Case Study: Amanda Sax
Read the narrative report for Amanda Sax before you view the life care plan. Read the information and assume that this is information that you collected during your clinical interview with Amanda. Click here for Narrative Report
Identify the following key elements of the case:
- What is Amanda’s current diagnosis?
- What are her physical limitations?
Based on Amanda’s information, determine what recommendations should be made in her life care plan. Include the purpose for each item, the beginning and ending dates for each item, and the frequency of replacement schedule for the items. You may want to refer to page 6 of your Life Care Planning and Case Management Handbook and reference the Life Care Plan Checklist.
Amanda’s current diagnosis is: Kidney damage and left above knee amputation.
Her physical limitations include:
She has numbness on her right lower leg in the scarring area from surgical sites to remove donor tendons to try to repair her left leg, prior to amputation. She does have phantom pains about three times per day. She is not on medication for phantom pains. She says the phantom pain has improved over early post injury.
Reach: Full range of motion and no pain in upper extremities. She does have some balance issues with reaching, but this has improved.
Lift: She can lift and carry light objects, but she tries to avoid this because she has fallen when carrying items. Amanda reports that she fell in Target the other day. When she fell, she fell on her prosthetic knee so she did not hurt herself. She can not lift and carry anything of moderate or heavy weight.
Prehensile/Grip:Intact. She feels that her upper arm strength has improved due to extensive use.
Sitting: Her prosthesis will pinch the back of her leg when sitting, particularly when sitting on hard chairs. She has to readjust frequently when sitting. It is hard for her to get up on higher stools, and it is difficult for her to sit in a booth at a restaurant, because the prosthesis sticks out further than her right knee. She has trouble sitting on airplanes, because there is not enough leg room between the seats for her prosthesis.
Standing: She can stand in the shower without wearing her prosthesis, but this causes pain in her residual limb due to the blood pooling at the terminal end. She does not have grab bars or a shower chair. She can stand for about 30 minutes with her prosthesis on before her leg starts to hurt. She does not usually sit but will just try to learn to deal with the pain. She wants to be able to stand and do the kinds of things her friends do, so she tells herself she just has to learn to live with pain, as it will be a part of her life from now on.
Walking/Gait:She can walk for about 30 to 60 minutes. Her prosthesis digs into her thigh right now causing pain. She is supposed to get a new socket, and she is hoping this will improve the pain in the thigh. She has pain in her residual limb with walking and standing. She walks with crutches when she does not have on her prosthesis. She does make it a habit to put her prosthesis on first thing in the morning, and she wears it all day. She also has pain in her right knee due to over use and frequent falling on the right knee. No diagnostics have been done on the right knee. She also has pain in her mid and lower back on the left with walking due to altered gait.
Bend/Twist: She can bend, but she is limited in bending due to prosthesis and knee being locked. No pain with bending and twisting.
Kneel: Nonfunctional for kneeling.
Stoop/Squat:Nonfunctional for stooping and squatting.
Climb: She can go up steps and stairs if there is a rail. She has to lock her prosthetic knee and swing her leg up the step. Nonfunctional for repetitive step or stair climbing.
Balance: She has some balance deficits and will fall at times. She feels her balance has improved.
Breathing: No dyspnea.
Vision: Normal intact.
Driving: She can drive, but she can not afford a car right now, so she does not have one. She has driven her boyfriends car post-injury. She does have some anxiety when driving.
Physical Stamina (average daily need for rest or reclining): She does tire easily when she has to ambulate. It takes more energy to walk with her prosthesis and walking with crutches also fatigues her.