17th Case of the Week, Due 11/29/18, by 1pmEST

Emblem Medicaid SNF, Review 11/8/18

CCR # 2. 59 y/o M. Admitting Diagnosis: 10/19/18 colostomy herniating/chronic ulcerative proctitis. Brief Clinical Course: s/p resection of prolapsed colostomy w revision on 10/25/18. Physical Findings: Patchy right basilar atelectasis; abdominal pain secondary to post radiation chemotherapy for anal cancer, confirmed with biopsy. Patient was on sub-acute rehab for 2 weeks after that. Target LOS: 18 days/TGD 11/20/18. DRG: 356. Expected DCP: Home as PTA. HH TBD. Number of Skill Days used out of 100 days: 17 Evicore days as of this review PMH: OA, ETOH abuse, Smoker, rectal carcinoma, s/p chemo and radiation, NCNC anemia likely d/t anemia of chronic disease, colostomy. PLOF: Independent, ambulates w/ a cane. Home Set Up: lives with brother in an apt.

*Skilled Medical Needs: Medication management, fall precautions, colostomy care, pain management, Percocet 5/325mg po q8h prn, perirectal abscess wound 1cm x 1cm x 0.2cm with purulent drainage, Nicotine patch, Cipro 500mg po BID x 10 days, Flagyl 500 mg po BID x 10 days, Fentanyl patch 50mcg transdermal q72h, C/O’s pain 10/10-Gabapentin 100mg po 3x/d added.

*Current Mental Status: A&Ox3

*Bed mobility: Mod A (Improved)

*Ambulation: 10 feet w/Max A and RW (Improved)

*Transfers: Max A (Improved)

*Stairs: DNT

*Bathing: Hygiene/Grooming: CGA (Improved)

*Dressing: UE: Max A (Improved) LE: Min A (Unchanged)

*Toileting: Max A (Unchanged)

*Toilet transfers: Max A (Improved)

*Speech Tx: NA

Pt is participating in 1hr PT/OT each 5-6 days/wk



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