Use the following case to answer questions 37-44 Donald is a 65-year-old male.  He is fairly sedentary, he is retired, and his leisure activities include watching TV, reading, and attending local collegiate sporting events.  He has presented to outpatient physical therapy for an exercise program at the request of his son, who has been urging him for years to “do something.”  He is now motivated to “get in shape” to see his grandchildren grow up.  Examination findings PMedHX: gout, HTN, hypercholesteremia, plantar fasciitis, and OA of bilateral knees (he has received several cortisone injections).  Meds:  Lopressor (Metoprolol), Lipitor, and Chondroitin supplements.  He recently had a non-remarkable stress test.  His physician cleared him to begin an exercise program. 5 feet 10 inches and weighs 240 pounds. (BMI 34.4) Vitals: BP 130/85, resting HR 80 Muscle strength testing (5/5) with the exception of hip ext. 3/5, hip abd. 4/5, ankle plantar flexors 3+/5, trunk flexors 2/5, trunk extensors 2/5. Transfers were independent. Gait pattern was slow and antalgic initially upon getting out of the chair for the 1st 30 ft, and revealed decreased push off bilaterally. He was able to walk up and down a flight of stairs with a handrail, but c/o 7/10 pain during and after and utilized a “step-to” gait pattern for both ascend and decend. Which of the following mode of exercise would be the primary choice for Donald to improve his aeorbic endurance?

Use the following case to answer questions 29-36 Ethyl is a 90-year-old female who was admitted to the hospital last night with a diagnosis of pneumonia.  The physical therapist received orders to evaluate and treat this patient to improve mobility. History and Examination Findings: History: She is retired and lives by herself in a 1-bedroom apartment in an assisted living facility.  Her husband died last year, and she reports to you several times that she is “lost without him.”  Her past medical history reveals that she wears glasses, has macular degeneration, has hearing aids, uses a 4 wheeled walker for ambulation, does not drive, has had 3 spinal compression fractures and a hip fracture within the last 5 years, is being hospitalized for pneumonia for the 3rd time in the last 6 months, and has high cholesterol.  Ethyl is 5 feet 3 and Weighs 85 pounds. (BMI 15.1) 2 years ago her BMI was 19 Alert and orientedX3, she answers all questions appropriately, and her voice is gurgly sounding. Posture: forward head, excessive kyphosis, and posterior pelvic tilt in sitting. Transfers: supine to sit with stand-by assist, sit to stand with moderate assist from a low chair Gait: 5 mph (.6 meters/sec.) with 4 wheeled walker 200 feet requiring 3 sitting rest breaks. Balance: High fall risk category on Tinetti (score 16) The PT checks in with the nurse that has been in charge of Ethyl’s care since her arrival last night. The nurse reports that Ethyl was confused and became “hard to manage” so she convinced the MD on call to order the use of restraints. Which of the following statements BEST describes appropriate use of restraints in a hospital setting?

Your older adult patient would like to implement a strategy to attempt to decrease their fall risk in their home. Which one of these assistive technology devices would be teh MOST appropriate?

 Refer to the following case to answer questions 19-28 Ralph is an  85-year-old male who has been referred for a PT evaluation by his primary care physician due to R shoulder pain, which began ~1 month ago.  The pain is at its worst when he attempts to lift his arm past ~45 degrees of flexion and abduction.  He reported that because of the shoulder pain he has trouble getting his shirt on in the morning, combing his hair, and washing his upper body in the shower. Ralph stresses the importance of being able to maintain his independence at home and states “this is a top priority”.  PMHX: CABGx3 with artificial valve replacement 15 years ago, spinal stenosis, high blood pressure, previous MI x2.  Current meds:  Lasix, Lipitor, Lopressor, Coumadin.  Current level of function: He walks with a cane a maximum of 150 feet.  He wears bilateral bifocal eyeglasses and hearing aids secondary to presbycusis. In addition to a numerical pain scale, which of the following tools is the BEST choice to further assess pain during Ralph’s examination?

 Refer to the following case to answer questions 19-28 Ralph is an  85-year-old male who has been referred for a PT evaluation by his primary care physician due to R shoulder pain, which began ~1 month ago.  The pain is at its worst when he attempts to lift his arm past ~45 degrees of flexion and abduction.  He reported that because of the shoulder pain he has trouble getting his shirt on in the morning, combing his hair, and washing his upper body in the shower. Ralph stresses the importance of being able to maintain his independence at home and states “this is a top priority”.  PMHX: CABGx3 with artificial valve replacement 15 years ago, spinal stenosis, high blood pressure, previous MI x2.  Current meds:  Lasix, Lipitor, Lopressor, Coumadin.  Current level of function: He walks with a cane a maximum of 150 feet.  He wears bilateral bifocal eyeglasses and hearing aids secondary to presbycusis. Which of the following statements BEST describes the effects of resitance training in the older adult?

 Refer to the following case to answer questions 19-28 Ralph is an  85-year-old male who has been referred for a PT evaluation by his primary care physician due to R shoulder pain, which began ~1 month ago.  The pain is at its worst when he attempts to lift his arm past ~45 degrees of flexion and abduction.  He reported that because of the shoulder pain he has trouble getting his shirt on in the morning, combing his hair, and washing his upper body in the shower. Ralph stresses the importance of being able to maintain his independence at home and states “this is a top priority”.  PMHX: CABGx3 with artificial valve replacement 15 years ago, spinal stenosis, high blood pressure, previous MI x2.  Current meds:  Lasix, Lipitor, Lopressor, Coumadin.  Current level of function: He walks with a cane a maximum of 150 feet.  He wears bilateral bifocal eyeglasses and hearing aids secondary to presbycusis. Which of the following represents the classification of functional skills that Ralph is having difficulty with as related to his shoulder pain (grooming and dressing)?

Use the following case to answer questions 43-51 Ingrid is an 81-year-old female who suffered a hip fracture and underwent a total hip replacement surgery (posterior approach) yesterday.  The physical therapist received orders to evaluate and treat the patient.   History and Examination findings: History: patient lived in an independent community living environment (widow of 10 years). She ambulated independently without an assistive device.   She was independent in all ADL’s and IADL’s except driving and she typically ate her meals at the cafeteria.  She has no history of dementia Since surgery alert and oriented to person only and has been combative with staff Low grade fever PWB on the involved LE due to severe osteoporosis. Which of the following  risk factors for falling did Ingrid display PRIOR to her admission to the hospital?

An 82-year-old woman is referred to outpatient physical therapy following two falls in the past 3 months. She lives alone in a single-story home. Her medical history includes hypertension, type 2 diabetes, osteoarthritis, and mild cognitive impairment. Her medications include a beta blocker, metformin, a statin, and a recently prescribed benzodiazepine for sleep. During the evaluation, she reports feeling “groggy” in the mornings and admits she is most afraid of “losing independence and having to move in with my daughter.” Examination reveals decreased gait speed, impaired dual-task balance, and mild short-term memory deficits. Using the Geriatric 5M framework, which of the following is the MOST appropriate initial physical therapy action?

A home assessment is a key part of your PT evaluation in the Home Health and Hospice setting.

Drug related problems in the older adult include which of the following: