TASK:

Read this summary of relevant clinical notes and answer the questions on your interpretation
of the information provided, with emphasis to:

1. Evaluation of information / hypothesis generation from information

2. Identifying Impairment, functional limitation and disability
3. Positive contextual factors
4. Answer questions 6-10

CASE SCENARIO

Sarah is a 69-year-old retired professor with a medical diagnosis of Osteoarthritis of both

knees. She is widowed and living alone in a third floor-apartment with elevator access.
Yesterday, Sarah underwent elective surgery for bilateral total knee replacement. Her medical
history includes emphysema, myocardial infarct 2 years ago, moderate obesity, and
hypertension. She lives independently but has a maximum walking tolerance of 100 meters
when using a cane for support (prior to undergoing surgery).

DIAGNOSIS:
Post op day 1 after (B) TKR

EXAMINATION:
Arousal/cognition Alert and oriented; follows complex commands; motivated to get out of
: bed
vital signs: pulse- 96 supine, 108 sitting; BP- 144/66mmHg supine, 126/64 mmHg
sitting;
Posture: Supine- Semi-flexed both knees, with (L) > (R) valgus knee deformity
Wounds: Dressed with gauze and clear tape, moderately soaked with bloody
drainage; peri-wound region is warm to touch, hyper-erythemic, and
swollen.
CVS: Pale with complaints of nausea; short of breath with exertion
Pain: 3/10 at rest; 8/10 with movement
AROM: (R) knee ext/flex 20 to 47 degrees (pain elicited); (L) knee ext/flex 15
to 52 degrees (pain elicited)
Strength testing: Iliopsoas (B) 2+/5; Gluteus Maximus (B) 4/5; Gluteus Medius 2+/5;
Quadriceps (R) 2/5, (L) 3-/5; Hamstrings (R) 2+/5, (L) 3-/5;
Resisted testing: Shoulder girdle extension and depression, elbow extension all strong &
pain-free
Endurance: Maximum sitting tolerance 15 mins; maximum standing tolerance 20
seconds
Gait: Wide base of support, stiff knees, flexed trunk, maximum upper
extremity support on walker
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SCORE SHEET:

No Questions
:
1. Evaluation of information / hypothesis generation:

2. Identifying Impairment:

3. Identifying Functional Limitation:

4. Identifying Disability:

5. Positive Contextual Factors:

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6. Any FIVE precautions the patient has to take:

7. Any THREE exercises to improve knee extension:

8. Any FOUR goals of PT treatment during Immediate Post-Surgical Phase (Day 0-

3):

9. Any THREE signs of Deep Vein Thrombosis:

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10. Any THREE Criteria for Discharge: