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Original Post: Mary's Questions

Elizabeth Tai

Posted: Fri Feb 05/10 10:44am

Swelling:

Concern: compartment syndrome:

Did not inform about: not talking to her, but around her

Does she have it, is there a test? Osteoporosis

Family practitioner

Nurse: health teaching, health education

Family history: marys mom had osteoporosis: 70, fracture, and passed away

Risk factors: postmenopausal women,

GP/Nursing: Health education

Is there a cure?

GP/Nursing: health education

Anything to do to prevent form getting worse?

Physician: Bisphosphates, vitamin D, calcium intake

Nursing: nutritional information: weight-bearing exercises, first person they see, so

PT: assessment: exercise

Nursing: OT first to do ROM

Left-handed: hard to zippers, fingers swollen, lids off jars, fingers blue

Physician: Pain medication, imaging, vascular issue.

OT: training with other fingers: getting dressed and

PT: for regain hand-funciton: suggestions

Concerned about swelling:

Physician: swelling to be addressed

Will Mary need to move? Does not want to move.

OT: ADL: functional assessments

Future info: ADL: for future

Life alert

Home care: nursing homecare (at some point)

Health education

OT consults on outfitting the home

Son wants her to go to nursing home, but Mary wants to remain independent: Mary is 65

Afraid of falling: red flag

Current Reply

Some ideas I thought of to complement our outline. I also added Krista's comments here! Main OT role-maximize participation and independence in daily life...in this instance help brainstorm how Mary will manage with ADLs in her task, home assessment to prevent additional falls, helping to make community links, education on fall prevention and instilling self esteem to encourage continued particpation (counter fear of falling) 1. Swelling:                 Concern: compartment syndrome:           Did not inform about: not talking to her, but around her   Does she have it, is there a test? Osteoporosis Family practitioner: BMD, ways to test. Assess for risk factors, absolute fracture risk, use T-score Nurse: health teaching, health education: focus on diet, supplements, medical managment and explanation of beneficial exercises           Family history: marys mom had osteoporosis: 70, fracture, and passed away                    Risk factors: postmenopausal women. Mum's history is a major risk factor, and indicates bone densitomatry according to Canadian guidelines.                    GP/Nursing: Health education           Is there a cure? No cure, however, focus on managmenent: Bisphosphonates, anabolics, dietary, as well as hormone therapy, antibody-targeted therapies. Many options to mantain bone health. Exercise also important.                    GP/Nursing: health education           Anything to do to prevent form getting worse? Physician: Bisphosphates, vitamin D, calcium intake, if severe, anabolics Nursing: nutritional information: weight-bearing , aerobic, and resistence exercises, PT: assessment: exercise ROM exercises, reassess in 2 weeks Nursing: OT first to do ROM, ADL Krista-I think PT/OT would collaborate on ROM, depending on where you work, I have most commonly seen PT do lower extemities and OT do upper extremities. Left-handed: hard to zippers, fingers swollen, lids off jars, fingers blue           Physician: Pain medication, imaging, vascular issue.check pulses, capillary return. also check neuro status. is swelling due to other cause such as infection? Or is it still normal to be slightly swollen at the 6 week mark? Rule out and make sure.           OT: alternative methods for dressing and meal preparation           PT: for regain hand-funciton: suggestions Krista-Again with the OT and upper extremit, I doubt PT would have much to do with regaining hand function. OT would definitely address ADLs for the non-dominant hand. There are tools you can get for buttons etc. One thing to think about it that its only a break-and it will get better. It would be good to help in independent ADL with the other hand, but will she be able to master the skills in 6 weeks. I think it might actually be better to compensate for how she does her ADLs for 6 weeks rather than re-teaching her skills. For example, does she have to wear button down shirts when she has to dress herself or is there something she can independently dress in more easily for the time being. You could also enlist the help of her daughter for the time she is healing, ask if it would be reasonable to depend on her daughter a little more during the time she in a cast. Concerned about swelling: Physician: swelling to be addressed Will Mary need to move? Does not want to move.                    OT: ADL: functional assessments                    Future info: ADL: for future Life alert                     Home care: nursing homecare (at some point) Health education                    OT consults on outfitting the home OT is huge here Krista-I think the home assessment is the most important. Yes, Mary fell, and she had a break. Most who fall once will fall again, and I think the statistic is 40% (or 60-not reall sure) are fatal. So preventing a fall is the most important factor in this case. From taking a look at her house, stairs are a major concern. The stairs to upstairs not only look steep but there is no defining step-the carpet is so mesmerizing-a ledge could be put on the edge of each stair or a new carpet. The stairs to the basement have no railing. In the fireplace room, her favourtie chair looks like it would be quite deep-which could be tough to get in/out of. There is a ledge by the fireplace she can trip on, but more importantly the carpet in the middle of the floor-they are very easy to catch a toe on and fall. I would also be concerned about the bathroom. I didn't see many supporting grab bars, the height of the tub would be of a concern-if its too high it can be a tripping hazard without supports, etc. Son wants her to go to nursing home, but Mary wants to remain independent: Mary is 65 Afraid of falling: red flag  Krista-definitely a red flag. If she is afraid of falling there is the potential for her to become holed up in her apartment, afraid to go anywhere. So I think, as she is discharged it is important to help make her feel more confident in herself by providing education on how to avoid falling, supports in the community such as an OT home visit. On the home visit, the OT can also assess the way she performs her activities and make suggestions on how to make them easier or safer. OT can also inquire on how she gets around in the community and make suggestions on community supports

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