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Group 7 ICE: Meet Lillian

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by

Stephanie Wise

on 21 November 2014

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Transcript of Group 7 ICE: Meet Lillian

Lillian
Occupational History
45 year old woman
Mother of 2
Fourth grade teacher
Enjoys photography, scrap-booking, swimming
Partner works irregular hours as a police officer
Stressful new hospital room environment
Distance from bed to toilet
Small space in hospital room
Best solution: Appropriate amount of stimulation
Alternative Solution: Preparation/education to explain what to expect while in the hospital

Best solution: Using a walker to get to the bathroom
Alternative solution: Bedside commode

Biomechanical
Changes and Adaptations

Transfers
Gait
Change: Weakness in her RLE produces a smaller effort force in her legs when sitting down and standing up


Symptoms
Progressively worsening headaches

Tingling, numbness, weakness in R hand

Slurred speech

Episodes occurring more frequently

Hospitalized due to seizure
Diagnosis:
Anatomical Constructs affected by the tumor

Cognition
Executive Function
Attention
Working memory
ADLs
Social Environment
Differential Diagnosis
Transient ischemic attacks (TIAs)

Presents with similar symptoms
TIAs would not occur as frequently
TIAs also not commonly treated with surgery

Joints
Blood Flow to the Brain
Central Nervous System
Change: Weakness in her RLE will affect both the swing and stance phase of her gait
Adaptation: A walker would allow her to put more weight on the walker and will increase her base of support for more stability.
Group 7
Migraines with stroke-like symptoms
No prior migraine history
No other common migraine symptoms: aura, dizziness, sensitivity to light, smell, or sound.
Localization
Left Parietal Lobe
Right-sided sensory and motor impairments
Brain Tumor
Lillian's diagnosis:
Assessing Lillian
Muscle Atrophy
Important Constructs

Environmental Barriers
Barrier 1: Stressful new hospital
room environment
Barrier 2: Distance from
bed to toilet
constant flow of people
noise
clutter
being hooked up to machines
hard to get to bathroom
Safety: wires and hook-up, mobility
what to expect in next stage of care
emotional preparation
Walker
Dressing Stick
Toileting Aid
Adaptive Toothbrush

Improving stamina to complete tasks
Activity Analysis
Activity: Brushing her teeth
Difficulties
ROM - wrist extension
Muscle tone
Grip strength
Poor endurance
Strengths
Impaired light touch will not interfere with ability to touch toothbrush
The FIM
The MoCA
The MOS Social Support Survey
The OSA
Emotional support
Informational support
Affection
Tangible support
Positive interaction

Volition (interprets and chooses occupations)
Habituation (habits and roles of everyday life)
Performance (abilities that allow them to participate)
attention and concentration
executive function
memory
orientation
language
conceptual thinking

self-care
transfers
locomotion
communication
social cognition
Assesses:
Assesses:
Assesses:
Assesses:
Decrease in muscle mass due to limited use
Muscle will grow weaker as mass continues to decrease
Cross-sectional area of muscle is decreasing
Decreased strength will likely impair function, especially if Lillian is right-hand dominant.
Cardiovascular system
Adaptation: A walker will increase her base of support and allow her to add both arms as effort forces.
Lillian's Treatment Plan
Education
Caregiver Education
What to expect due to impairment
Level of support Lillian will need
Community Resources
Patient Education
Safety in Healthcare
Keep lines and wires separate and traceable
Help staff, Lillian, and visitors to be aware of various wires and machines
Contemporary Issue!
Skilled Instruction of ADLs
Completing ADLs
With right-sided weakness
With sensory deficit
With crowded/stressful environment
Assistive Technology Training
veins and arteries
Blood flow pathway
Intracranial pressure
smooth muscle collapse
tissue needs oxygen
send, receive, and interpret information from all parts of the body
Intact superficial pain
occurs locally in the spinal cord
No evidence or history of peripheral nerve trauma
Damaged Neurons of CNS
Numbness and tingling
due to CNS inability to process and integrate PNS signals
Numerous factors affect ROM
Muscle weakness vs joint structure
Cause of AROM deficit determines course of treatment
Contemporary Issue!

short, self-report
Good for acute care
How she is feeling about her occupations at this moment
Reasoning:
easy to administer/common in acute
physical impairments could affect her ADLs
Reasoning:
Reasoning:
Short, self-report
Parenting with a disability
Partner works irregular shifts
Needs social support
Reasoning:
short, easy to administer
safe
occasional confusion and headaches
Other Considerations:
Spirituality
Psychological
Alternate Contemporary Issue!
Sarah Colwell, Krista Fox, Anita Khoong, Jill Krampe, Kelsey Melchior, Samantha Slutzky, & Stephanie Wise
Other Considerations:
Mobile Apps
Alternate Contemporary Issue!
Solutions:
Solutions:
Full transcript