25th Case of the Week Due 6/6/19, by 1pm EST

Medicare/SNF...Review 5/29/19
CCR2. Admit 5/2/19 few weeks to months of functional decline & syncopal episode in the context of micturition. Dx: Syncope/Failure to thrive. Previously admitted to hospital for functional decline/weight loss. Target LOS 18 days provided to facility based on DRG 312 Syncope & Collapse. TGD: 05/26/2019. Expected DCP: Home w/others; date not provided. SW preparing alternative D/c for LTC. Number of Skill Days used prior to current review/100 days: 12. PMH: Dementia, A-fib, CAD s/p CABG & PCI, PPM implantation 2002 after syncopal episode. PLOF/ Living Situation: Lived alone w/private aid 7hrs/day, 7 days/wk. ADLs Min A. Home Setup: Apartment w/elevator. Behavioral Health: Dementia. Advanced Directive/Living Will: DNI/DNR. Service requested for: SNF. *Skilled Medical Needs: TPR: 98, 60, 18, 02 sat 98% RA. Monitor behavior/Diet/B&B/Weight wk, Fall/Safety Precaution. Med Management: Plavix 75mg 4x wk Angina, KCL 20mEq Hypokalemia, Remeron 22.5mg HS Mood, Sacrum-stage1 5x5x0, red. Coloration under Lt gluteal fold. Dry scabs & multiple brown colorations to bilat LE-NSS, Zinc Oxide Ointment, DPD daily/PRN. Mycotic toenails to feet. Blanchable redness to heels. *Current Mental Status: AAOX1 w/ redirection. Dementia, Score: N/A. *Bed Mobility: WC w/ extensive A x 2 person change order (Unchanged Max A x2). *Ambulation: Not tested. *Transfer: Dependent (Unchanged). *Stairs: Not tested (Unchanged). *Bathing UB: Dependent (Unchanged). *LB: Dependent (Unchanged). *Dressing UB: Dependent (Unchanged). *LB: Dependent (Unchanged). *Toileting: Incontinent Dependent (Unchanged). *Toilet Transfers: Dependent (Unchanged). *Speech Tx: Thickened liquid. Dependent, weak, no functional gains although participating in therapy. Pt participated in at least 1.5-2 hours of therapy 5 days a week.

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