Exercise Refferal Case Study for Rheumatoid Arthritis, Depression & Elderly

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Summary of clients details
Name: Ms. Lewis
Gender: Female
Age: 66
Contact No: 01234 5678910
Next of Kin: Mrs Levenhulme

Referral reason: Rheumatoid Arthritis, Depression & elderly
Medication: Acelofenac & Nortriptyline

Physiological Information
Blood Pressure (seated): 122/82 mmHG
Resting Heart Rate: 64 bpm
Predicted VO2max: 24 ml/kg/min

Present physical activity:
Very low, essentially sedentary

Patient’s statement regarding state of change:
“I want to exercise, and I think I can do it, but I will need some support” (Preparation) Medical conditions
Rhematoid Arthritis – Is an autoimmune disease which can cause chronic inflammation of body`s organs, joints, and the surrounding tissue of the joints. It can be defined as: “a disease of synovial tissue, i.e. a joint linings, tendons, tendon sheaths and associated structure. So widespread is the inflammatory process that inflammatory nodules may form almost anywhere, the extensor surfaces of the limbs being most common, such as elbow and forearm nodules, but nodules may also form in the lungs and other visceral tissue” (Wright Foundation Exercise referral manual, 2008)

The onset of Rheumatoid Arthritis is generally between 45-65 years (Stenstrom & Minor, 2003) Specific inclusion criteria –Mild to moderate severity
Specific exclusion criteria – Severe severity
Depression – “An illness that involves the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. Without treatment, symptoms can last for weeks, months, or years.” (http://www.medterms.com/script/main/art.asp?articlekey=2947) Specific inclusion criteria –Mild to moderate severity

Specific exclusion criteria – Severe severity

Additional Information
As the client is 66 years of age she will be considered as elderly. Elderly – Whilst aging there is a steady functional decline, cardio-vascular, flexibility and strength. Reduction in functionality could be a possible cause of depression due to a reduction of independence and possible social isolation. (Wright Foundation Exercise referral manual, 2008) Medication

Drug: Aceclofenac
Drug group: Non steroidal anti-inflammatory drugs (NSAID)
Reason for Prescription: Rhematoid Arthritis
Desired effect: - “It works by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury or certain diseases and would otherwise go on to cause pain, swelling and inflammation. Arthritic conditions are one example of this. Aceclofenac is used to relieve pain and inflammation in arthritic condition” (http://www.tiscali.co.uk/lifestyle/healthfitness/health_advice/netdoctor/archive/100004233.html) Possible side effects: Nausea, Gastro-intestinal discomfort, diarrhoea, hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. (http://www.bnf.org.uk/bnf/bnf/current/5183.htm#_5183.9)

Possible effects of drug during exercise: Dizziness during transitions, Bronchospasm during exercise, vertigo can effect balance, photosensitivity may cause skin irritation if outdoors in the sun and hearing disturbances may affect communication. Implications of exercise prescription: Avoid transitions, implement intervals allowing for toilet breaks, if physical activity is outdoor then advise on suitable weather conditions and ensure that instructions are well communicated and understood.

Drug: Nortriptyline
Group name: Tricyclic antidepressants (TCA)
Reason for Prescription: Depression
Desired...
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