Peripheral Neuropathy Case Analysis
(This will serve as your Long Quiz)
Mrs. Emma Taffey is a right-handed 73-year-old woman who comes from a small outport in Newfoundland. She is married to a retired fishery worker. Mrs. Taffey is a native-English speaker who has never worked outside of the home. She has raised 12 children, seven of whom still live in the vicinity.
The Taffey home is a two-storey wooden house with a shanty (i.e., outhouse) attached to the back porch. There is a water pump in the kitchen and a wood burning stove for heat.
Mrs. Taffey enjoys canning, knitting, needlepoint, and quilting. She has a small income from her knitting and quilting work. She has a sizeable social support system that includes her children, her husband, and many friends.
Mrs. Taffey is overweight and has insulin-dependent diabetes mellitus (IDDM). In conjunction with being a brittle diabetic, she has peripheral neuropathy with paresthesias of her fingers and feet, vision problems (diabetic retinopathy), bilateral sensorineural hearing loss (SNHL), and peripheral vascular disease. Mrs. Taffey also smokes, on average, one package of cigarettes daily.
Mrs. Taffey's physician(s) has recommended the amputation of her right leg, below the knee. Pressure sores on the left foot require monitoring and may lead to another amputation. The cost of prosthesis is relatively high, given the limited family income. The outport in which the family resides is very isolated from September to May. Mrs. Taffey must be discharged within eight-to-ten weeks in order to catch the coastal supply boat to her home town, or else she may be stranded in St. John's for the winter.
1. What is your diagnosis/impression of Mrs. Taffey’s condition? (Specific) Diabetic peripheral neuropathy
2. Briefly discuss here the nature of Mrs. Taffey’s condition. There is an impaired glucose tolerance due to too much glucose in the blood stream or prolong blood glucose throughout the body which is metabolize differently into the body as energy that would result to the following signs and symptoms pertinent to the case: paresthesias of her fingers and feet, vision problems (diabetic retinopathy), bilateral sensorineural hearing loss (SNHL), its association in smoking and peripheral vascular disease.
3. Identify at least 3 problems on this case.
• Difficulty in manipulating needle secondary to paresthesia in right fingers • Difficulty maintaining grasp on canning equipment secondary to paresthesia in right fingers • Difficulty in calibrating movements during knitting and quilting work secondary to vision problems • Difficulty controlling fluid in right UE movements during IADLs secondary to bilateral sensorineural hearing loss. • Need for leisure participation
4. On your 3 problems identified. Make 1 complete treatment plan.
LTG: Client will be able to continue to complete leisure activities independently in 2 months of OT session. STG1: Client will be able to complete quilting activity given moderate to minimal verbal cues and prompts within 2 weeks of OT session. STG2: Client will be able to complete knitting activity given moderate to minimal verbal cues and prompts within 3 weeks of OT session. STG3: Client will be able to complete needlepoint activity given moderate to minimal verbal cues and prompts within 3 weeks of OT session.
• TUS: Active friendliness will be used to establish rapport and to promote client’s participation in activities given during the session. Kind firmness will be used when client starts to stop continuing activities and when he will not follow the therapist’s instructions. Client will be given instructions one at a time to address the bilateral sensorineural hearing loss. • EMT: One on one treatment sessions will be done in one part of activity area with client facing the corner and...
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