30th Case of the Week Due 11/7/19, by 1pm EST

LTAC, Medicaid Reviewed 10/23/19
CCR2. Acute Respiratory Failure. Fall w/trauma to back of head 4 days prior to admission. Bradycardic, Hypothermic, & Hypoglycemic. PEA arrest x3, 17 mins down time x 3 arrests. IVF, ABX, & Dextrose. Intubated. Necrotic L foot ulcer cellulitis s/p debridement 9/28/2019. Poor renal function. May need dialysis. Extubated w/re-intubation 10/3/2019 acute respiratory distress. Trach/PEG 10/8/2019. LLE edematous. Expected DCP: Vent SNF Expected. DC date: 11/09/2019. Physical Findings: Elder abuse hotline contacted d/t poor hygiene/dentition & meds not properly administered while home. PMH: CHF w/EF 20%. CKD. DM 2. Hypothyroidism. Asthma. Chronic LE wounds managed by wound care. PLOF/ Living Situation: Ambulated w/walker & SBA. Lives w/daughter & sister. Home Setup: Lives in basement w/sister, poverty, no windows, mold. Behavioral Health: Mental retardation baseline. Self extubated x2, PICC line removal. Restrained. Advanced Directive/Living Will: Yes. Service requested for: LTAC. *Skilled Medical Needs: IV ABX, PICC line, Trach-Vent, PEG tube, Foley, Rectal tube. Isolation: MDRO & scabies. Ventilator information: 12/450/30%/5. Multiple failed weaning attempts. Medications & IV fluids all on 9/23: IV Meropenem/Vanc/Fluconazole. PEG Tube:K+ Bicarb, Lasix, Acetazolamide, Prednisone, Protonix, Imdur. Subcut Insulin, Topical Bacitracin/Povidone Iodine. IVPB. VS/LABS: A1C 10.1. WBC 7.2, RBC 2.35, Hgb 7.1, Hct 22.5, Plt 147, K+ 5.5, BUN 63, Creat 1.9, Ca 7.8, VS: T 97.5, P 76, RR 13, BP 101/78, O2 97% Vent. Wounds Improving: Excoriations sacrum/buttocks. Lower lip 1x4x1. L upper arm 7x3x0. Back stage3 9.x5x0. Buttock/groin 9x9x0. R lower calf stage3 10x6x0. L foot stage4 23x10x0.5 w/80% fibrous necrotic tissue. Lip Tx apply Oint BID. Nutrition: Novasource Renal 65/mL *Current Mental Status: AAOX1. Follows commands. Mobility ModA Improved; Total A ADLs.

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