for limited joint range of limited joint range of motion and muscle motion and muscle strength.strength.

Items in refrigerator Items in refrigerator and cabinet should and cabinet should be arranged so that be arranged so that they are in the most they are in the most accessible place.accessible place.

Remember that because of the Fair Housing Remember that because of the Fair Housing Act, it is illegal for a landlord to outright Act, it is illegal for a landlord to outright refuse to make reasonable accommodations. refuse to make reasonable accommodations. The tenant pays for these accommodations. The tenant pays for these accommodations. When tenants move out, they must restore When tenants move out, they must restore the dwelling to its original condition, if the the dwelling to its original condition, if the landlord desires. Sometimes a landlord will landlord desires. Sometimes a landlord will pay for part of the accommodations because pay for part of the accommodations because accessibility features enhance the dwelling. accessibility features enhance the dwelling. Grab bars or levered door handles will make a Grab bars or levered door handles will make a unit potentially more marketable to more unit potentially more marketable to more people, such as elderly tenants or tenants people, such as elderly tenants or tenants with limited mobility. The landlord and tenant with limited mobility. The landlord and tenant should be able to work out the modifications should be able to work out the modifications amicably. amicably.

Home Modification

For more information on the Fair For more information on the Fair Housing Act and Amendments of 1988, Housing Act and Amendments of 1988, see the U.S. Department of Housing and see the U.S. Department of Housing and Urban Development (HUD) Urban Development (HUD) Web site: Web site: http://www.hud.gov:80/sec8.html#a.http://www.hud.gov:80/sec8.html#a. HUD also offers a "Disability" HUD also offers a "Disability" resources page loaded with helpful resources page loaded with helpful information: information: http://www.hud.gov:80/disabled.htmlhttp://www.hud.gov:80/disabled.html

Home Modification

Support groups for stroke Support groups for stroke survivors and their familiessurvivors and their families

Glen Cove Hospital: Glen Cove Hospital: 33rdrd Tuesday of every Tuesday of every month from 2-3:00pmmonth from 2-3:00pm

LIJ Medical Center: LIJ Medical Center: 22ndnd Tuesday of every Tuesday of every month from 1-3:00pmmonth from 1-3:00pm

North Shore North Shore University Hospital: University Hospital: every Friday from 10-every Friday from 10-1:30pm1:30pm

Glen Cove Hospital Glen Cove Hospital 516 674 –7895516 674 –7895

Long Island Jewish Long Island Jewish Medical Center(LIJ) Medical Center(LIJ) 718 470-7706718 470-7706

North Shore North Shore University 516 562-University 516 562-49474947

Renal Disease Support Renal Disease Support

National Kidney National Kidney FoundationFoundation30 East 33rd St., 30 East 33rd St., Suite 1100Suite 1100New York, NY New York, NY 1001610016(800) 622-9010(800) 622-9010(212) 889-2210(212) 889-2210www.kidney.orgwww.kidney.org

Patient & Family CouncilPatient & Family Council

Goals:Goals: EducationEducation -- to educate -- to educate

and empower patients and empower patients and families to make and families to make informed decisions about informed decisions about the quality of care they or the quality of care they or their loved ones receive their loved ones receive http://www.kidney.org/patihttp://www.kidney.org/patients/pfc/pfform.cfments/pfc/pfform.cfm

PRESENTED BY:

RACHEL DECRESCENZO

RACHEL BIANCA MALLARI