2. 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.

3. PROBLEM LIST DECREASED 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.)

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

5. Long Term Goal (LTG)-Increase active range of motion and muscle strength of the affected extremity. Short Term Goal (STG) #1 – Mr. Jesse will increase active range of motion of left shoulder flexion and abduction to 90˚. (STG) #2- Client will increase muscle strength of the left shoulder to F+. Functional Outcome- With increased range of motion and muscle strength, client will be able to perform self-care activities or tasks such as dressing and transfers.

6. 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.

7. DRESSING  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.

8. 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.

9. 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.

10. 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.

11. TRANSFER AND MOBILTY

12. LTG: Resident will independently and safely ambulate and transfer. STG #1- Client will use proper positioning in order to safely transfer from bed to wheelchair with the use of an assistive device by two weeks.STG #1- Client will use proper positioning in order to safely transfer from bed to wheelchair with the use of an assistive device by two weeks. STG #2- With the use of transfer techniques, client will independently ambulate and transfer from bed to wheelchair without the use of an assistive device by a month.STG #2- With the use of transfer techniques, client will independently ambulate and transfer from bed to wheelchair without the use of an assistive device by a month.

13. Con’t… Rationale- The goal of the transfer is for the person to do the activity safely and independently. As Mr. Jesse grows stronger, he will require less assistance and will eventually be able to ambulate independently. The ability to transfer will allow the client to perform activities of daily living.Rationale- The goal of the transfer is for the person to do the activity safely and independently. As Mr. Jesse grows stronger, he will require less assistance and will eventually be able to ambulate independently. The ability to transfer will allow the client to perform activities of daily living.

14. Positioning The 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.

16. 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

17. HOME MODIFICATION

18. Bathroom Shower Stall: Place Non-skid strips or stickers in shower stalls or tubs. Shower Stall: Place Non-skid strips or stickers in shower stalls or tubs. A shower chair with adjustable legs may be installed A shower chair with adjustable legs may be installed

19. Bathroom (cont) Patient stands parallel to tub facing shower fixtures and using walker or crutches,steps into shower sideways while bending at knees not hips. Patient stands parallel to tub facing shower fixtures and using walker or crutches,steps into shower sideways while bending at knees not hips. Long handled bath sponge may be used to wash legs and feet, while a towel wrapped on a reacher may be used to dry the legs and feet. Long handled bath sponge may be used to wash legs and feet, while a towel wrapped on a reacher may be used to dry the legs and feet. A tub bench may be used if balance is an issue or weight- bearing is to be avoided. A tub bench may be used if balance is an issue or weight- bearing is to be avoided.

20. Bathroom (con’t…) Grab bars should be screwed directly into wall studs on either side of the toilet and in the bathing area.

21. Kitchen Adaptive one-handed cutting board,one- handed electric can opener,jar openers, and built-up handle utensils may be used to compensate for limited joint range of motion and muscle strength. Adaptive one-handed cutting board,one- handed electric can opener,jar openers, and built-up handle utensils may be used to compensate for limited joint range of motion and muscle strength. Items in refrigerator and cabinet should be arranged so that they are in the most accessible place. Items in refrigerator and cabinet should be arranged so that they are in the most accessible place.

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

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

24. Support groups for stroke survivors and their families Glen Cove Hospital: 3 rd Tuesday of every month from 2-3:00pm Glen Cove Hospital: 3 rd Tuesday of every month from 2-3:00pm LIJ Medical Center: 2 nd Tuesday of every month from 1-3:00pm LIJ Medical Center: 2 nd Tuesday of every month from 1-3:00pm North Shore University Hospital: every Friday from 10- 1:30pm North Shore University Hospital: every Friday from 10- 1:30pm Glen Cove Hospital 516 674 –7895 Glen Cove Hospital 516 674 –7895 Long Island Jewish Medical Center(LIJ) 718 470-7706 Long Island Jewish Medical Center(LIJ) 718 470-7706 North Shore University 516 562- 4947 North Shore University 516 562- 4947

25. Renal Disease Support Renal Disease Support National Kidney Foundation 30 East 33rd St., Suite 1100 New York, NY 10016 (800) 622-9010 (212) 889-2210 www.kidney.org National Kidney Foundation 30 East 33rd St., Suite 1100 New York, NY 10016 (800) 622-9010 (212) 889-2210 www.kidney.org www.kidney.org Patient & Family Council Goals: Education -- to educate and empower patients and families to make informed decisions about the quality of care they or their loved ones receive http://www.kidney.org/pati ents/pfc/pfform.cfm Education -- to educate and empower patients and families to make informed decisions about the quality of care they or their loved ones receive http://www.kidney.org/pati ents/pfc/pfform.cfm

26. PRESENTED BY: RACHEL DECRESCENZO RACHEL BIANCA MALLARI