Week 4 - Study manual

Case study

Marijke Groen (28), has an office job, she is a secretary at a large accounting office. She goes to work by car (distance 2 kilometres). Weight 100 kg, height 172; BMI 33.8; abdominal girth 89 cm. She is a real sociable person, loves going out, eating out and smokes about 5-10 cigarettes a week.

Last month, Marijke became unwell twice at work. She was unresponsive; she regained consciousness shortly after the ambulance personnel arrived.

Before Marijke became unwell, she was thirsty and had difficulty concentrating on her work. Her colleagues told her she was speaking gibberish.

After much advice, Marijke still went to the GP. The GP suspected that Marijke had type II diabetes mellitus. After examination, both her blood sugar and blood pressure were found to be highly elevated.

The GP drew up a treatment plan: medication for the high blood pressure (Enalapril) and medication for her diabetes mellitus II (Metformin), a consultation with the dietician and a visit to the physiotherapist. Possibly, a (reimbursed) Combined Lifestyle Intervention (GLI) could be a solution for Marijke.

Marijke thinks this is all a bit over the top, after all, she is not yet 30 years old.

Anamnesis

Impairments

• last week → unwell x 2 at work place

• unresponsive, re-gained consciousness shortly after that

• before becoming unwell

  • thirsty

  • poor concentration

  • speaking gibberish

• GP diagnosis: diabetes mellitus II

• blood pressure and blood sugar high elevation

Activities

• working

Participation

-

Personal factors

• female 28 yo

• 100 kg - 172 cm - BMI: 33.8

• abdominal girth 89 cm

• sociable person (going out, eat out)

• smoker - 5/10 cigarettes x week

• PT thinks is an “extrageration“

  medications

• medication for the high blood pressure (Enalapril) and medication for her diabetes mellitus II (Metformin)

Environmental factors

• office job, secretary at large firm

• goes to work by car

Psychosocial factors are very important!!

with this patient → the anamnesis is the most important part of the assessment here, she is still in pre-contemplation phase (di Proska & Diclemente TST model)

• does she has health literacy? What are her looks on health style and benefits of treatment and life changes

Assessment

• observation

  • discoloration of skin, especially at the extremities

  • total observation of body

  • Functional → tie shoe laces

• weight (if not measured)

• circumference (is she didn’t measure it)

• measure blood pressure

• measure Heart rate

• auscultation of HR

• ask for loss in sensation (ASK FIRST) in case, do the pin-prick

• skin fold measurment

• saturation

• Questionnaires:

  • DDS (diabetes distress scale)

  • Diabetes Quality of Life (DQOL) Assesses the impact of diabetes on daily life, including diet, physical activity, and treatment satisfaction.

Specific tests

• 6MWT

• 5TSTS

• Astrand test

• grip strength

• BORG scale

Treatment

• aerobic training: interval training 2-3 times x week

  • go to group classes for this type of training, to get more sociable, take a friend with out.

• stationary cycling/ walking / swimming 3 week x 20 minutes

• smoking cessation → motivational interview

• nutritionist (multi disciplinary program)

• change of habits → go to work, walk/cycle

MB preparations

• I do it in another sheat → done

PT care preparations

To do: watch these videos

• YouTube video: https://www.youtube.com/watch?v=j2YX4b7KWwQ

Find these words:

Keywords PT

Acute coronary syndrome, Arteriosclerosis, Angina pectoris complaints (APK), Cholesterol, Coronary artery disease, Diabetes Mellitus type I, Diabetes Mellitus type II, echocardiography, Ejection fraction (Left Ventricular Ejection Fraction), Embolism, Enzymes (Creatine phosphokinase; CPK, CPK-mb, Troponin, myoglobin), Fatty streak, Phospholipid, HDL (High Density Lipoprotein), Main stem, Hypercholesterolemia, Medication, Hypertension, Infarction, Catheterisation, Coronary artery, LDL (low density lipoprotein), Myocardial perfusion, Metabolic syndrome (syndrome X), Normal weight, Obesity, PTCA (Percutaneous Transluminal Coronary Angiography), Stress, Triglycerides, Thrombus, Vascular disease, Fat-free mass, Wall motion score. Measuring instruments (guideline)

Study task 2

Study task 3

Study task 4

• we did it in class with Jolanda, look below the case study week 4

Study task 5

BC preparation

Terminology

To do the other study tasks u have first to watch the lecture and read the guidelines, then try to answer again

MB work assignments → they are quite long, I do them in a separate sheet