Case 2: 82-year-old woman who fractured the head of her left femur and then had

Question

Case 2: 82-year-old woman who fractured the head of her left femur and then had a heart attack trying to crawl to a phone in her bedroom. She has been in the hospital for 10 days and is transferring to a transitional care facility in 2 days.

Mrs. Anderssen was seen today in her room for work on toilet transfers and dressing. She transfers from bed to wheelchair with minimal assist using a transfer belt and a pivot transfer. This is an improvement, since she was requiring moderate assist 2 days ago. She propelled herself to the bathroom and washed her face and upper body with a washcloth independently. The toilet seat is raised to same height as wheelchair seat. Toilet also has handrails. Client locked the wheelchair at a right angle to the toilet, put both hands on the arms of her wheelchair, and using both arms and her right leg raised herself to standing. She moved her right hand to the toilet rail, pivoted on her right leg, and sat down on the toilet with stand-by assistance. She independently obtained and used toilet paper. She reached behind her and flushed the toilet while still sitting. Then she again used her arms and right leg to stand and then used a pivot transfer with minimal assist to get back to the wheelchair. She reports that except when OT is in her room, the nurses give her a lot of assist with toilet transfers. She has not yet tried toileting independently while wearing street clothes, which would require her to worry about adjusting her clothing. We will attempt to do it this afternoon.

She propelled herself into her room and in front of her closet. From her closet she used a long-handled reacher to get a hanger down from the hanging rod. She removed a sweat suit and replaced the hanger, again using the reacher. Then she got her bra and panties out of a drawer. She removed her gown and put on her bra (using the hook in front, then twisting it around and pulling up the straps) and sweatshirt without assistance. Next, she used a sock aid to put on anklets. It took three tries and some verbal cues, but she did do it without physical assist. Then she used the dressing stick to put her panties and pants on and pull them just over her knees. This was a slow process and she expressed some frustration at how tired and slow she felt. Until she fell, she was a very active woman and participated in a local mall-walking club. It is probably because she was in good condition for her age that she has made the progress that she has. She slid her feet into Velcro sneakers with a long shoehorn. She pushed herself up to standing, pausing for a couple seconds to make sure her balance was good. She steadied herself with her left hand on the bed. Finally, she pulled her panties and pants the rest of the way up and then sat back down in her chair. The entire process of washing, toileting, and dressing took 35 minutes. She reports that it used to take her 10 minutes to do all that, although she didn’t have to use all that extra equipment. She is progressing as planned. OTR left instructions for undressing with both Mrs. Anderssen and the nursing staff.

Write two long term goals and two short term goals for each long term goal. Relevance of goals as well as adherence to S.M.A.R.T guidelines for writing goals.

Explanation / Answer

S. M. A. R. T guidelines include of features such as specific, measurable, Attainable, Realistic and Timely

Long term goal will be to make her walk again.

Short term goal will be for achieving above purpose is to make her practice atleast five to ten minutes walk everyday as a result she can try to regain her self confidence back again and sometimes she should be allowed to walk independently too.

Another long term goal will be to acheive her independently performing all the necessary task and make her feel better.

Short term goal will be to acheive above task is to utilise her self confidence as a strength. As we have seen Mrs. Anderssen is trying to get her work as much as possible by herself we can utilise this strength of her for self encouragement as a result she can have strong mental strength. The urge of getting back to normal is lying within her so this can help her to get back to perform her task within timeframe. She should be put on basic movement exercise which will make her body flexible keeping her blood flow appropriate.

Related Questions

Navigate

• Browse (All)
• Browse C
• Subjects

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.