Acute Myeloid Leukemia Case Study

Author/s

Chelsea Bentley, Aubrey Jacobi, Lauren Jones, Gina Pottkotter, and MegAnne Punt from the Bellarmine University Physical Therapy Program's Pathophysiology of Complex Patient Problems Project.

Patient Characteristics

• 66 year old male, named Bert 
• Retired Navy Seal and school bus driver
• Current Volunteer at Veteran’s Affairs Hospital in Louisville, KY
• Lives with wife of 45 years
• Type II diabetic, controlled
• Left Transtibial Amputation secondary to diabetic ulcer
• Previous physical therapy in acute, rehabilitation, and outpatient settings following surgery
  

Examination

SUBJECTIVE:

• Chief Complaint: Patient presents to outpatient physical therapy clinic (2 months post discharge), with desire for further prosthetic training. Patient’s prior outpatient PT included gait training and stair training with use of cane. Now, patient desires more independence without assistive device and further training to accommodate his increased activity level in the community with his volunteer work. Patient notes that he feels increasingly tired after a day of volunteering, therefore he wants more endurance training with his prosthetic.
  
• Medical History:
  • Previous history of smoking, 30 pack years
  • Quit smoking at age 48, when he was diagnosed with Type II diabetes
  • Diabetic ulcer on L heel, led to transtibial amputation approximately 1 year ago
  • Patient reports history of anemia while in hospital post-op
• Recent onset of headaches, 3 out of 10 on pain scale
• Patient reports shortness of breath with increased activity
• 1 year post-operation from amputation
  • Discharged from outpatient physical therapy 2 months prior to current visit

Self Report Outcome Measures:

• Pain Scale:
  • Headaches reported 3 out of 10 on Visual Analog Scale
  • Otherwise, patient complains of no pain
• Short Form 36 Questionnaire (Quality of Life Measure)
  • Physical Functioning Score (PF) of 45 (significant decrease in physical functioning )
  • Role limitations due to physical health (RP) score of 25 (significant limitations)
  • Vitality Score of 20 (significant decrease in quality of life)
  • Physical Health overall largely impacted, score of 31
  • Mental Health, stable with score of 59
  • Scores under 50 represent significant impact

Physical Performance Measures:

• Amputee Mobility Predictor
  • Score of 37/47
  • Indicates Functional Level 3/K3 (Rehab Techniques PowerPoint)
• 5 Time Sit Stand Test (endurance)
  • 12.5 seconds (average for age group 11.4 secs, fall risk over 12 seconds)
  

OBJECTIVE:

• Vital Signs:
  • Blood Pressure 110/75 mmHg
  • Heart Rate 64bpm
  • Respiratory Rate 18bpm(at rest)
  • Temperature 99.4°F
• Patient presents with cough. Auscultation reveals adventitious lung sounds.
• Petechaie and bruising noted on patients R lower leg and ankle, also minor spots noted on residual limb
• Due to fever, palpation of abdomen revealed enlarged spleen and tenderness
• Upper and lower quarter screen ROM WNL.
• All deep tendon reflexes present and symmetrical
• Sensation diminished over L residual limb and R foot
• Hip flexion 4/5 bilaterally, Shoulder abduction 4/5 bilaterally, shoulder flexion 4/5 bilaterally. All other manual muscle tests within normal limits.
  

Summarization of Examination Findings

Working Diagnosis and Targeted Interventions

Intervention

• Phases of Interventions (e.g. protective phase, mobility phase, etc.)
• Dosage and Parameters
• Rationale for Progression
• Co-interventions if applicable (e.g. injection therapy, medications)

Outcomes

Findings Over time

Discussion

Summary Statement which should include related findings in the literature, potential impact on clinical practices

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