10th Case of the Week, Due 10/18/18, by 1pmEST Medicare SNF
CCR2. PHI verified via Fax. Brief Clinical Course: R arm DVT. Admitted 09.26.2018 to SNF. Previous hospital stay: Admitted 9/10/2018 lower extremity swelling and CHF. Recently d/c from hospital and has been taking Lasix po. Physical Findings: ANEMIA, cardiomegaly with improved left lower lobe infiltrate, Stage 1 Pressure Injury lateral aspect of b/I heels, Hyponatremia with hypervolemia. Target LOS 18 days provided to facility based on DRG 299 (MDC 05) Peripheral vascular disorders w MCC. Target LOS Date: 10/20/2018. Expected DCP: Home with wife and son support. Expected DC date: 10/18/2018. Number of Skill Days used prior to current review/100 days: 38. PMH: CAD, A fib, COPD, CHF, CKD, DM, HLD, lung CA, HTN, PAD, THA, TKA, cardiac stents PLOF/ Living Situation: Mod I RW, Independent. Home Setup: Lives with spouse in a ranch style home, 2 steps to enter. Behavioral Health: Not provided. Advanced Directive/Living Will: Full code. Service requested for: SNF. *Skilled Medical Needs: Respiratory treatment Albuterol Q8H PRN, Spirva, Breo, and Ventolin; foley catheter management; medical and medication management; bilateral heels red and mushy; R dorsal foot wound 1.5x1cm partially pink with some slough and yellow drainage (was 1x1cm 100% granulation); wound care: cleanse with normal saline and cover with vaseline gauze and mepilex dressing daily and PRN; Levaquin start 10/4/18 x4 days Pneumonia. *Current Mental Status: A&OX2-3. Dementia Score: NA *Bed Mobility: ModA (Unchanged). *Ambulation: 30 ft CGA w/ RW --> 40 ft MinA w/ RW (Declined). *Transfers: ModA --> ModA/MaxA (Declined). *Stairs: Dependent (Unchanged). *Bathing UB: MinA (Unchanged); *LB: MaxA (Unchanged). *Dressing UB: MinA --> ModA (Declined); *LB: MaxA (Unchanged). *Toileting: ModA --> MaxA (Declined). *Toilet transfers: ModA --> ModA/MaxA (Declined). *Speech Tx: Mech soft diet. Discharge barriers: decreased strength and balance, SOB on exertion.
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