|
|
Dx: SLE and CRF
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Dx: SLE and CRF - March 30, 2008 7:46:22 PM
|
|
|
venuschow1
Posts: 3
Joined: March 30, 2008
Status: offline
|
I'm a student working on a pathophysiology presentation in which we must prescribe a program for a 55 y.o. female pt. with Lupus and CRF. I have two different prescriptions and I was wondering if I could get feedback.
Prescription for Lupus patient:
n During the 1st session, the patient should have: 5 min warm up on treadmill (0% grade, 2.5 mph)
n Stretch large muscle groups for 15-20 seconds to the point of mild discomfort
n 10 minutes on treadmill
n 1 circuit of 10 reps on leg press, leg curls, leg extensions, rows, front press, bicep curls, tricep extensions, push ups (bent knee)
n 10 minutes on treadmill
n 1 circuit of 10 reps of same exercises
n 10 minutes on treadmill
n 1 circuit of 10 reps of same exercises
n 5 minute cool-down on treadmill
n Stretch (this time holding for 20-30 seconds)
n Follow with Soft tissue mobilization for edema
A six week program should include:
n 1 session first week
n 2 sessions 2nd week
n 3 sessions 3rd week with 2 treadmill bouts of 15 minutes each (can increase grade to 2 % and speed to 3.5 mph)
n 3 sessions 4th week with 12 reps each set (increase grade to 3)
n 4 sessions 5th week (1 session without circuit training and all 4 sessions with 1 30 minute bout on treadmill)
n 4 sessions 6th week (1 session without circuit training and increase grade to 4 %)
n The precautions for our patient are:
n Extreme muscle soreness
n Extreme fatigue
In either of these cases, decrease intensity next session
Prescription for pt. with CRF:
n 1st session: 5 min warm-up on treadmill or bike (0% grade, 2.5 mph)
n Stretch
n 10 minutes on treadmill or bike
n 2 sets of 8 reps low weight on leg press, leg curls, leg extensions, rows, front press, bicep curls, tricep extensions, push ups (bent knee)
n 10 minutes on treadmill or bike
n 1 set of 8 reps of same exercises as above
n 5 minutes cool down on treadmill or bike
A six week program should include:
3 sessions 1st week
n 3 sessions 2nd week (3 bouts of 10 minutes on treadmill or bike)
n 3 sessions 3rd week (increase weight and increase grade: 1 % Monday, 2% Wednesday, 3 % Friday)
n 3 sessions 4th week (3 bouts of 15 minutes on treadmill/bike)
n 3 sessions 5th week (increase weight and grade: 4% Monday, 5% Wednesday, 6 % Friday)
n 3 sessions 6th week (3 bouts of 20 minute on treadmill/bike
The main precaution is to stop for leg fatigue at low heart rates.
If I could get feedback that would be great. You can also e-mail me at venuschow1@yahoo.com. Thank you!
|
|
|
|
|
RE: Dx: SLE and CRF - March 30, 2008 8:06:27 PM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
You know, this forum really isn't to guide students through their projects. At least I don't think it is.
|
|
|
|
|
RE: Dx: SLE and CRF - March 30, 2008 8:19:53 PM
|
|
|
venuschow1
Posts: 3
Joined: March 30, 2008
Status: offline
|
The membership said that students were welcome, so I'm just assuming that I could reach out to the vast network of experienced professionals. I have already prescribed a program and just wish for feedback for the direction I am taking.
|
|
|
|
|
RE: Dx: SLE and CRF - April 1, 2008 6:17:56 AM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
Students are always welcome - I know I don't want to do your work for you. You know, I'll actually bite though. Look at #1. 1) What type of insurance plan does your patient have in #1? 2) What resources does the patient have at home or in the community? 3) How do you define "skilled intervention?" 4) What has been the patient's exercise history? 5) How did you determine frequency of visits? 6) What are your goals? 7) How will your program lead to those goals? 8) What are the patient's goals? 9) What medications has the patient been prescribed? 10) Will or how may medications impact your program? 11) What evidence has guided you in creating that program? 12) What will you be documenting to prove progress is occurring? 13) What deficits have you found with the patient's presentation? 14) What will you be monitoring during the activities and why? 15) What intensity or resistance will be performed with the resistance training and how will that level be determined?
|
|
|
|
|
RE: Dx: SLE and CRF - April 1, 2008 1:19:38 PM
|
|
|
venuschow1
Posts: 3
Joined: March 30, 2008
Status: offline
|
I don't want you to think that you are doing my work for me. Part of the assignment is to confer with a practicing PT to see if the program we designed is realistic.
We don't know much about her except that she is a 55 year old woman with SLE and CRF. She lives in a first floor aparment and she is a first grade teacher at a local private school. She was Dx at age 35 and is currently recovering from a SLE exacerbation in which she developed patchy alopecia. She wants to return to work next month; she is easily fatigued, has knee pain and has been depressed recently. She also has trouble lifting objects over 5 lbs.
She is on hydroxychloroquine which acc. to ACSM Exercise Management for Persons with Chronic Diseases and Disabilities improves exercise function by relieving sx. She is taking captopril which decreases BP but has either no effect or increases exercise capacity. She is also taking Zocor which can cause skeletal muscle rhabdomylosis, calcitriol which has no effect as well as erythropoietin which can increase V02max as well as SV and BP.
We don't know the insurance, if she lives with someone or what her past exercise history is . My goals are to improve her fatigue, decrease her knee pain, improve her mood, her chances of returning to work as well as her strength with walking and lifting objects over 5 lbs.
My sources are Dawes 2007, Guidelines for Training Individuals with Lupus and Clarke-Jenssen etal 2005 Effects of Supervised Aerobic Exercise in Pts. with SLE for the Lupus program and for the program for CRF my sources were Castaneda etal 2001 Resistance Training to Counteract the Catabolism of a Low protein diet in Pts. with CRF., Adams etal 2006 Skeletal muscle dysfunction in CRF, Johansen 2005 Exercise and Chronic Kidney Disease: Current Recommendations and Kouidi 2001 Central and Periperal Adaptations to Physical Training in Pts. with ESRD.
I used those guidelines of 40-60% V02max for SLE and 50-60% of VO2max for CRF with a 3RM or 5RM for strength testing to create my program.
I will be watching for extreme fatigue and and extreme muscle soreness for the SLE program and leg fatigue at low HRs for the CRF program.
I hope this shows that I've done the work and just need feedback.
|
|
|
|
|
RE: Dx: SLE and CRF - April 1, 2008 6:05:12 PM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
I only looked at your #1 example. Your goals and her goals need to be measurable, functional and need to have a timeframe.
Reality is that my questions 1-5 are highly relevant in the real world with real clinical thinking. In the real world you will be paid for your services and you need to know the answers to those questions with all your patients. Your instructor didn't do his or her part in providing you adequate information to perform your role properly. #12 and #13 are highly relevant to also provide support for physical therapy intervention.
She reports problems lifting objects heavier than 5#... from what height levels?
No, your program isn't realistic. Is it worth someone to be flipping a bill that might cost say $30/unit and I'm guessing that would be a 95 minute program which would run say $180? In my opinion, your program isn't showing "skilled" intervention to be allowed for 6 weeks and for 16 visits (if I counted correctly). Real life is that insurance plans sometimes are capped in the number of visits allowed per year or per condition OR within a short time frame. 4 visits per week is ridiculous and won't be substantiated as needed anywhere. Also, you need to consider that she was diagnosed when she was 35 years old... I'd be more than willing to bet that she knows what she needs to do and how to go about it in a general sense - she's had multiple eposides of exacerbations over the years. "Real" patients, especially this day in age, are quite knowledgeable about themselves and often times require guidance in progression. You should also have some discussion with the patient with what has worked in the past and how the patient has dealt with previous episodes.
|
|
|
|
|
RE: Dx: SLE and CRF - April 8, 2008 11:47:36 PM
|
|
|
Nicole Matoushek PT MPH CSHE CEES
Posts: 727
Joined: January 15, 2005
From: St. Petersburg, FL
Status: offline
|
Realistically, a patient with Lupus with fatigue would most likely not be able to tolerate that much activity. You should focus on the goal of independence, to teach the patient not to exercise to fatigue w/ that condition and to provide her with a HEP of when she is doing well and when she is exacerbating. I agree with SJBird above, ins co will most likely not approve a program of that duration for a chronic condition so focus on the tools and education you can give her.
Just trying to give you a glimpse of the real world.
_____________________________
Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com
http://www.ErgoRehabBlog.com
http://www.ComputerAccessoriesOnlineStore.com
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
 Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.125
|
Printable Version
All Forums >> [RehabEdge Forum] >> Open Forum >> Dx: SLE and CRF 
