Cаse Study Pаrt 1 A retired elementаry schооl teacher, Gertrude, 93, was transferred tо an acute care medical unit after spending the last two days in the emergency department waiting for a bed. At home, Gertrude fell after missing the bottom step of her basement stairs while carrying a laundry basket. She was lying on the basement floor for at least 18 hours before her daughter arrived to take her grocery shopping. Gertrude sustained two small rib-fractures and multiple bruises. She is presently confused and agitated. The emergency room physician has given you a referral to see Gertrude when she arrives at the acute medical unit to support discharge planning. The client record indicates: Gertrude has been a widow for less than one year. She lives alone in the suburban bungalow where she has lived for 60 years. The laundry room is in the basement. Her daughter assists with heavier household chores and drives her mother to appointments and the grocery store. Gertrude receives a modest pension. Co-morbidities include hypertension, type 2 diabetes, hypercholesterolemia and a left hip replacement due to osteoarthritis. Gertrude wears glasses and bilateral hearing aids. Prior to admission to the hospital, she was ambulatory without a gait aid but had limited community mobility in bad weather. Lab results demonstrated an elevated white cell count, elevated fasting blood glucose levels, and a urinary tract infection. Gertrude is receiving IV antibiotics with the last dose scheduled in two days. Physiotherapy provided Gertrude with a thoracic brace which she wears when she is not in bed. During your initial meeting with Gertrude she was confused and unable to accurately respond to one-step commands, even with physical cues and prompts. Self-Study Exercise for Part 2 Instructions: Read the additional case information below and, 1. Identify the relevant assessment data that is presented in the case study. 2. Identify the client's occupational performance issues. 3. Determine the services you would recommend for this client. You are provided 30 minutes to complete this self-study exercise. Following this, the assessor will take you through a series of oral questions related to the case. Assessment details: You called Gertrude’s daughter to obtain additional information and confirmed that Gertrude was living independently with minimal supports prior to her fall. The daughter explained: The confusion is a new behavior. She stated, "Prior to admission to the hospital, my mother was very aware, pleasant and self-dependent given her age.” The daughter provided consent for you to re-evaluate Gertrude at a later date to determine cognitive abilities and conduct the assessment when it is appropriate to make recommendations for discharge planning. During the consent process, the daughter indicated that she’s concerned about her mother living on her own, now that she has fallen. She indicated that her mother has several aged friends in the neighborhood who are also not coping well by themselves. After speaking with the daughter, you met with Gertrude again and completed your occupational therapy assessment. Through your assessment, you determined: Her ability to follow multi-step verbal commands and ability to participate in the assessment had improved. AROM (active range of motion) and muscle strength were within normal functional limits, with some reduced trunk mobility related to pain from fractures and immobilization from the brace. Cognitively, Gertrude scored 25/30 on the mini mental status exam (MMSE). She was unable to correctly recall the day of the week and date and had difficulty with attention and calculation task (serial 7s). Gertrude tolerated sitting in a chair by the bedside for only one hour. She stated that her ribs were “very sore sitting so long” and the thoracic brace seemed to "cut into" her stomach when sitting for long. Gertrude indicated she was concerned that her mobility “seems to be limited since the fall.” She stated she is “really afraid of falling.” The ADL (activities of daily living) assessment demonstrated: o Good ability to wash her face and engage in denture care from a seated position at the sink. o Required a bath bench and supervision for showering, primarily due to fear of falling. o Performed toilet and tub transfers with one assist. o Ambulated 30 meters with one person assist and a two-wheeled walker. o Gertrude declined assessment of her ability to ascend and descend stairs due to fear of falling. o Donned and doffed her thoracic brace without assistance. In the kitchen assessment, Gertrude demonstrated the ability to stand at the counter and prepare toast and tea. However, she was unable to carry the items from the fridge or counter to the table because she needed the walker as a gait aid. Gertrude is a faithful Catholic and prior to her fall she enjoyed walking to the church at the end of her street. Gertrude stated, "My church friends have helped me a lot since my husband died; they help take away some of the loneliness and my pain." However, Gertrude stated that she had not been to church for a few months prior to admission to the hospital. Gertrude stated that she “would rather die than move” from the home she shared with her husband for 60 years, saying that she does “not want to lose the memories.” Gertrude reported that she enjoys cooking a fresh meal every day for herself. She does not like pre-made food. Gertrude said, "It must be homemade to be good." Gertrude indicated that she does not have much of an appetite lately. Her daughter is retired and is caring for her own husband who has prostate cancer; the daughter and her husband live in a multi-level home.
If E[Z] = 14 аnd Vаr(Z) = 4, find Vаr(-3Z - 9).
The bаsketbаll plаyer Lebrоn James is a great free thrоw shоoter. In fact, his shots are independent and all have probability 0.9 of being successful. Suppose he takes 6 shots in the next game. What’s the probability that he makes at least 5 of them?