Lab Practical Final Assignment Group A / B and #: B15

Group Members: Katie Hartman, Morgan Daniels, Katie Hood, Will Woods
Case History:
George is a 75-year-old-man that has been admitted to your healthcare facility. He is
obese according to his BMI. He has hypertension which has been controlled with
medication, but recently has struggled with this. There is nothing else significant in his
PMH (past medical history). He reports that he does not have the strength to move
around like he used to due to weakness in both his arms and legs. He does not have
any assistive devices at home. He lives with his wife who assists him with ADLs and
functional mobility, but she can only provide about 25% assistance. He has a pressure
ulcer on his left ischium and left elbow. He is retired and lives in a one level home with
one step to enter the home without any rails. He struggles with getting in and out of the
shower/tub combination. He does not have a raised commode and requires assistance
from his wife with getting on and off the commode. He still drives, but only short
distances from the house. He has increased difficulty getting in and out of the car and
usually only drives if there is a drive-through he can access such as his pharmacy and
grocery store. He reports that he wants to be more independent with walking and taking
care of himself to take the burden of care off his wife.
Vital Signs:
Consider the patient’s history and assessment, (1) please list appropriate vital signs that
you assume a patient like George may present with.
Vital Sign Values Date 11/22/21
Temperature 98.8
Pulse Rate 140
Respiratory Rate 17
Blood Pressure 143/92
Pain 6
EKG:

Rate: between 100-150 bpm but closer to 150 bpm Rhythm: sinus tachycardia
Based on this EKG, (1) Please identify Rate and type of rhythm above. (2) Would you
treat a patient with this rate and rhythm? (3) Please justify your reasoning.
Lab Practical Final Assignment Group A / B and #: B15

Group Members: Katie Hartman, Morgan Daniels, Katie Hood, Will Woods
We would treat this patient, but we would monitor his heart rate during treatment to
make sure it does not get too much higher. We would treat him because there are no
dysrhythmias detected. We would avoid high cardiac demand exercises.

Bed Mobility and Body Mechanics:

Using VoiceThread, (1) complete a video that shows proper bed mobility and body
mechanics for getting this patient from supine to sitting edge of bed (EOB). Consider the
patient’s history and assessments on how George will perform bed mobility. Select one
of your classmates as the patient for the videos (who is demonstrating George’s body
structure and activity deficits). (2) Identify which deficits your group selected George to
have, please include a brief written justification.
George does not have the strength to move around like he used to due to weakness in
both his arms and legs. He has a pressure ulcer on his left ischium and left elbow. We
chose to have George roll on his right side so he does not put pressure on his left side
that has the pressure ulcers. We assisted him with crossing extremities before the roll
and with sitting him up after the roll due to his UE and LE weaknesses. We then made
sure he was not dizzy or lightheaded after sitting because of his hypertension and
tachycardia. He responds no, therefore, we are safe to proceed with our UE and LE
gross assessments.

Gross Assessment:
Using a VoiceThread video, (1) perform a gross assessment with this patient that
features the therapist identifying the deficits found. Select one of your classmates as the
patient for the videos (who is demonstrating George’s body structure and activity
deficits). Consider the patient’s history and assessments. (2) Identify which deficits your
group selected George to have, please include a brief written justification.
George will have difficulty with shoulder flexion, shoulder abduction, and elbow flexion
with his upper extremities. He will also have difficulty with plantarflexion and
dorsiflexion. We chose these deficits for George because he has weakness in both his
arms and legs.
Basic Exercise:
Using a VoiceThread video, (1) demonstrate 5 different exercises/interventions that
would be appropriate for George based on the findings of your gross assessment.
(Please select a group member to act as George). (2) List these selected interventions
including frequency (how often) and intensity (sets, repetitions, and resistance
type/weight). Provide proper education and training of the exercises/interventions with
George. (3) Justify your reasoning for selecting these exercises relating them to deficits
from the gross assessment section above.
Lab Practical Final Assignment Group A / B and #: B15

Group Members: Katie Hartman, Morgan Daniels, Katie Hood, Will Woods

We will have George do shoulder abduction, shoulder flexion, and plantarflexion

exercises because they were weak during his UE and LE gross assessments. The first
intervention we will provide for the patient will be a shoulder abduction exercise with a
dumbbell. This will help the patient strengthen his supraspinatus and deltoid muscles.
To complete this exercise, George will perform shoulder abduction holding a 2-pound
dumbbell (light weight) for 2 sets of 10. This will be repeated for both arms by
alternating arms with each set. The second intervention we will provide will be a
shoulder flexion exercise with dumbbells. This will help George strengthen his anterior
deltoid, pectoralis major, and coracobrachialis muscles. George will perform shoulder
flexion holding a 2-pound dumbbell (light weight) for 2 sets of 10. This will be repeated
for both arms by alternating arms with each set. The third intervention we will provide
will be an elbow flexion exercise with dumbbells. This will help George strengthen his
biceps. George will perform elbow flexion holding a 2-pound dumbbell (light weight) for
2 sets of 10. This will be repeated for both arms by alternating arms with each set. The
fourth intervention we will provide will be plantarflexion with a theraband. George will
perform plantarflexion while holding the theraband for light resistance for 2 sets of 10.
He will do this on both feet by alternating feet with each set. The fifth intervention we will
provide will be dorsiflexion with a theraband. George will perform dorsiflexion while
holding the theraband for light resistance for 2 sets of 10. He will do this on both feet by
alternating feet with each set. George will do these exercises 2x a day. We chose these
exercises so George could do these independently at home with minimal assistance
from his wife because he is wanting to be less reliant on her.

Transfer:
Using a VoiceThread video, (1) select and demonstrate how you would educate the
patient/client on a transfer from bed to chair using an assistive device. (Please select a
group member to act as George). (2) Describe why the assistive device chosen to use
with the transfer was appropriate for this patient. (3) Considering the deficits noted on
the basic gross assessment, describe and justify why this is an appropriate transfer for
this client.
Lab Practical Final Assignment Group A / B and #: B15

Group Members: Katie Hartman, Morgan Daniels, Katie Hood, Will Woods
We chose a standard walker to maximize stability for George to use as an assistive
device during a stand step transfer from the bed to the chair. We chose this transfer
because according to his history, the patient should be weight bearing as tolerated on
his extremities. With this transfer, he can be more independent with minimal assistance
from the therapist. For this transfer, we will put a gait belt on George while he is sitting.
The patient will put one hand on the walker and the other hand on the bed and push up
using his legs and arms to a standing position while the therapist holds the gait belt from
the side. The patient will then step with the leg closest to the chair then move the walker
one step at a time until the patient is fully turned. Once George feels the chair against
the back of his legs, he will reach back for the armrest of the chair with one arm while
the other arm is on the walker, then sit in the chair.

Positioning:
Using a VoiceThread video, (1) show how you would position George in bed following
treatment. (Please select a group member to act as George). (2) List and describe why
these considerations need to be made.

Following George’s treatment, we would want to position him in bed lying on his right
side due to his pressure ulcers on his left ischium and left elbow. We would want to
make sure there is enough cushion under the bony prominences on his right side and
reposition him every 2 hours to prevent more pressure ulcers. We would want a pillow
between his knees while side lying. We would make sure the call light is within reach,
and George knows where it’s at.

Communication:
Based on your above responses, (1) fill out an SBAR communication to identify to
another member on the care team a concern you would wish to have addressed. Using
a VoiceThread video, (2) demonstrate this interaction and how you would communicate
to that member of the care team (Please select a group member to act as another
member of the care team).

Hi CNA Morgan, this is Katie with the OT/PT team for George. He is having trouble
S
getting in and out of the shower/tub.
Lab Practical Final Assignment Group A / B and #: B15

Group Members: Katie Hartman, Morgan Daniels, Katie Hood, Will Woods
He is a 75 year old obese male with hypertension. He has pressure ulcers on his left
B
elbow and ischium. He lives with his wife who is only able to provide about 25%
assistance.

George has bilateral upper and lower extremity weakness and has trouble with
A
functional mobility.

We recommend a sliding board transfer using a gait belt from a chair to the
R
shower/tub combination due to his weakness.