24th Case of the Week Due 5/9/19, by 1pm EST

Medicaid/LTAC; Review 4/12/19

CCR 4 Clinical Review: 50 yo F admitted to hospital 2/24/2019. Brief Clinical Course: Found on floor unspecified amount of time. Fell a couple of wks ago, Rt hip swelling/pain. Admitting Dx: Unspecified Convulsions. Developed hypertensive emergency, lethargy & respiratory distress, intubation after cardiac arrest w/ VT requiring cardioversion. Stroke code activated, CTH showed blood in the 4th ventricle, 3rd ventricle, frontal horns & temporal horns suggesting a large SAH. Expected DCP: SNF after successful weaning of Vent. Expected DC date: 4/25/19. PMH: COPD, CVA, HTN, DM2, Hemorrhagic CVA, HLD, Schizophrenia. PLOF/ Living Situation, Home Setup, and Advanced Directive/Living Will not provided. Behavioral Health: Schizophrenia. Service requested for: LTAC.

*Skilled Medical Needs: Vent weaning, Daily Peg tube/Vent monitoring & Suctioning, Breathing Tx 4 puffs Albuterol MDI/Cylindrical Spacer q 4-6 hrs/PRN, BS checks 3x day/PRN, Insulin NPH. Contact Precaution MDRO Sputum. Ventilator: Placed on vent: 3/18/19. Weaning attempts: 4/7/19-2nd weaning unsuccessful, no weaning in 24-48 hours, possibly in 2 wks, stabilization needed. Current Vent settings: A/C 12, 500, 35% O2. Tracheostomy: 3/18/19. Medications & IV fluids: IV Levaquin 500 mg until 4/25/19; Ertapenem re: RRL PNA x 7 days; Keflex 500 mg Peg q 8 hrs x 7 days Abscess Lt buttock. 4/9/19 Vs/Labs: WBC 16.20, Albumin 2.5, P 99, R 14, BP 138/77. Wounds: Unstageable Sacral ulcer 7.5x 2.5 cm, multiple dry scab Rt ear, stage 2 to Lt ear; multiple discoloration to bilat hands/feet, healing skin lesion to Lt outer knee, Rt upper leg. Nutrition: PEG Tube, Glucerna 1.2 cal @60 ml/hr.

*Current Mental Status: AAOX1. Dementia Score: Not Provided.

*All Functional Statuses: Not tested.

*Speech Tx: Speech/Swallow evaluation performed, results not provided.



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