Cаse study pаrt 1 Ken, аge 72, had a left cerebrоvascular accident (CVA) twо years agо and suffered physical impairment. He is aphasic but able to communicate his basic needs. Ken has lived in a long-term care facility for the past year. He has a recurring pressure wound (decubitus ulcer) on his left ischial tuberosity that has not fully healed with bed rest. As the occupational therapist providing monthly services to the long-term care facility, you receive a referral to see this gentleman. Information in the client record: Ken has residual physical impairment with aphasia but can communicate his basic needs; Co-morbidities include hypertension, type 2 diabetes, hypercholesterolemia and mild obesity; Ken is receiving wound care twice daily from nursing staff, and a wound care specialist consults on a monthly basis; The wound care specialist’s notes indicate that the pressure wound has been slowly healing over the past month; For the past two weeks, Ken has refused to eat in the dining area and has not participated in social activities in the long-term care facility; Ken requires a one-person assist to use the commode; Ken uses a wheelchair for mobility due to right-sided weakness; Ken never married. He has a sister who lives close by and provides support with managing Ken's finances; Ken is alert and oriented to person, place and time. Ken is a retired police officer and was active in his community. He receives a full pension from the police department as well as Canada Old Age Security and Canada Pension. The long-term care facility offers social work, nursing care and dietician services. The attending physician provides weekly on-site services. Nursing staff identify which clients the physician is to see. Self-Study Exercise for Part 2 Instructions: Read the additional case information below and, 1. Identify the relevant assessment data that is presented in the case study. 2. Identify the client's occupational performance issues. 3. Determine the services you would recommend for this client. You are provided 30 minutes to complete this self-study exercise. Following this, the assessor will take you through a series of oral questions related to the case. Case study part 2 As an occupational therapist you conducted your initial assessment and determined: Ken indicated that he wants to resume participating in the community outings as well as other social activities at the long-term care facility; for example, playing cards with his friends in the dining area and participating in pub night. Ken indicated that his pain is a 6 on a scale of 0 to 10 (with 0 being no pain and 10 being severe), and that when he is sitting upright the pain increases. Ken indicated that he wants to reduce his pain so he can resume social activities. Ken's sister indicated that Ken has adjusted to the long-term care facility and enjoys the social contact of his roommates. His sister also stated that Ken complains that “he is left sitting on the toilet too long by nursing staff" and that he “finds transfers to the toilet painful." His sister occasionally brings Ken supper and joins him in a traditional Jewish meal. On the subsequent assessment, you determined the following: Ken is 6 feet 1 inch tall (185cm) and weighs 225 pounds (102kg). You note that he has lost 10 pounds (4.5kg) in the past month. Ken wears glasses for reading. Ken is a practicing Jew who attends synagogue with his sister once a month. Ken can follow commands and responds to yes and no questions with appropriate gestures; for example, by nodding his head. Formerly, Ken was right-hand dominant but is unable to use his right upper extremity for functional activities due to dense hemiparesis. Ken has increased flexor tone in his right hand, wrist, elbow and shoulder. Ken can use his left upper extremity to assist with propelling his wheelchair, applying the hand brakes, washing his face, and using a spoon or fork to lift food into his mouth. Ken has poor trunk control related to right-sided lower extremity hemiparesis and pain from the pressure wound (decubitus ulcer). Ken could not tolerate sitting in the wheelchair or commode for longer than 15 minutes due to pain from the pressure wound and poor skin condition around the wound site Ken’s seated position in the wheelchair: weight bearing predominantly on his left side and sitting on the edge of chair with left hip rotated forward so he can reach the floor with his left foot for propulsion. Wheelchair cushion has decompressed and lost shape ("bottomed out").