Examkin

Soru

Zorluk: OrtaDisposition and Care Setting Transitions

During multidisciplinary rounds, the care team is planning the next steps for a patient who recently underwent an emergent colectomy for perforated diverticulitis. The patient, a retired teacher, has been hospitalized for two weeks. Acute infectious processes have resolved, and intravenous antibiotics were discontinued yesterday. Vital signs are currently within normal limits.

The physical therapy team notes that the patient experiences significant fatigue, tolerating only 40 minutes of low-intensity mobilization exercises before needing to rest for the remainder of the day. Prior to admission, the patient lived independently with a spouse. Currently, the patient requires moderate physical assistance for bed-to-chair transfers and is unable to safely ambulate. Additionally, the patient has a newly formed stoma; the spouse is eager to assist but has not yet demonstrated competency in ostomy appliance changes despite repetitive nursing instruction.

Which of the following is the most appropriate disposition for this patient?

  1. Skilled nursing facilityCevap
  2. B
    Inpatient rehabilitation facility
  3. C
    Home with home health services
  4. D
    Long-term acute care hospital
  5. E
    Continued management on the acute care surgical floor

Cevap

Skilled nursing facility
The most appropriate disposition is a skilled nursing facility (SNF). This patient requires continued physical therapy and skilled nursing care for a new ostomy. However, because the patient can only tolerate 40 minutes of physical therapy daily, they do not qualify for an inpatient rehabilitation facility (IRF), which requires tolerance of at least 3 hours of therapy per day. Furthermore, the patient is unsafe to be discharged home because they require moderate assistance with transfers, and the spouse is not yet competent to manage the ostomy independently.

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1
Evaluate the patient's acute medical needs.
The acute infection has resolved, IV antibiotics are complete, and vitals are stable.
This establishes that the patient no longer requires an acute care hospital or a long-term acute care hospital (LTACH).
2
Assess functional status and therapy tolerance.
The patient requires moderate assistance with transfers and only tolerates 40 minutes of therapy per day.
This rules out an inpatient rehabilitation facility (IRF), which strictly requires patients to tolerate at least 3 hours of therapy daily.
3
Evaluate skilled nursing needs and caregiver support.
The patient needs ostomy care teaching and transfer assistance that the spouse cannot safely provide at home yet.
This rules out a safe discharge to home with home health services, as the 24-hour care needs exceed the capabilities of the current home environment.
4
Determine the most appropriate facility based on the combined needs.
A skilled nursing facility (SNF) is chosen.
An SNF bridges the gap by providing 24-hour nursing care (ostomy management), lower-intensity physical therapy, and assistance with activities of daily living.

Anahtar Kavram

Appropriate care setting transitions rely on matching a patient's medical stability, functional therapy tolerance, and caregiver support with specific facility admission criteria (e.g., SNF vs. IRF vs. Home).
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Konular

Disposition and Care Setting Transitions

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