Every evaluation must have

• Identification of information
• Source of referral
• Reason for referral
• Occupational profile (history, patterns, interests, values, beliefs, needs, contexts…)
• AOTA adds: analysis of occupational performance (synthesis)

Normal HR and how 2 ways you measure it?

• 60-100 bpm
• Temporal, Femoral, Popliteal, Posterior Tibial Carotid, Brachial, Radial, Dorsalis Pedis

What does pulse signify?

Pulse signifies rate, rhythm and volume (i.e. how the beat feels)

You walk into your client's room and begin your session by taking their vitals. Your client is healthy, has no cardiac history, and is fairly active, so you're expecting a blood pressure within the typical range.

What is the typical range that you expect to see?

Under or around 120/80 mmHg

You are seeing a client who has broken their arm, this client comes into your session and says "my arm hurts throughout the night and I'm really having trouble sleeping."

You believe that this quote is important to include in your daily documentation, but where do you put it?

Subjective

Your client arrives to their occupational therapy session, knowing that you will be completing some demanding activities, you decide to measure their baseline heart rate.

As you're taking their pulse, you count 17 beats in 15 seconds. You quickly do the math to document a heart rate of...

68 bpm

The Quick DASH (pictured) is an upper extremity assessment that has clients rate how difficult it is to complete a task like washing their back or cutting food. This evaluation looks at…

Occupational Performance

While deciding what assessments that you would like to complete in your OT Evaluation, you add Range of Motion (ROM) to your list. You want to measure the ROM of the shoulder, elbow, and hand, which is looking most at your client's…

Client Factors

1. Match the term for a type of goal to the definition/purpose of the goal.
1. These goals are to reduce risk of developing occupational performance problems.

⇒ Preventative

1. Match the term for a type of goal to the definition/purpose of the goal.
1. These are goals to teach new skills that a client has not have

⇒ Habitalative

1. Match the term for a type of goal to the definition/purpose of the goal.
   1. Rehabilitative or Remediative. Your client used to be able to do this, now they cannot.

⇒ restorative

Hugh is an 81 year old who was admitted to the hospital with symptoms of headache, dizziness, altered mental status, and shortness of breath. He was diagnosed with acute hypertension with an admitted BP of 180/120. Following your initial evaluation, you plan to see him again for an OT treatment the next day.

You decide to implement one of the following assessments into your session:

Borg RPE Scale

After a 7 day stay on the PCCU (Progressive Cardiac Care Unit), Alfred is discharged home with the support of his spouse and home health occupational therapist. You review his chart and see that Alfred’s cardiothoracic surgeon recommends Alfred only engage in activities that are ≤4 MET values for 2-4 weeks. You determine that the following home activities are safe except:

Carrying groceries upstairs

You are working in the emergency department and receive an OT evaluation order for a patient who presents with pain in chest, diaphoresis, dyspnea, and lightheadedness. You check in with the nurse who reports that the patient is leaving the unit for an EKG.

You deduce that the medical team is working up the following differential diagnosis:

Myocardial infarction (MI)

The following are all appropriate sleep interventions within the OT scope of practice except:

Recommending over the counter sleep aids

Prior to helping Hugh mobilize, you decide to take his blood pressure at rest.

Based on your knowledge of vital signs and high blood pressure or hypertension, you anticipate seeing the following in Hugh’s blood pressure reading:

Resting systolic blood pressure (SBP) of 130 mmHg or more, or Diastolic pressure (DBP) of 80 mmHg or more

You are working with D’Andre, a 53 year old auto mechanic. He was diagnosed with osteoarthritis 2 years ago and you are seeing him in outpatient hand therapy.

D’Andre complains of hard, bony growths on his DIP joints. You explain to D’Andre that these are:

Heberden’s nodes

Alex suffered a femoral neck fracture and underwent a right total hip arthroplasty. You'd like to prepare some education on hip precautions and ADLs.

Alex’s surgical post operative instructions include “TDWB” (touch down weight bearing) in RLE which generally means:

10-15% weightbearing through LE

Vitals

Tempreture

• 96.8-99.3
• Oral cavity, retum, axilla, ear canal, inguinal fold
• Thermometer

Vitals

Heart rate

• 60-100bpm
• Brachial, temporal, radial, femoral, carotid, posterior tibial, popliteal, dorsalis pedis
• 2nd & 3rd digits

Vitals

Pulse

• “Strong and Regular”
• Same as HR
• Same as HR

Vitals

Respiratory Rate

• 12-18 respirations
• Observation/feeling of chest cavity rising OR falling
• Eyes and hand

vitals

blood pressure

• 120/80 mmHg
• Brachial
• Sphygmomanometer

hip precautions

1. NO hip FLEXion beyond 90 degrees
2. NO hip ROTATION
3. No crossing operated leg over the unoperated LE
4. NO ADDUCTION of the operated leg

Andre arrives at your outpatient OT clinic and reports difficulty with the occupation of pet care. Andre loves his three dogs and is having difficulty with feeding, walking, and grooming his pets.

You start your evaluation process with The Canadian Occupational Performance Measure (COPM) to look at Andre’s occupational role and his performance before considering his client factors.

You have selected an assessment that is:

Top-Down

Identify the different types of goal approaches.

1. Restorative
2. Habilitative
3. Maintenance
4. Modification
5. Preventative
6. Health Promotion

Define Tetraplegia/Quadriplegia

cervical or upper thoracic injury causing sensory and/or motor loss in the arms, legs, pelvic organs, and trunk

Define Paraplegia

Thoracic, lumbar or sacral injury causing sensory and/or motor loss in the trunk, legs, and pelvic organs

Your client presents with the following symptoms: Dyspnea, fatigue, wet cough, sputum production, and inefficient respiration.

What is their condition?

Chronic Obstructive Pulmonary Disease (COPD)

Top Down goals

First = performance, occupation roles

Then = client factors, context, activity demands

Bottom up goals

First = client factors, context, activity demands

Then = occupational roles and performance

Degenerative Hip disease

Avascular necrosis

• Death of bone tissue due to disrupted blood supply to femoral head
• Worsens over time
• Treatment → lifestyle management, pharmacological management, surgery

Degenerative Hip disease

Osteoarthritis

• Inflammation and injury cause a breakdown of CARTILAGE
• Progressive pain and degeneration
• Treatment → lifestyle management, surgery

Emphysema

• What is it? → progressive and irreversible destruction of alveolar walls
• Symptoms → shortness of breath, wheezing, chronic cough, tightness of chest

Pneumonia

Symptoms → fever, wet productive cough, chest tightness, exacerbated by inspiration, dyspnea, may sometimes be associated with changes in mental status, especially in older adults

energy conservation approach (modify)

• education and training intervention (teach sleep/strategies + practice applying them), NOT and occupation ⇒ applied to modification to daily occupations
  
  • Pacing, Prioritization, Modification, Delegation, Pursed lip breathing, Education

RPE and breathing

• 4/10 or 13/20 is notable audible breathing
• keep RPE < 4/10 or <13/20

Centrally Mediated
(Brain & Spinal Cord)

• Proprioception
• Stereognosis
• Injury or illness can result in other diminished discrimination or sensation

Peripheral Sensation
(Peripheral Nerves)

• Touch & pressure awareness
• Temperature
• Pain
• Two-Point Discrimination

Paresthesia =

abnormal sensation

Dysesthesia

unpleasant sensation

Hyperalgesia =

increased pain sensibility

Allodynia

pain perception to a stimulus that is not normally painful