DIAGNOSIS
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RIGHT CVA WITH LEFT HEMIPARESIS
(WEAKNESS ON THE LEFT SIDE OF THE
BODY.)
FEMORAL NECK FRACTURE (BIPOLAR
ARTHROPLASTY OF THE LEFT HIP.)
HISTORY OF DVT (DEEP VENOUS
THROMBOSIS.)
END-STAGE RENAL DISEASE.
PROBLEM LIST
DECREASED ACTIVE RANGE OF
MOTION ON THE LEFT UPPER
EXTREMITY.
 DECREASED MUSCLE STRENGTH.
 DEPENDENT WITH LOWER EXTREMITY
DRESSING.
 UNABLE TO TRANSFER SAFELY (E.G.,
FROM BED TO WHEELCHAIR/
WHEELCHAIR TO TOILET.)

Mr. Jesse’s goals will focus in the
area of self-care .
Long Term Goal (LTG)-Increase active range
of motion and muscle strength of the
affected extremity.
Short Term Goal (STG) #1 – Mr. Jesse will
increase active range of motion of left shoulder
flexion and abduction to 90˚.
(STG) #2- Client will increase muscle strength of
the left shoulder to F+.
Functional Outcome- With increased range of
motion and muscle strength, client will be able to
perform self-care activities or tasks such as
dressing and transfers.
Con’t…
Rationale- Mr. Jesse will sand and assemble a
simple wood working project while using a
bilateral sander on an inclined plane. The activity
can be graded by adding weights on the sanding
box or by having the client wear a 3 lb. wrist
weight to improve muscle strength. The client will
work on the project for 15 minutes a day and
gradually increase the duration of the task.
Changes in client’s position or sanding direction
will facilitate shoulder movements necessary to
carry out tasks of everyday living.
DRESSING
 LTG- TO PERFORM LOWER BODY
DRESSING INDEPENDENTLY.
 STG #1 - Client will doff lower body clothing
independently with the aid of an adaptive device
while following safety precautions by a week.
 STG #2- Client will don lower body garments
independently with the aid of an adaptive device
while following safety precautions by two weeks.
Dressing
 RATIONALE- The client will use a dressing
stick, sock aid and a reacher to don and doff
lower body clothing while following hip
precautions. Assistive devices will allow the
client to independently perform lower body
dressing while reducing the risk of injury.
 ASSISTIVE DEVICES- “Hip Kit” which includes
a reacher, shoe horn, sock aid, and dressing
stick.
Dressing precautions and
modifications
 Patient should be
 A reacher or dressing
seated in a chair
with arms or on the
edge of bed.
 Crossing the
operated leg over the
non-operated leg at
the knees or ankles
should be avoided.
stick should be used
for pants or shoes.
 When putting on
pants, the operated
leg is dressed first by
using the reacher or
dressing stick to
bring pants over the
foot and up to the
knee.
Dressing( Continued)
 A sock aid may be used to
put on socks, while a
reacher or dressing stick is
used to remove them.
 A long-handled shoe horn
may be used to put shoes
on while limiting hip flexion
motion.
 Button hook with zipper aid
may be used for limited
range of motion and finger
coordination.
TRANSFER AND MOBILTY
LTG: Resident will independently
and safely ambulate and transfer.
• STG #1- Client will use proper positioning in
order to safely transfer from bed to wheelchair
with the use of an assistive device by two weeks.
• STG #2- With the use of transfer techniques,
client will independently ambulate and transfer
from bed to wheelchair without the use of an
assistive device by a month.
Con’t…
• Rationale- The goal of the transfer is for the
person to do the activity safely and
independently. As Mr. Jesse grows stronger, he
will require less assistance and will eventually be
able to ambulate independently. The ability to
transfer will allow the client to perform activities
of daily living.
Positioning
The surfaces for
transferring should be nonmovable, firm and well supported and of similar
heights.
When transferring from a wheelchair, the wheelchair
should be locked, should be in a position that
allows the client to use the better side and the
footrest should be out of the way.
During transfer from a bed to a wheelchair, it is
often advantageous to position the wheelchair at a
slight angle to the bed, so that the wheel is not in
the way of the transfer. It is better if the bed is a
little higher than the wheelchair - to allow for a
downward transfer. The most common procedure is
for the patient to sit on the edge of the bed and then
slide across to the wheelchair on the Sliding Board
.
Health Management
Deep Venous Thrombosis(DVT)
Symptoms and Prevention
leg pain in one leg only
 leg tenderness in one leg only
 swelling (edema) of only one leg
 increased warmth of one leg
 changes in skin color of one leg, redness
 Prevention: perform simple exercises during
long car rides or airplane flights;wear elastic
stockings.

HOME MODIFICATION
Bathroom
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Shower Stall: Place
Non-skid strips or
stickers in shower
stalls or tubs.
A shower chair with
adjustable legs may
be installed
Bathroom (cont)
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Patient stands parallel
to tub facing shower
fixtures and using
walker or
crutches,steps into
shower sideways while
bending at knees not
hips.
Long handled bath
sponge may be used to
wash legs and feet,
while a towel wrapped
on a reacher may be
used to dry the legs
and feet.

A tub bench may be
used if balance is
an issue or weightbearing is to be
avoided.
Bathroom (con’t…)
Grab bars should be
screwed directly into
wall studs on either
side of the toilet and
in the bathing area.
Kitchen
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Adaptive one-handed
cutting board,onehanded electric can
opener,jar openers,
and built-up handle
utensils may be used
to compensate for
limited joint range of
motion and muscle
strength.
Items in refrigerator
and cabinet should be
arranged so that they
are in the most
accessible place.
Home Modification
Remember that because of the Fair Housing Act, it
is illegal for a landlord to outright refuse to make
reasonable accommodations. The tenant pays for
these accommodations. When tenants move out,
they must restore the dwelling to its original
condition, if the landlord desires. Sometimes a
landlord will pay for part of the accommodations
because accessibility features enhance the dwelling.
Grab bars or levered door handles will make a unit
potentially more marketable to more people, such
as elderly tenants or tenants with limited mobility.
The landlord and tenant should be able to work out
the modifications amicably.
Home Modification
For more information on the Fair
Housing Act and Amendments of 1988,
see the U.S. Department of Housing and
Urban Development (HUD)
Web site:
http://www.hud.gov:80/sec8.html#a.
HUD also offers a "Disability" resources
page loaded with helpful information:
http://www.hud.gov:80/disabled.html
Support groups for stroke
survivors and their families



Glen Cove Hospital:
3rd Tuesday of every
month from 2-3:00pm
LIJ Medical Center:
2nd Tuesday of every
month from 1-3:00pm
North Shore
University Hospital:
every Friday from 101:30pm

Glen Cove Hospital
516 674 –7895

Long Island Jewish
Medical Center(LIJ)
718 470-7706
North Shore
University 516 5624947

Renal Disease Support

National Kidney
Foundation
30 East 33rd St.,
Suite 1100
New York, NY
10016
(800) 622-9010
(212) 889-2210
www.kidney.org
Patient & Family Council
Goals:
 Education -- to educate
and empower patients
and families to make
informed decisions about
the quality of care they or
their loved ones receive
http://www.kidney.org/pati
ents/pfc/pfform.cfm
PRESENTED BY:
RACHEL
DECRESCENZO
RACHEL BIANCA
MALLARI