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Chase Farm Case Study

Chase Farm Case Study. By Sarah Hart Student no’s 0604985. Introduction. 84 year old gentlemen BIBA (Bought In By Ambulance) at his GP’s request Gp querying AF (Atrial Fibulation), CCF (Congested Cardiac Failure) and Bilateral ankle swelling. Obs on admission 110/83 Bp 95% SaO2 on air

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Chase Farm Case Study

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  1. Chase Farm Case Study By Sarah Hart Student no’s 0604985

  2. Introduction • 84 year old gentlemen BIBA (Bought In By Ambulance) at his GP’s request • Gp querying AF (Atrial Fibulation), CCF (Congested Cardiac Failure) and Bilateral ankle swelling.

  3. Obs on admission 110/83 Bp 95% SaO2 on air 136 bpm Increased JVP (Jugular venous pressure) Na+ 137 K+ 4.8 Total Protein 5.2 Albumin 29 CRP 1.1 Troponin 0.04 On Admission

  4. Past Medical History • Multiple Myeloma, Radiography Therapy • Vertebral Collapse and Impending Cord Compression • Hypertension • Bilateral Total Knee Replacement (TKR) • Congested Heart Failure (CHF)

  5. A progressive haematological disease. Cancer of the plasma cells which are an important part of the immune system 3 stages- I, II, III is based on four measurements: levels of M protein, the number of lytic bone lesions, haemoglobin values (a measure of the number of red blood cells in the blood), and serum calcium levels. Multiple myeloma

  6. Multiple myeloma continued http://www.multiplemyeloma.org/about_myeloma/

  7. Social history • Currently lives with his wife in a house • Set up on ground floor. • Wants to move to Basingstoke to live near his daughter in a flat. • Baseline mobility:- able to mobilise indoors with a rollator frame approx 5-10m, uses a wheel chair when outside.

  8. Drug history • Hypo tension:- Amlodipine, • Anti-Coagulants:- Aspirin & Clexane • Constipation:- Movical • Ulcers:- Omepazale, • Antibiotics:-Co-dydramol &Co-trimoxazole • Fluid regulating:- Simvastatin • Diabetes:- metformin hydrochloride • Insomnia:- temazapan • Palliative role:- Thalidomide • Gout:- Allopurinol

  9. 1st week on the ward • Generally very pale and very weak. • Blood tests • ECG- To confirm AF • ECHO- Ejection Factor • CTPA? (Computed Tomography Pulmonary Aneurysm)

  10. ABG’S (Arterial Blood Gases) Ph- 7.46 pC02- 5.5 P02- 10.4 HC03- 29.2 Base- 4.9 Hb- 9.4 Obs Bp- 90/63 Bpm 104, RR 17 95% SaO2 on air. 1st Week on the ward contd

  11. Objective assessment • Laying in bed • Unable to SOEOB without assistance • No independent standing balance ass x 2 • Unable to mobilise with r/f

  12. Problem list • Transfers require assistance of 2 people - Weakness in LL? - Spinal cord compression? - End stage multiple myeloma • Standing requires support of 2 people - Fatigues quickly - Poor exercise tolerance

  13. Treatment goals • Practise the transfers SOEOB (Sit On Edge Of Bed)- Chair. • Practise Sit- Stand and Stand- Sit safely with the r/f. • Mobilise short distances

  14. Long term goals • Ideally it would be his baseline. • Mobilise with a rollator frame. • Able to transfer independently • D/C planning liasing with other members of the MDT

  15. 1st week of physiotherapy intervention 1a) Practising sit- stand, swaying R-L and toe tapping, Knee extensions in the chair. With assistance of 2 1b) Bed exercises- pushing heel into bed, knee bends and SLR. 2a) Practising sit- stand, swaying from R-L, toe tapping and heel raises. With assistance of 2 2b) Continue with bed exercises.

  16. 1st week of physiotherapy intervention 3) SOEOB- Standing, marching on spot, toe tapping. Increasing the amount of sit- stands. Moderate assistance of 2 4) SOEOB- Chair, min ass of 2, sit to stands from the chair. Marching on the spot. 5) Able to independently t/f from SOEOB to chair with supervision

  17. Medical • CTPA as the medical team was querying a PE (Pulmonary Embolism) • No PE was found. • 6 days of no physiotherapy input.

  18. 2nd attempt of physiotherapy intervention • Very pale, and very tired each time I have seen the patient. • Blood pressure was still very low. • De-saturated to 88% on air, so the patient was put on 2l of O2 by nursing staff and Sa02 went up to 94%, then we put the pt on 4l Sa02 went up to 96%. • 1st attempt of physiotherapy t/f from chair- bed with max ass x 2 • 2nd attempt of physiotherapy sit-stand x 3 max ass x 2

  19. Limitations • Reduced Confidence? • Eating and Drinking? • Lack of Sleep? • General Weakness?

  20. Reassessment short term goals • Transfer from bed- chair independently and safely. • Increase exercise tolerance • Liase with the OT

  21. Conclusion • The patient still has rehab potential • Continue to re-assess on a daily basis

  22. Any Questions???

  23. References • Pictures http://www.multiplemyeloma.org/about_myeloma/ • http://www.multiplemyeloma.org/about_myeloma/2.05.php • http://en.wikipedia.org

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