1 / 23

CASE STUDY VI

CASE STUDY VI. Lizette Luna, SPT Doreen Ruiz, SPT PT 7326 Neuroanatomy. Patient Background. Ms. Stultz 72 y/o female Retired nurse Loves to travel Lives alone in a one-story house. Patient Scenario. Pt suspects she has the flu—weakness

rhys
Download Presentation

CASE STUDY VI

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE STUDY VI Lizette Luna, SPT Doreen Ruiz, SPT PT 7326 Neuroanatomy

  2. Patient Background • Ms. Stultz • 72 y/o female • Retired nurse • Loves to travel • Lives alone in a one-story house

  3. Patient Scenario • Pt suspects she has the flu—weakness • Increasingly difficult to take care of herself and home • Unable to get out of bed • 911 is called when her sister finds that she has fallen out of bed trying to get to the phone and her respiration is labored.

  4. Examination • MOI: Unknown • MH: Admitted to ED 2 days ago, attending MD orders blood work, CT scan and a lumbar puncture (spinal tap) • Lab work results: spinal tap shows elevated level of protein without an increase in the number of WBC in the CSF

  5. Examination Cont. Physical Examination • A&O x 3 • Appears overwhelmed and fatigued • BP &HR slightly elevated • Respiration labored • Administered O2 • Peripheral pulses intact Neurological Exam • No memory deficits found • Cranial Nerves—intact

  6. Examination Cont. Motor System • Bilateral LE weakness: 2/5 • Bilateral UE weakness: 3/5 • DTRs: LE absent; UE diminished Sensation • Paresthesia—toes (bilaterally) • UE—N

  7. Follow Up Examination Same • DTRs • LE—absent • UE—diminished • Sensory—diminished distally Different • Motor system • Bilateral LE: 1/5 • Bilateral UE: 2/5

  8. Pathology • GuillainBarre Syndrome (GBS) • Demyelination disease that affects the peripheral nervous system • Autoimmume disease • Symptoms are characterized by: • Ascending symmetric motor weakness • Progressive weakness >1 extremity, usually stops progressing within four weeks. • Mild sensory signs and symptoms • Usually distally • Loss of deep tendon reflexes

  9. Pathology Cont. • Cause of the disease is unknown • Frequently occurs after an infectious illness • Surgery, viral infection, immunization • Diagnosed: • Lumbar Puncture - Elevated Albumin in CSF after 1 week - Without an increase in the number of WBC in the CSF • Electrodiagnostic tests • Nerve conduction velocity(NCV)—slowed • Electromyogram (EMG)—loss of nerve impulse

  10. Differential Diagnosis • Myasthenia Gravis • Condition where antibodies block receptors in muscles that receive signals of acetylcholine thus impairing muscle function • Clinical signs and symptoms • Muscle weakness and fatigability • Commonly in mms involved in eye mvt, chewing, swallowing and facial expression • Proximal muscles affected more than distal muscles • Diagnosed with: • Blood test • Tensilon

  11. Evaluation: Disablement Model • Pathology: Guillain-Barre Syndrome (GBS) • Impairment: Progressive weakness • Functional Limitation: Pt is unable to take care of herself & her home • Disability: Pt will not be able to live independently

  12. APTA Practice Patterns • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated With Peripheral Nerve Injury • 5G: Impaired Motor Function and Sensory Integrity Associated With Acute or Chronic Polyneuropathies • 6E: Impaired Ventilation and Respiration / Gas Exchange Associated with Ventilatory Pump Dysfunction of Failure. • 7A: Primary Prevention / Risk Reduction for Integumentary Disorders

  13. Pt Prognosis Factors influencing Px: • Mortality rates 5 % or higher • Age • Time before recovery • Need for artificial respiration • 67 % patients completely recover in 1 year • 20 % sustain disabilities • The prognosis for this patient is fair/poor.

  14. Pt Goals • LTG 1: Pt to maneuver powered WC through hallways, doors, and bathroom independently to allow DC to home in 6 weeks. • STG 1: Pt to transfer min. assist from bed to WC with sliding board in 4 weeks. • LTG 2: Pt to increase muscle strength 3+/5 in UE & 3/5 LE to be more functional at home in 6 weeks. • STG 2: Pt to demonstrate increased muscle strength 2+/5 UE & 2/5 LE in 2 weeks.

  15. PT Implications • Patient may be easily fatigued & overwhelmed • Care in ICU requires monitoring arterial blood gases • Loss of control of respiratory muscles • Meticulous skin care • Overstretching & overuse of muscles • Recovery could take years

  16. PT Intervention • Ascending Phase (2 – 4 weeks) • Pt & family education • ROM • Monitoring muscle strength • Skin Care • Careful watch of respiration

  17. PT Intervention • Stable Phase (after 2- 4 weeks) • Aquatic Therapy • Gentle Stretching • AROM, Assisted AROM

  18. PT Intervention • Descending (Recovery) Phase • Hot Packs • Gentle Massage • Pt education on AD, WC, home modifications • Proprioceptive Neuromuscular Facilitation Techniques

  19. Medical Treatment • Plasmapheresis – plasma removed and filtered to dilute circulating antibodies - 4 to 6 exchanges / week - Can improve GBS impairments • Intravenous injections of immunoglobulins

  20. Andy Griffith

  21. FDR http://www.cnn.com/2003/HEALTH/10/31/roosevelt.polio.reut/index.html

  22. References 1. Goodman CC, Fuller KS, Boissonnault WG. Pathology, Implications for the Physical Therapist. 2nd ed. Philadelphia, PN: Saunders; 2003. 2. Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed. St. Louis, MO: Saunders; 2007. 3. Kandel ER, Schwartz JH, Jessell TM. Principles of Neural Science. 4th ed. New York, NY: McGraw Hill; 2000. 4. Griffith A. Journey to Health. Guideposts: a Practical Guide to Successful living. [serial online]. 1996; 51(9). Available at: http://www.mayberry.com/tagsrwc/wbmutbb/anewsome/private/guidpost.htm. Accessed: October 19, 2008.

More Related