Student Name: __Krysife Mitchell Case #6 Wendy Date: 4/10/17 1, Diagnosis, Referral, Seting, Reimbursement, LOS hi UT, She fives with er two doy She comp! Referred to tran: LC Transitional Care Unit Medicaid Treatment Length: 3 weeks (approximately) Diagnosis: Pneumonia, CHF, COPD, Type Il diabetes, OA, gout, and TKA (x3 years aga) 1 information: 73 y/o female retired rancher who will ceturn to live alone in singlewide trailer in Emory, three eats, and occasionally her grandson, Phillip. Her health has been declining over the past few years with several short stay hospitalization and difficulty regulating blood sugars. of unsteady gait, deereased overall strength, progressively worse visio! fingertips and taes, She received a score of 24 on MoCA. fional eare unit after short stay at hospital for pncumonia, Physician predicts that ill go home after 3 weeks of treatment with O2 use af night and for exerting activity. and tingling in bathroom, kitchen, and bedroom. Transitional consider Wendy's 01 will be there during i - 2. Pragmatic Factors to Consider Treatment will be af a transitional rchab facility that typically bas access ta more ADL faci Rehab requires a designated amount of therapy. Equipment will ‘be what is in the facility, what the family wants to bring, or what the therapist brings. Treatment has to follow Medicaid guidelines and may not cover all cheonie needs. The therapist must be aware of the medical and ‘hursitig priorities, as well as monitor the patient and their condition during therapy. Therapy is goit el and she may require her ©2 during therapy. Its also important to consider wha py so thal family (grandson) can be included in therapy to hear the information and strategies if she wishes, The therapist must be aware of the medical and nursing prioritics, as well the patient and their condition during therapy. Therapy tienes will have to be scheduled with other appointments in mind (possible PT, nursing, doctor appointments, visitors, meals). Home is.a singlewide in Emory, whieh is rural area a large distance from center. May be alone or with grandson (is he reliable), ities such asa full tw have to as monitor 5. Diagnosis and Fxpected Course Medical Diagnosis: Prewmnonia, Type IT diabetes, CHF, COPD, gout, OA Common Symptoms and Effects of medical ‘events Diabetes: Polyuria, Polydipsia, Recurrent ‘blurred vision, Irritability, Tingling or :mumbness in hands and feet, Fatigue, Weakness, and Asymptomatic ‘General Course: Diabetes is a chronic, systemic disorder. It can contribute to damage ‘of eyes, kidneys, nerves, heart, and blood vessels. Although long-lerm complications of diabetes develop gradually, they can ssventually be disabling or even life- threatening. Some of the potential complications of diabetes include: Neuropathy, ‘Cardiovascular Disease, Nephropath: Retinopathy, Foot damage, Skin conditions ©. Scientific Reasoning & Evidence List the barriers to performance typical of this diagnosis: for Diabetes Type I (and all the others) may include the COPM, Health Status Questionnaire, Activity Card Sort, Assessment of Occupational Funetioning- Collaborative Version (persona causation, values, roles, habits, and skills), Occupational Performance History Interview Hf, Occupational Questionnaire, Occupational Profile of Sleep, and a Stress diary. Assessments that evaluate ADL and IADL include Kohiman Evaluation of Living Skills and the Assessment of Mator aud Process Skills, Some clients ‘ay also benefil from completing a Beck Depression Inyentory-I1_ Evaluations for CHF, COPD, gout also may include hand function tests, he PASS, pinch and grip, AMPS, and role checklists, Barriers to perform: # Loss of sensation can decrease functional participation im ADL and JADL + When bload glucose levels re persistently high, a Page tof sed L917(bacterial and fungal infections), Hearing ‘impairment, and Alzheimer’s discase corp: ‘Symptoms may include ehronie productive ‘cough, dyspnea with exertion, banel ehest- chronic lung over inflation, uses acecssory museles to breathe, Supplemental O2, increased breathlessness, frequent coughing ‘with and without sputum), sneezing, tightness ‘of chest neral Course: Symptoms of COPD typically begin in peaple aged over 40 who have smoked for 20 years or more. A ’smoker's ‘cough’ tends to develop at first. Once ‘symptoms start, if you continue to smoke, there is usually 1 gradual decline over several years. You tend to become more and more breathless. In time your mobility and genetal quality of life may become poor duc to sncreasing breathing difficulties ‘Chest infections tend to become more frequent as time goes by, Flare-ups (exacerbations) of sytiptoms occur from time to tume, typically during a chest intection Ifthe condition becomes severe then heart failure may develop. This is duc to the reduces! level of oxygen in the blood and changes in the lung tissue, which can cause increased pressure in the blood vessels in the lungs. This Increase in pressure can put a strain on the heart muscle, leading to heart failure, Meart failure ean cause various symptoms including, worsening breathlessness and fluid reteition. Respiratory failure is the final stage of COPD, AL this point the lungs are so damaged that the Jevels of oxygen in the blood are low, The ‘waste product of breathing, called carbon diowide (C02), builds up im the blood stream. People with end-stage COPD need palliative care to make them more comfortable and ease any symptoms. Pneumonia: Doctors use antibiotics to treat pneumonia caused by bacteria, the most non cause of the condition, Anibioties have a high cure rate for pneumonia, The doctor will choose the antibiotic based on a number of things. including age, symptoms and how severe they are, and whether they wide range of chronic complications ean occur. ‘These ean include kidney disease, vision loss, heart disease, stroke, and neuropathy, among others Many of these long-term complications can be barriers to performance of activities necessary to successfully self-manage diabetes. Diabetes is also frequently accompanied by depression and anxiety, Treatment: Promote healthy food choices and safe cooking methods; Instruct in safe and appropriate ways to incorporate exercise and physical activity into daily routines, Provide techniques to organize and track medications, Instruct in the use of low-vision and nonvisual devices to-draw up and measure insulin; Instruct and provide strategies to successfully use a talking blood glucose monitor or use any blood «glucose monitor one handed; Incorporate protective techniques and compensate for peripheral sensory loss in activities that involve ‘exposure to heat, cold, and sharp objects; cate in techniques to structure time and simplify activities to cope with depression such as breaking down dietary changes and an exereise program into manageable steps and incorporating them into present daily routines, Can be controlled with diet, exercise and oral hypoglycemic agents Occupational therapy practitioners can assist clicnts to develop simple, conerete, measurable, and achievable selE-management goals consistent with the seven. bbchaviors advocated by the American Association of Diabetes Educators (AADE). These ADE 7TM Sel Care Behaviors arc: (1) healthy cating, (2) being active, (3) monitoring, (4) taking medications, (5) problem solving, (6) healthy coping, and (7) reducing, risks. Includes not only blood glucose testing but also tracking blood pressure, weight, foot health, and “steps walked” ta ensure the person is elting enough physical activity. Reducing risks eneompasses a diverse group of behaviors including, but not limited to, smoking cessation; foot sel/inspeclions; maintenance of persanal health records; and regular eye, foot, and dental exams, ercating a need for clients to track and diligently attend appointments with their diabetes hrealth care tear. Page 2of 15 Revised 119817nieed to go to the hospital. The number af days to take antibiotics depends on general health, how serious the pneumonia is, and the type of antibiotic being used, Most people see some nprovement in symptoms in 2 to 3 days The most noticeable symptom associated with pncumania is @-cough {most likely with ‘mucus/sputum from your lungs), fever, fast breathing and feeling short of breath, shaking and “teeth-chattering’" chills, ehest pain that often feels worse when you cough or breathe in, fast heartbeat, feeling very tired or very weak, nausea and vomiting, and diacrhea Gout: The most common sign of gout is a nighttime attack of'swelling, tendemess, redness, and shamp pain in the big toe. There can also be a gout attack in the foot, ankle, or knees, or other joints, The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for ‘months or years. A buildup of uric avid may lead to gout CHE: Heart is unable to pump sufficient blood to supply the body"s oxygen needs, Back up of blood in pulmonary veins, High pressure in pulmonary capillaries, Leads to pulmonary congestion and hypertension, Chronic or acute S&S: Cough, Dyspnea on exertion, Paroxysmal nocturnal dyspnea, Orthopnea, Decreased urine production, Fatigue. weakness, faintness, Palpitations _, Shortness | of breath, and Weight gain from fluid retention | OA: Joint inflammation that results trom aging, heredity, trauma, . Signs and symptoms include swollen joints, joint stiffness, joint creaking, and loss. motion. Progressive References Used: Pedrelti Rook, Beth's condition notes, Feanetie’s 6240 lecture notes, AOTA (diabetes), mayo clinic, webmd, Willard and Spackman book Barriers of COPD: © Difficulty breathing will impact ability to participate in activities * Funetional mobility may be affected by shortness of breath, inability to go up stairs oF walk for long, periods of time Chest infections Lack of sacial interaction due ta symptoms Pain or swelling eould oceur. Treatment: STOP smoking Medication management Oxygen management Regular exereise Weight management Environment adaptations; mobility assistance Barriers of performance for pneumonia: © Possible hospitalization © Hard to breathe and complete ADL and TADL Decreased activity tolerance Pain may prevent motivation fo participate in activities © Vulnerable immune system ‘Trealment for person with pneumonias: ment * Energy conservation training © Environmental modifications ¢ Health and wellness education and training, *) Medication manag Barriers of performance for gout * May lead to possible hazardous interaction and salety concerns or fall risks © Problems completing fine motor tasks ‘= Impaired ability to read leisure or hom Treaiment for person swith gout: ‘+ Prevent accidents and injury: change environment and Point out hazards © Modify the task or environment: adapted equipment * Proniote-a healthy and satisfying lifestyle Problem solving skills Barriers Pain, stifiness, decreased ROM and strength prevent activity participation Treatment © Weight loss, adaptive equipment, splints, medication nagement, physical activity Poge 3.of Revived 19/177, Practice Models Guiding Assessment and Treatment | Rationale 1 PEO PEO consists of considering the client, environment, and occupation and the transactions between each of these eaegories to increase o¢cupational performance. We can increase Wendy’s occupational performance through creating change in any one of these areas. We can help Wendy improve her own skill level, insight into her situation, and physical activity level and condition as part of the person of this model. We can make changes to the environment adaptive equipment for vision or sensory loss, Finally, we ean make changes to her occupations through making the task simpler or organizing the tasks in an easier and safer way. Making any change to these three different areas ean lead to overall increase in occupational performance, [20 Rehabilitation Model “The rebubilitetion model is more concerned with what the client can do, than ‘what the client can’t do, It utilizes assistive deviews, adaptive techniques, environmental modifications, and compensatory strategies to increase occupational performance, There ure many tasks that Wendy is having trouble with that can be achieved through modification such as a completing tasks in sitting for balance or compensatory strategies used during functional ‘tasks such as cooking. It is important to assist Wendy with the physical needs to help her body work towards being more physically safe and functional, However, some physical ability may not be able 1o be regained, and it is important to incorporate adaptive strategics and equipment to help Wendy compfete the tasks she wants to do. 3 ‘Transthooretical Model ‘The Transtheoretical Model works tawards changing a behavior (ceasing @ | poor habit, or starting s good habit, especially in regards to health). This ‘made! guides the therapist fo effectively educate and train thos at risk fos or ‘who currenily have diabetes to modify current habits and routines and develop new ones to promote a healthier lifestyle and minimize disease Progression, A person may not yet be ready for change, in this case, positive suggestion, and education for the client can help shift towards the client thinking about change--before taking actions for change. An OT's role is ‘mast important during the action phase. A client may feel vulnerable and cessily relapse, as an OT, help maintain system of actions, and daily programs and plans, Understand that relapse is a part of change, and is another obstacle to expect and meet without discouraging the client, The goal of maintenance is for the clien! to possess self-efficacy, as an OT we reinforce an environment and support system that promotes this success. 4 Biomechanical Model The biomechanical model is meant for people wha experience limitations with moving freely, stability end motion, limited joint range of motions, muscle weakness, and reduced strength and endurance. Improving balance and enduranec in order to prevent falls can he achieved through the biomechanical model. The use of exereise programs for clients with Diabetes ‘ean be effective to prevent falls, increase oscupational performance, and prevent further risks and declining health, Though some performance may hot be able to be regained, it would be important to work on Wendy's care strength and overall balance and endurance to make sure she is safe or Lifestyle redesign Page dap Revived 195)?valuation: What Asseysment tools and other means of assessment will you use? 1-11 Top Down Assessment: Prioritize onc Occupation to abserve the client perform __ Observed Oecupation Ritionale/How will you use this information T would like to observe Wendy make a simple meal like a sandwich. She will have to choose the ingredients, initiate the steps, manipulate the ingredient containers, navigate the kitchen area, and complete movements This task wauld consist of multiple steps and movernents that will be important to observe. I would like to see a number of motor and processing skills ina functional task, 1 want to soe her ability to initiate, continue, and terminate movements. | want to sec her fine and bilateral motor coordination to handle utensils and manipulate Ingredients and containers. | would leke to See her ability to navigate the necessary ingredients and layout of the kitchen, | want to see what strategies she uses to conserve energy or support her needs. | want to see her move and transport items (ability, strategies) I want to see what kind of sequence she is able to follow. How does she problem solve through the task? Her performance can help make a judgment on the degree of independence, effectiveness, efficiency and safety in the patient's occupational performance gain insight into motor and process skills which hinder occupational performance or, as it may be, support i. Acquire an indication of the options to improve ‘occupational performance: whether it seems possible for her to ‘improve actual skills or whether interventions need to focus on compensations by modifying activities, he environment or the amoust ‘of support. Vou eat alo sereen possible vision and sensory issues in a functional task to decide if more complex testing is requir Method/Tool Rationale‘What is being Assessed 1 PASS— Money management (dressing, medication, cooking) 2. Vision (acuity, pursultsitracking, saceades, convergence, ROM, peripheral) Amsler grid testing (central vision and visual fields) ‘PASS is a performance-based, criterion-referenced, and clent-centered ‘observational tool, The purpose of the PASS is to have a holistic snapshot (petson-task-env ironment) of the client's ability to live ‘independently and safely in the community by assessing performance ‘on various ADLs and IADLs. This test also allows for ratings on independence, adequacy, und safety outside of the typical can they or can't they finish the task This task will also allow for the upportunity to observe Wendy's cognition, ability to sequence through a task, problem solve, altend to a ‘ask, coordination, completion of ADL and LADL, and her posture and ‘body movement during tasks. ‘Wendy states that her vision is progressively worse than two years ago. Diabetes ean cause retinopathy and she may have inercasingly decreased vision affecting her occupational performance and safety. It would be beneficial to know how hee vision is to help her develop ‘compensatory strategies and ways to work with the vision she has. 1 ‘wuld do the H-paticrn with a pen to look at saccades and ROM, | would bring the pen fram around Wendy's head to test her visual ficld and peripheral vision. The Amsler grid testing would look at possible ‘centtal vision or visual field issues by having Wendy look ata grid. ‘This would consist of a quick sercen to see where issues with her vision are, Has she been to an eye doctor? Information on Wendy's vision may merit a referral before compensatory strategies are Page Sof Revived 1/9817incorporated for loss of vision: 3. BUE MMT and AIPROM ILis important to assess Wendy's BUE MMT and activelpassive ROM, ‘The information stated that she has overall decreased strength. | would like to see where her current level of strength and ROM is, how itis affecting her fietional perfarmance, and how it is iffected over time, Tawould like to observe how long it takes for hee to initiate movement and what the movement looks like, The diagnosis of OA may also affect her joint movement in her RUE, [ would lie to if she has compensaiory movernent, During these tests, it may be helpful to also be aware of time, reflexes, and sensitivity to touch (possible neuropathy issues) Sensation (Monofilament (pressure), sterengnosis, two-point, pain, and temperature The case states that Wendy has tingling in her toes and Fingertips. One of the possible symptoms of diabetes is neuropathy, which can make the completion of functional tasks difficult as well as dangerous. It Would be beneficial to know what kind of sensory deficits are occurring and where, to plan treatment accordingly. This information would also be helpful to track (0 assess whether the condition is worse The sensation testing should be done on bilateral hands and fect. It ‘would be important fo observe for any sores or skin damage during this time 5. Balance/Pall risk Berg Balance Or the PPT -The Physical Performance Test assesses multiple domains of physical funetion using obscrved pertormance of tasks that simulate activities of daily living of various degrees of difficulty in “elderly persons. 6, Home Evaluation SAFER TOOL — or an evaluation ‘modified to be similar (but can be done by picture, skype. or interview) It is stated that Wendy fas decreased overall strength loss of sensation, and unsteady gait. | would be concemed with her balance and risk for falls, The Berg Balance Scales is designed to assess static balance and fall risk in adult populations, This scale measures balance among older people with impairment in balance function by assessing the performance of functional tasks. I want to sec how Wendy's balance is and note what factors may be leading to safety concerns. When balance js impaired. the client may have difficulty performing daily tasks that require standing, such as meal preparation and fimetional mobility. The Berg Balance Seale assesses multiple areas such as retrieving objects ‘from the floor, sitting unsupported, and reaching forward with ‘outstretched arm. = ‘Wendy will eventually be retuming home where she lives alone with her many pets, It is important to know how the home is set up so you ean assess ways fo make sure she is safc and independent at home. ‘Dependent an the way the home is setup, differemt recommendations ‘for adaptive equipment and strategies will he taught. The information ‘from a home evaluation can assist the therapist with training sate mobility, transfers, and other strategies accordingly to the set up of the home, The information will guide the therapist through a better understanding of how the patient would recover and live at home, How big is the bedroom? Are there safety hazards? Is il crowded? Is it easily accessible? Are there grab bars? Is the bathroom on the the bedroom? ‘Consider the fact that the home is rural and far away > May need to sce pictures or do a skype evaluation. Page oof 13 Revised 1/981715. CPT Evaluation Code: | Justification sTie7 ‘Wendy's occupational profile i an expanded and complex medical history of Type Il Diabetes, CHP, zout, OA, pneumonia, TRA (x3) Disease, age, independent living, decreased cognition, decreased strength, and changes in sensation, Wendy's situation invelves a list of possible physieal, cognttive, and psychosocial issues related to her Fimetion. Her assessnient would consist of maximum complexity. The level of clinical decision-making consists of haximum complexity. The CPT code is based off of the lowest level of compleaity which was maximum, and therefore the code is determined as maximum complexity (87167) 17. Resources and Team Members: - Type TT Diabetes suppor group, American Diabetes Association, Diabetes Management Groups, community center, diabetes/QA exercise programs, state assistance programs (meals on wheels), Arthritis foundation, possible substance abuse pamphlets or groups; dictician; DME centers, brary for using the internet, raining: on research, and books), Heart Association handouts , ge gan 09 18, Intervention Plan Barriers 7 Supporis «Lives alone (sometimes with grandson) * Grandson is sometime invalved * Grandson may live with her (may be using her for her item ‘(may be helpful with some house may have substance abuse problems shores); someone to cheek on + Responsible for care of pets her 4 Habits ~ Smokes and three light beers aelay + Has company of her pets ‘Lives ina singlewide, her home is far away in a eural urea * Receives Medicaid ~ may © Change in sensation/Sensory loss provide helpful services + Discave may get progressively worse — new issucs may occur * Has lived alone successfully for + Age 73, older 50 years (Her PLOF appeats to © Treatment is at transitional center (not at home): cannot treat her in ‘have been mostly independent); her environment, see her rooms, equipment, barriers of home she most likely has-an eavecstiban ‘established way of ‘+ Home may not be properly set up for safety and efficiency living/tamiliarity with area + Possible cmotional barricrs/depression © Bs he own bone: * Cognition- MoCA is below average oc Hppy lo ne aene— Sealy # Multiple diagnoses; OA, gout, CHE, TKA (x3), COPD, Diabetes, motivated to return home pneumonia; declining health; requires constant management + Has determined goal/priority + Unsteady gait and decreased strength Ed ‘+ Has to manage medication and manage oxygen * Vision is getting worse # Weight - heavier [Goals [Practice Model for each goal 1, L1G: SELF-CARE By discharge, client will be able tw complete morning routine PEO, rehabilitation, biomechanical independently utilizing A/E and compensatory strategies. Page 106 Reve 194171aSTG: Within I week, elient will be able to don preferred socks and shoes dependently with the use of A/E and compensatory strategies while sitting in chair. PEO, rehabilitation, biomechanical 1b.STG: Within 2 weeks, client will be able to bathe emtére-bedy with min A using AVE and compensatory strategies. PEO, rebabilitation, biomechanical Joint protection, cnergy conservation, (medication management, monitor __meal plan) 2 L7G: DIABETES MANAGEMENT By discharge, client will demonstrate the ability to independently complete her health management and maintenance routine, blood wlucose, and prescribed PEO, rehabilitation, transtheoretical 2a. STG: - Within 2 weeks, client will demonstrate the use of a medication organizer system to remember to administer medication on time with min A. PEO, rehabilitation, transtheoretical 2b. STG: Within 1 week, client will demonstrate ability to regulate blood glucose level with min A, PEO, rehabilitation, transtheorctical 5. L1G: COOKING By discharge, client will be able to independently plan diabetic appropriate meal utilizing A/E and compensatory strategies PEO, rehabilitation, trunstheorelical, biomechanical a STG: Within 1 week, elient will demonstrate ability to plan a diabetic appropriate meal with min A PEO, rehabilitation, transtheoretie l3b. STG: Within 2 wecks, client will demonstrate an increase in activity tolerance PEO, rehabttation, biomechanical through the ability (o complete a 10-minute cooking task with the use of compensatory strategies. on one tfi f off Bs ee fad 19. Treatrnent Sessions: Plan for first two: 45 mmimate treatment sessions: {What will you do? Meaty One of the most concerning parts of Wendy's situation is that she is not managing her medications and her conditions Therefore, it would be important to discuss how her current medication management and organization is going, For the first tueatiment session, we will work on medication raunagement Modify EstablishyRestore ‘Approaches | Rased an which goal(s)? L1G2 Page 8 of 15 Revised 1917uiilizing different techniques and adaptive equipment. ‘Compensatory strategies would include cognitive strategies, location af medication, alarms, organizers, and problem solving We will discuss ways of reducing the chalicnge, protecting her Joints, and compensating for her decreased activity tolerance such ais simplifying the activity or routine, changing the -duration or timing ofthe day, and chasiging the type of activity (owhat type of clothes). We can use external cues and cognitive ‘prompts, adjust the layout and lighting, and use adaptive equipment. © Focus om the task and the rautine — Within scope of ‘occupational therapy ~ Not medication teaching + Analysis of the component skills required + [entification and implementation of appropriate compensatory strategies # Integration of medication management into daily habits and routines ‘Together we will create an orgunized way of remembering her medications and diabetes protocol, We will set up an organizer. During this time, {will also work on educating Wendy (and her grandson, if he is there) about how her condition can affect her performance and safe ways of adjusting the environment and the task. We will analyze her daily routine way of doing things at home and compare it to when she is supposed to administer medication or check her blood glucose. How she is currently doing with her medication. Consistency? When? Where? How! ‘What type? What parts of her medication management are difficult? (We ean change the holder or bottles she is using. Introduce easy to use holders for her OA. We will problem- solve ideas for why managing her diabetes is difficult. We wall also discuss energy conservation and joint protection during, tasks We can work towards creating a more efficient and arganived ‘way to manage her medical needs. This can include building a dar or placing alarms into a phone system. We will work Ww 10 organize medication into categories such as by time of day and week. We will also discuss placement, stich as placing medication ot a geminder by her nightstand iF it is ‘meant to be taken before bed, or a reminder in the kitchen if the medigation is meant to be taken during meal times. The goal is to make the task as simple and relevant routine. At the end of the session, reflect on priorities, motivation, and coping stratcgics. Provide opportunities to allow client to team, about all possible options and to select best fitting options. Assist client with crealing appropriate actions and problem Page 90f 13 Revised 1/9417solving, Allow for time for Wendy or family to ask questions, Throughout the session, if Wendy's grandson (or other caregiver) is there, they may be included in treatment as appropriate. They should be encouraged to usk questions and be invelved as much as beneficial to Wendy's needs. IW: Information an Type If diabetes (including risk factors Sich as smoking, eating habits, and lack of physical exersise), diabetes management handout including medical management (medication, skin checks, protecting skin, etc,), Simple diagnoses approved exercises she can do in her root ‘Home safety handout (remove or be aware of sharp edges on furniture, rugs'furniture close to walls), and assistive device handout for both client and her family (grandson) to look over and be educated on. Handout on strategies for organizing, and completing cognitive tasks 2. What will you do? During this treatment session, we will work on completing simple meal prep utilizing diabetic appropriate dietary recommendations. First part of the session will be a discussion on how Wendy is eurrently preparing hermeals. When? Where? How? What type? We will talk about what types of Food would be smart for her to make with her conditions. We will also discuss cognitive strategies, energy conservation, and joint protestion during tasks such as meal prep. Important task considerations: © Reduce demands of the activity (pre-cut veggies) * Compensatory strategies for vision and sensory loss = Avoid mullitgsking + Allow sufficiem t Balance rest and activity (in case of fatigue) Balance pleasurable activities and “must do” activities = Do one thing al a time + Visualization + Sclfacheck Conserving Fnerey considerations ‘© Analysis of existing routines and habits in relation to energy demands and capacities + Pacing and planning to balance demands to capacities © Selfmonitoring energy and energy expenditure Adapting routines '* Specific techniques (controlled breathing, relaxation ete.) Healthy Eating Goal Discussion: ‘© Attain/maintain optimal ABC levels Identify Approaches| Establish/Restore Moulity Based on which goal(s)? LIG3 Energy conservation information for goal 1 Page 10-0f 13 Revived 19487+ Prevenv/manage diabetes complications # Address individual nutrition needs # Address barriers to healthy eating + Maintain the pleasure of cating! + Creating sustainable routines around meals # Safety ~ adaptations in cooking ‘© Planning and meal preparation + Grocery shopping ‘+ Meaning of food and cooking, Sociale ating “Alternative “healthy pleasures” + Portion control o, it will be important to teach the client how to idler problems i in the environment and how to adjust it for their fneeds (visual contrast, location of items, lights, noise, time of day). We can work towards ereating a more efficient and organized ‘way to make meals. Utilizing the counter or placing items in easy lo reach lovations, Organize food and kitchenware by mast used. Teach client about different A/E options far sensory, Vision, anid motor loss, Dysem to open jars ar hold bowls stil Rocker knifes or knife rings 1 cut food Depending on time after discussing strategies, we will doa Tight snack in the kitchen (veggies) practicing energy conservation and environmental niodifications. Wendy can use different A/E that is at the facility to see how they assist {adapted knifes) ‘Onee again, throughout the session, if Wendy's grandson (or other caregiver) is there, they may be included in treatment us appropriate. They should be encouraged to ask questions and be involved as much ay beneficial to Wendy's needs. TIW: Diuthetes food guidelines handout, meat ideu handout, provide Wendy with resource page such as haoks or websites that give meal ideas. Compensatory strategies and energy conservation handout, importance of taking breaks, handout on physical activity and healthy coping, importance of self ‘examination, sclFinstruction and self-evaluation. | Provide information for any questions Wendy or family had Lorevious!: Page I of 13 Revived VOI