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Running head: OCCUPATIONAL PROFILE & ANALYSIS

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Occupational Profile & Occupational Analysis Breanne Rowland Touro University Nevada

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Occupational Profile Who is the Client? The client is a 74 year old female who has lived in Las Vegas for the past 30 years ago. She is a retired certified public accountant who loves working with the public. The client is extremely family oriented and currently lives with her son, daughter in law, and two grandchildren. They live in a one story home that is accessible to the client. The home includes many available resources for the client that consists of a limited number of stairs, a walk in shower with a built in bench, in which she has utilized independently in the past, spacious hallways, and built in handlebars for toileting. The client has three children and 7 grandchildren, whom she loves to spend time with. She loves to cook, spend time with her family, play with her grandchildren, and garden. Her significant other is not in the picture. Her favorite hobby is cooking because she loves to provide food for her family, and enjoys the time she gets to spend with them. Family time is also very important to the client’s culture. Spending time cookin g together is something that is valued to the client’s culture and is an important occupation. She is also an active member in her church community and bible study. She presently has a Personal Care Attendant (PCA) that spends 3 hrs. /day, 5 days a week with her. The PCA attends to her when her family is working. This individual supports her with any difficulties she has in her ADLs, IADLs, and performance capabilities. Currently, she presents with bilateral Pneumonia (PNA), Chronic Obstructive Pulmonary Disease (COPD), Diabetes Mellitus (DM), Hypertension (HTN), Renal Insufficiency, history of a right Lobectomy, and Hypo-magnesium. Why is the client seeking services, and what are the client’s current concerns? The client is seeking services due to a decrease in independence and performance capabilities in the areas of activities of daily living (ADLs), functional mobility, range of motion,

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endurance and activity tolerance, balance, safety, and coordination. The client has many concerns relative to engaging in occupations and in daily life activities. The client’s concerns primarily involve independence. She is concerned with not having the ability to be independent in her everyday activities and becoming reliant on her family and PCA. She also has concerns about losing the ability to interact with her grandchildren and family. Additionally, the client has concerns with ambulating around the house, dressing and grooming independently, and losing the ability to interact with her family. She also states that due to her age, her eyesight is decreasing and she is losing the ability to see. This is affecting her ability to cook, read recipes, and garden. Areas of occupation that are successful and causing problems/risks The areas of occupation that are successful for the client includes bowel and bladder management, eating and feeding, toilet hygiene, communication management, religious observance, and rest and sleep. The client has maintained her independence in bowel and bladder management and toilet hygiene. She has also continued to be independent in eating and self-feeding. She has not experienced any difficulties with any activities related to rest and sleep. Areas of occupation that are causing problems include the client’s ADLs, instrumental activities of daily living (IADLs), leisure activities, and social participation. The client’s ADLs that are problematic include functional mobility, which includes ambulating and transferring safely, dressing and grooming independently, bathing and showering, and difficulty in breathing. IADLs that are difficult for the client include caring for her grandchildren, community mobility, health management, cooking for family, and safety awareness. She also has had difficulties participating in leisure activities or family functions, such as gardening and cooking, due to her

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illness. Social participation with friends and family has also been effected due to limited mobility and illness. Contexts and environments supporting or inhibiting participation and engagement The contexts and environments that support and inhibit the client’s participation consist of the cultural, physical, and social environments. Culture is very important to the client and expectations and behavior standards are essential. It is important for the client to be able to participate and attend all family events. This includes being present and contributing in social participation. This supports participation in the desired occupations because the client is surrounded by a support system that enables her to contribute in the occupations that are meaningful to her. This includes cooking, socializing with family, interacting with grandchildren, and contributing to family gatherings. The context and environment that is inhibiting participation is the physical environment. The client is having difficulties in functional mobility and safety. She is unaware of the environment around her, making safety a concern. This is a concern for the family because they fear that she will fall and injure herself. The client’s social context and environment supports participation and engagement in occupations. The client has many resources available to her. This includes family support and provision from a PCA. She also has many relationships with friends and family that are influential and supportive to her success. Occupational history The client was previously independent in her occupations prior to her hospitalization in 2010. She has been utilizing help from family and a PCA for the last three years. She has also become increasingly unsafe and her family worries about her health and safety. The client’s occupational history revolves around her family, work, and maintaining her home. She has been

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independent in cooking, cleaning, functional mobility, and working. Previously, much of her time was spent in the kitchen cooking for family and family functions. She also primarily did the household work, including yard work and gardening. Maintaining the yard and planting flowers was a way for the client to relieve stress and find balance in life. She also found stress relieve in spending time with family and cooking for family. This included cooking for large amounts of people and participating in social gatherings and games. The client is currently retired, but formerly worked as a certified public accountant. She enjoyed working with the public and enjoyed the social aspect of her job. Much of the client’s occupational history has focused around family and friends and participating in occupations such as gardening and cooking. Priorities and desired outcomes The Client’s priorities involve becoming more independent and safe during functional mobility and transfers. She is also concerned with being more independent in her everyday activities such as dressing, grooming, and hygiene. Another priority of the client is having the energy and ability to play with her grandchildren. She is very family oriented and does not want to lose the ability to interact and participate in family functions. She is mainly concerned with activities that involve taking care of her own body and activities to support her daily life in the home and with her family. Occupational Analysis Deficits in body functions The deficits in which the client is experiencing involves the functions of the mental, sensory and pain, neuromuscular-skeletal and movement-related, cardiovascular and respiratory, metabolic, and genitourinary system functions. The client is experiencing difficulties with mental functions, specifically in attention and mental functions of sequencing and complex movement.

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The client has trouble keeping her attention on one task at a time and becomes distracted very easily. She is also very impulsive and does not think about the execution of her movement patterns. This may be a reason as to way she is having trouble with safety. She is unaware of her sequencing and movement patterns, and her environment. The client is also having problems with her sensory functions and pain. She is having difficulties with her visual functions. This may be due to the aging process and related aging problems. She is also experiencing problems with proprioceptive and vestibular functions. The client is unaware of her body position, space, and movement against gravity. She also presents with decreased balance. This is impacting areas of her ADL’s. She has also been complaining of localized pain in different areas of her body, such as the back of her neck and head. The client is also experiencing many difficulties with her neuromusculoskeletal and movement-related functions. She is having complications in her joint mobility (limited range of motion), power (strength), endurance (walking and activity tolerance), and gait patterns. Cardiovascular and respiratory system functions are also an issue for the client. She has been diagnosed with hypertension, bilateral pneumonia, COPD, and has a history of a right lobectomy. These have all influenced her physical endurance, aerobic capacity, and fatigue. Other body functions that are impacted include metabolic and genitourinary system functions. The client is diagnosed with diabetes mellitus, and renal insufficiency. Activity demands The areas of occupation that were performed involved functional mobility, grooming, and hygiene. The task involved transferring out of bed, and using a front wheel walker to ambulate to the bathroom to practice grooming and hygiene tasks. The objects that were required for this task included a front wheel walker, a toothbrush, toothpaste, a hair brush, and hairspray. The space required was the client’s room, bathroom, lighting, and other objects in the environment cleared

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out of the way. The physical context needed to be clear in order for the client to be safe. The client was instructed on the social demands of the task. She was given instructions and safety concerns, in which she followed. The sequence and timing required of the task involved the client carrying out functional mobility, grooming and hygiene, and rationalizing the mental functions of sequencing complex movements. This involved executing the learned movements of walking and grooming/hygiene tasks. The required actions and skills to perform the tasks involved thinking about the required movements, feeling both feet on the floor in order to safely stand up, scanning the room for anything that might cause a fall, feeling the front wheel walker and gripping the handles, determining how to move one foot in front of the other, manipulating the front wheel walker, estimating the distance to the bathroom, remembering to breath correctly, and carrying out all of the tasks of brushing teeth, washing face, and brushing and styling hair. Performance patterns The performance patterns related to the task and the client includes habits, routines and roles. These are what influence the client’s motivations and helps the client continue to improve performance capabilities. Performance patterns, such as habits, are vital to the task of functional mobility and grooming and hygiene. Functional mobility, such as walking, is an automatic activity that is essential to life. Mobility is what enables people to be independent and function on a daily basis. Functional mobility is automatic, spontaneous, and supports performance for everyday activities. Functional mobility is important when accomplishing any type of routine. Routines provide structure to an individual’s life and consist of patterns of performance. Routines are hard to accomplish when mobility is compromised. Routines of the client include sequences that are carried out during the day, which include grooming and hygiene tasks. These routines give the client structure and meaning to everyday activities. Roles of the client involve

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a set of behaviors that are meaningful. These behaviors include being a mother, a grandmother, and a respectable elder. Being a respectable elder is very important in the client’s culture. Performance skills The performance skills that are required for the tasks of functional mobility, specifically walking with a front wheel walker, and grooming and hygiene include motor and praxis skills, sensory-perceptual skills, cognitive skills, and communication and social skills. The motor and Praxis skills that are required include coordinating sequential body movements to brush teeth, wash face and hands, brush and style hair, and walk with the front wheel walker. It also includes pacing appropriate movements, manipulating the front wheel walker, and maintaining balance while ambulating and standing. Sensory perceptual skills that are required for the client include positioning the body in a safe and relaxed location to begin, visually scanning the environment and determining if it is safe, selecting and locating the destination, determining the water temperature, and locating the appropriate supplies for hygiene and grooming. Cognitive skills that are required include judging the environment and the distance walking, selecting the appropriate clothing and foot wear to walk, sequencing steps one at a time and taking the appropriate time, multitasking while walking (talking and walking), and determining water temperature and safety. The communication and social skills required for functional mobility and grooming and hygiene include communication with others if tired or decreased endurance, looking and walking to where someone is pointing at, talking and having a conversation while walking, and keeping an appropriate distance behind and beside others. Body functions and body structures The client’s body functions and structures that are impacted involve the functions of the mental, sensory and pain, neuromuscular-skeletal and movement-related, cardiovascular and

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respiratory, metabolic, and genitourinary system functions. The client is experiencing difficulties with mental functions specifically in attention and mental functions of sequencing and complex movement. The client has trouble keeping her attention on one task at a time and becomes distracted very easily. She is unaware of her sequencing and movement patterns, and her environment. The client is also having problems with her sensory functions and pain. She is having difficulties with her visual functions. This may be due to the aging process and related aging problems. She is also experiencing problems with proprioceptive and vestibular functions. The client is unaware of her body position, space, and movement against gravity. She also presents with decreased balance. This is impacting areas of her ADL’s. She has also been complaining of localized pain in different areas of her body, such as the back of her neck and head. The client is also experiencing many difficulties with her neuromusculoskeletal and movement-related functions. She is having complications in her joint mobility (limited range of motion), power (strength), endurance (walking and activity tolerance), and gait patterns. Cardiovascular and respiratory system functions are also an issue for the client. She has been diagnosed with hypertension, bilateral pneumonia, COPD, and has a history of a right lobectomy. Other body functions include metabolic and genitourinary system functions. The client is diagnosed with diabetes mellitus, and renal insufficiency. Context and environment The contexts that specifically relate to the performance of this intervention include physical, social, cultural, and personal. The physical context relates to the performance of functional mobility and grooming and hygiene because the natural and built physical environment directly influences mobility. This includes devices used, furniture around the client, sensory qualities, and the physical terrain. The social environment consists of the client’s

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family members, friends, multidisciplinary team members, and PCA. The cultural environment includes the activity patterns, behavior standards, and expectations accepted by the client. It is very important to the client that she is mobile and present for cultural and family gatherings. It is also important that the client has appropriate hygiene routines. The client’s personal context includes being a 74 year old retired female who is an active member in her church community and bible study. Problem List 1. Client requires CGA in functional mobility due to ↓ safety, endurance, and coordination 2. Client requires S/U in hygiene/ grooming due to ↓ activity tolerance, endurance, and safety. 3. Client requires Min Ⓐ in LE dressing due to ↓ activity tolerance, strength and safety 4. Client tolerates less than 20 minutes of ADL participation due to severe shortness of breath 5. Client is unable to bathe Ⓘ due to ↓strength and activity tolerance. The top two problem statements were chosen based on the client’s goals and priorities. Functional mobility, safety, and ADL retraining are required in order to allow the client to be as independent as possible.

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References American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy 62, 625–683.