32nd Case of the Week Due 1/9/20, by 1pm EST...HF Case

CCR 2. Review completed 12/20/19. Brief Clinical Course: NSTEMI Admit 11/9/19 w/ SOB, newly reduced EF, DKA, Lactic Acidosis. Worsened DOE X 4-10 days, frequent PND, w/one episode of CP 2 wks ago. Reports N/V, diarrhea. Became more decompensated, developed DKA. Troponin Type II NSTEMI d/t demand of severe pulmonary edema and DKA. IV ABX for PNA. IV Bumex and Heparin started. Last TTE 8/2019 Mild AS. Target LOS 18 days provided to facility based on DRG 291 (MDC 05) Heart failure & shock w MCC. TGD: 12/22/2019. Expected DCP: Home w/children. Expected DC date: SW working w/family. Number of Skill Days used prior to current review 100 days: 24. PMH: CAD s/p PCI w/ DES x 4, HTN, DM2, HLD, Asthma, CVA, PAD, Peripheral Neuropathy, Pericardial Effusion, Cholecystectomy, Former smoker, EF to 35%. PLOF/ Living Situation: Independent, uses cane, Lives w/children. Home Setup: 1 STE, 2nd floor walk-up. Behavioral Health: N/A. Advanced Directive/Living Will: CPR. Service requested for: SNF2.*Skilled Medical Needs: Medical and medication management. Bactrim 160mg/800mg PO 2 Tabs Q 12hrs x 4 wks Bronchitis. Prednisone 20mg PO Daily to be tapered. O2@2L. Neb TX Q6. VS 116/69-18-95-97%. Temp is 102, coarse breath sounds, intermittent wheezing-VS Q4H, Blood cx x 2, Tylenol 325mg PO 1-2 Tabs PRN Fever. Levofloxacin 500mg IV Q 24hrs x 7 days. Pulmonologist Appt 12/20/19. CXR ordered. *Current Mental Status: AAOx3. Dementia Score: NA.*Bed Mobility: CGA (Unchanged). *Ambulation: 40 ft CGA-MIN w/RW --> 50 ft CGA/Min w/2-wheeled walker (Improved). *Transfers: CGA-Mins --> CGA (Improved).*Stairs: Not Tested --> 4 steps CGA (Improved). *Bathing UB: Mod A --> MinA/ModA (Improved); *LB: Mod A--> MinA/ModA (Improved). *Dressing UB: SBA (No Update).*LB: CGA-MinA --> CGA/MinA (Unchanged). *Toileting: CGA-MinA --> CGA (Improved). *Toilet transfers: Not Provided. *Speech Tx: NA.


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