Ms J 1 Meredith Smythe Ted Zabel Meet Ms J 78 year old Retired nursing professor phd PMhx Bilateral knee replacements R revised a year later in 2008 Broken R patella 2010 ID: 778266
Download The PPT/PDF document "Geriatric Presentation of" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Geriatric Presentation of Ms J 1
Meredith
Smythe
, Ted
Zabel
Slide2Meet
Ms J 78 year old
Retired nursing professor (
ph.d
)
PMhx:Bilateral knee replacements (R revised a year later in 2008)Broken R patella (2010)Generalized arthritis Colitis, esophagitis, gastritis (long-term use of NSAIDs)HypertensionBipolar I disorder 2 falls (over a year ago)
2
Slide3Medication List
Celebrex (NSAID) 200 mg am and pm for arthritisLipitor 40 mg am for Cholesterol controlAllegra 180 mg am for allergiesAdvair 250 BID for asthmaFlonase spray 2 times a day for allergies and asthmaSingulair 10 mg in am for asthma
Nexium
40 mg am
for GERD
Delzicol Dr 400 mg 2 time a day for ColitisAmbien 10 mg in pm for InsomniaLamictal 50 mg in pm for Depression/ Mood Stabilizer for bipolar disorderClotrimazole and Betamethasone cream for rectal irritationZopenex (prn) for shortness of breathGabapentin 100-200 mg (prn) for pain and burning in feet 3
Slide4Social History
RetiredLives in a nice CCRC: Carolina MeadowsThere are 10 people in her building that the goes to eat with and does activities withParticipates Silver sneakers at YMCA and goes to coffee with friends twice a week
Has a g
ood
friend in
building who is her outing buddy: ballet, symphony, playsSings in choir at church/ and at funerals Takes her grandchildren (in Hillsborough) out to each each week 4
Slide5Subjective Findings
“I’m in good shape”Bilateral pain on the dorsum of her feetAfraid of falling/ balance problemsAfraid of loosing her memoryIndependent with ADLs
Joints ache: back, knees, feet
Exercise
:
Water aerobics 4x weekBalance/ strength training 1x time a week (Carolina Meadows) 5
Slide6OBJECTIVE: Communication
Alert and Oriented x 4Very eloquentNo hearing loss
6
Slide7Objective: strength and ROM
Full ROM bilaterally UE and LE 5/5 LE strength Other FindingsPes cavus+ navicular drop test
7
Slide8Objective: Balance and Outcome Measures
Berg Balance Scale 52/ 56 4 stage balance test: performed twice: better outcome with shoes feet together 30 seconds
tandem : 30 seconds
SLS : 10 seconds left, 3 right5 x sit- to-stand : 14.5 seconds 8
Slide9Problem List
Her concerns:Balance Memory decline PT problem List:Minimum Falls risk
Over pronation
Referrals:
Pharmacist
medication interactions/ lightheadedPT/ orthotist orthoticsPCP memoryPhysiatrist
checkup
Psychologist and Psychiatrist
monitor bipolar symptoms and medication management
Slide10Plan/ Intervention
Home Exercise Program:3x 20 toe scrunches bilaterallyJustification: We included this exercise in the patient’s HEP because we noted instability/weakness in the arch of the patient’s foot which contributed to over pronation and decreased balance.
Balance exercises
: We instructed the patient to complete this exercise at her kitchen counter for safety.
We instructed the patient to complete 3x 10 seconds of feet together
Eyes open or closed depending on her comfort levelWe also instructed the patient on proper progression of tandem stance and to complete 3x 10 seconds bilaterally of this exercise as well.
9
10
Slide11Barriers to Success/ Positive factors
BARRIERS: Having trouble admitting when she needs helpToo much self monitoring: the need to get outside opinionsBecause of her profession “doesn’t need advice about drug interactions”
POSITIVE FACTORS:
Good at advocating for herself
Highly educated
Uses her resources Has social supportIs motivated and a hard worker
Slide12Resources
Well aware of her resources-Carolina Meadows: gym, pool, library, social, intellectual activities-YMCA/ silver sneakers-Seymour Center
-
Transportation
11
Slide13Outcomes/ Follow-Up
She went to fleet feet to get shoes that limit pronationBought off the shelf orthotics felt “more stable” Exercises: tried it once or twice but felt unstable (before she bought her shoes)
Referral Follow-up:
PCP – will see
provider in
April and doesn’t think her memory is an issuePhysciatrist- due to make an appointmentPharmacist: “not necessary”
Slide14She saw value in our exercises and will “continue to do them”
We motivated her to get better footwearShe felt we gave her “safe” exercise options
Slide15What we learned
How someone presents on paper is very different from in personIt’s important to really listen to the clientMaking things relevant to what she was interested helped with compliance
13
Slide16References:
1. Library C. Vietnam War Fast Facts. http://www.cnn.com/2013/07/01/world/vietnam-war-fast-facts/ index.html. Accessed June 20, 2002.2. Ocampo D. New UNC School of Nursing Dean. http://chapelboro.com/news/unc/new-unc-school- nursing-dean. Accessed February 20, 2016.
3. Group JU. Medication Costs. http://
www.jerseyurology.com
/patient-education/medication-costs/.
Accessed February 20, 2016.4. Fun Heap SF. Free SF Civic Symphony Concert “Mozart to Mendelssohn.” http://sf.funcheap.com/free- sf-civic-symphony-concert-mozart-mendelssohn-sf/. Published 2016. Accessed February 20, 2016.5. Lewis R. 11 Amazing Seniors Doing Yoga. https://www.doyouyoga.com/11-amazing-seniors-doing- yoga-18985/. Accessed February 20, 2016.6. Pinterest. Art Impressions. https://www.pinterest.com/tonyanddiane77/old-ladiesmen-silly-clipart/? lp=true. Published 2016. Accessed February 20, 2016.7. Pinterest. Cute Hamster. https://www.pinterest.com/pin/363173157421469513/. Published 2016.
Accessed
February 20, 2016.
8. Dangers S.
Strange Elephant Balances One-legged on a Ball!
http:/
/www.strangedangers.com
/content
/
item
/117353.html. Accessed February 20, 2016.
9.
Rosengart
M. Foot and Ankle
Activation. http
://
www.prehabexercises.com
/ankle-activation/.
Accessed February
20, 2016.
10.
Moreels
, Bart, Abdul
Khadir
, Sheik, Jackson, Daphne, Buxton, Scott, Lowe T. Romberg Test. http:/
/
www.physio
-pedia.com/
RombergTest
.
Accessed February 20, 2017.
11. Carolina Meadows: A Continuing Care Retirement Community. Campus Wellness. https:/
/
carolinameadows.org
/health-and-wellness/campus-wellness/.
Accessed
February 20, 2016.
12. Tools M. Giving
Feedback.https
://
www.mindtools.com
/pages/article/newTMM_98.htm.
Accessed February
22,
2016.
13. Blog FUFL and C. The Best 6 French Reference Books All Learners Should Have on Their Desks. http:/
/
www.fluentu.com
/
french
/blog/
french
-learning-books/. Accessed February 20, 2016.