Case Jeff

Jeff: Total Knee Replacement
Occupational Profile
Jeff is an 89-year-old man who lives in a large city with his 87-year-old wife of 65-years. He was admitted to the acute care hospital for voluntary knee replacement surgery of his right knee. Jeff and his wife have three adult children, one who lives in the same city, and two who live out of town, each about four hours away. His children are all supportive and involved with both their parents care. Paul and his wife have six grandchildren, scattered around the country. Jeff has been retired from his job as a fundraiser for a non-profit agency for more than 15 years. He is the primary caretaker in the family because his wife has severe depression and short-term memory loss. They have a companion who works three days a week for three to four hours each day to assist Jeff’s wife’s hygiene and with meal preparation. Jeff is independent in his ADLs and has assistance with hot meal preparation, although he enjoys making light meals from the food he buys at the neighborhood markets. He enjoys going out in his neighborhood and shopping at the gourmet food stores and grocery shopping; however, his mobility has become more limited because of his deteriorating right knee. He likes to watch sports in the news on television and read the daily newspapers. Jeff used to enjoy concerts and shows and going to lectures, but he gave up these because his wife would call his cell phone every 10 minutes wondering where he was and when he was coming home. They live in a large (2,000 square feet) apartment (all on one floor). There are three bedrooms and two and a half bathrooms. There are no grab bars; the bathtubs double as a shower and has half sliding glass doors. The toilets have a toilet frame for holding on to when getting on and off the toilet. The apartment building has three steps to get into the building with handrails on one side and then an elevator to get to the apartment. There is a 24-hour doorman who will help with bags and other items as needed. Because Jeff and his wife have lived in the building for more than 50 years, the members of the building staff are eager to assist. His goal is to return home and resume taking care of his wife and to go shopping in the neighborhood. He is being seen by PT and OT. Jeff has Medicare Part A and Part B for his insurance and wants to return home to continue his rehabilitation.
Analysis of Occupational Performance
On day one post-surgery, an OT evaluation was completed, based on functional activity and observation. Jeff was able to wash his upper body while sitting in bed with set up assist level on bedside table. He required moderate assistance to move to the edge of the bed and angle his legs. Transfer between bed and chair required maximum assistance of two with non-weight bearing on his right leg using a walker. Jeff is alert and oriented, although at night he has had some delusions that he is in the middle of an earthquake and that he is at a banquet in some hall. For safety, he has an aide with him 24 hours a day while he is having the delusions at night. Jeff’s wife visits daily and stays for 8-hours, sitting in a chair in his room. The companion accompanies her to the hospital and also sits in the room. Daily PT is working on transfers from bed to stand and ambulation with a walker. His length of stay is expected to be one week.

QUESTIONS

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Occupations

What occupations can you focus on given the short timeframe that you have with Jeff in acute care? Why are these important to address before his discharge?

What priority order would you put them in and why?

Write a problem list for Jeff of the issues that need to be addressed during his acute care hospital stay.

Performance Patterns

Jeff’s role as caregiver is important to him. What immediate impact does his knee replacement have on this role?

Given Jeff’s age, what are your expectations for his ability to return to his previous level of function? Explain your reasoning.

Performance Skills

Identify 5 to 8 performance skills that would be addressed during Jeff’s OT sessions.

Describe an intervention session to address 3 of your identified performance skills. What types of interventions would you use? (e.g., occupation, activity, or preparatory)

Client Factors

Identify three key body functions that are affected by Jeff’s knee replacement.

Contexts and Environment

Are there any safety issues you would address regarding his return home? Who would you talk to about these?

Intervention Plan and Goals

Write a problem list for Jeff, noting the issues that need to be addressed during his acute care hospital stay.

Write three long-term and three short-term goals for OT intervention.

Situations

Jeff’s wife is sitting in his room, and you start to transfer him from his bed to a chair so he can begin a sponge bath with his upper body. His wife tells you that he does not need to know how to do that because she will take care of him. However, you are aware that she does not do any caretaking. You have never been in Jeff’s room without his wife being there. How would you handle this situation?

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