LTG 2: Client will complete LB dressing with modified independence with adaptive equipment

(a/e) in 2 weeks.

The OT will begin by reviewing Sam’s chart, donning PPE, washing hands, and taking

vitals the same way it was done in the previous treatment session. Again, due to Sam’s current

condition, the OT will use client education as a preparatory method. The OT will educate Sam on

different breathing exercises. “Proper breathing techniques can help reduce stress, decrease

fatigue, and prevent shortness of breath” (Dreiling, 2009, p. 28). The OT will instruct Sam to

breathe through his nose for two counts, keeping his mouth closed. He will then exhale the

breath for four counts while his lips are pursed (Radomski & Trombly, 2014, p. 1317). The OT

will explain to Sam that this will allow him to conserve energy while doing activities and avoid

further fatigue. Similar to the last treatment session, the OT will educate Sam on a piece of

adaptive equipment that will aid him in dressing. After she demonstrates how to use a reacher,

she will ask Sam to verbally recall what she has explained.

Because of Sam’s goal of being able to dress himself with only a/e, the OT will have Sam

gather clothing off of the floor using a reacher. Sam will be EOB and the OT will lay five articles

of clothing on the floor. Sam will be instructed to do one round of pursed lip breathing, and then

use the reacher to pick up one article of clothing and place it on the bed beside him. Sam will

then take a two minute rest break before completing the activity four more times. The OT will

take vitals before he starts the activity when he is EOB, and after he picks up all five articles.

This will be done for three sets. This purposeful activity will allow Sam to become comfortable

using the reacher and also simulate gathering clothing to begin dressing. “Adaptive equipment

can reduce functional decline, … have positive financial implications, … reduce the number of

days spent in bed, … and the strain on informal carers” (Brittle, Lett, Littlechild, & Sackley,
2007, p. 479). Using this adaptive equipment will allow Sam to be less dependent on his

children, return home faster, and will increase his overall level of independence.

After Sam has completed this activity three times, he will take another rest break and

have his vitals checked again. After he is stable and rested, the OT will place his pants and his

reacher beside him. She will instruct Sam to grab the pants using the reacher, and she will assist

him in putting each leg into the pant-holes. The OT will then give Sam verbal cues as he pulls his

pants up using his reacher. She will remind him to breathe using his pursed lip breathing and take

rest breaks frequently to conserve energy. She will continue to aid him until his pants are on.

This activity is appropriate for Sam because of it’s MET level of 2.0, therefore he is not over-

exerting himself (Ainsworth, et al. 2000, p. S512). To grade up this activity, the OT can ask a PT

to help stand Sam up, and Sam can complete the dressing while standing with the ww in front of

him and both therapists on either side of him. To grade this activity down, the OT will hand Sam

the pants, rather than him using his reacher to retrieve them.

Again, due to Sam’s diagnosis of Cdiff and MRSA, all equipment that was brought into

Sam’s room, including the blood pressure cuff, stethoscope, pulse oximeter, and adaptive

equipment must be thoroughly washed, if possible, or left in Sam’s room to only be used for him.