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Soru

Zorluk: OrtaDisposition and Care Setting Transitions

A hospital medicine physician is finalizing transition plans for an 84-year-old woman recovering from a severe urinary tract infection complicated by bacteremia and acute encephalopathy. After 5 days of inpatient treatment, her infection is controlled on oral antibiotics, and her mental status has returned to her baseline of mild neurocognitive disorder. Prior to this acute illness, she lived with her son and was independent in basic activities of daily living. Currently, profound deconditioning limits her mobility; she requires maximal assistance of two staff members for bed-to-chair transfers and cannot participate in physical therapy for more than 15 minutes at a time due to severe fatigue. Her son works outside the home during the day. Which of the following is the most appropriate next step in care setting transition for this patient?

  1. A
    Discharge to the primary residence with home health services
  2. B
    Transfer to an intensive inpatient rehabilitation program
  3. Placement in a subacute nursing and rehabilitation centerCevap
  4. D
    Transfer to an extended care hospital for medically complex patients
  5. E
    Discharge to a long-term custodial care home

Cevap

Placement in a subacute nursing and rehabilitation center
The correct answer identifies that a subacute nursing and rehabilitation center (often referred to as a skilled nursing facility) is the most appropriate disposition. This patient is medically stable to leave the acute care hospital but has profound deconditioning that makes returning home unsafe, particularly because her primary caregiver is absent during the day. Because she fatigues after only 15 minutes of physical therapy, she cannot meet the strict Medicare criteria for an intensive inpatient rehabilitation program, which requires tolerance of at least 3 hours of therapy daily. A subacute facility will provide the necessary 24-hour nursing assistance and lower-intensity therapy to help her gradually regain her baseline function.

Adım Adım Çözüm

1
Assess the patient's medical stability.
The patient is afebrile, hemodynamically stable, and transitioning to oral antibiotics, indicating she is medically ready for discharge from the acute care hospital.
Determines if acute inpatient hospitalization is still warranted.
2
Evaluate the patient's functional status and rehabilitation capacity.
She is severely deconditioned, requires two-person assistance for transfers, and fatigues after only 15 minutes of physical therapy.
Matches the patient's endurance and needs with the appropriate intensity of post-acute care.
3
Analyze the patient's social support and home environment.
She lives with her son, who is unavailable during the day, rendering the home unsafe for someone requiring maximal physical assistance.
Ensures the selected discharge setting can safely accommodate the patient's physical limitations.
4
Determine the optimal care setting based on the synthesis of findings.
A subacute nursing and rehabilitation center is chosen because she needs lower-intensity therapy (cannot tolerate intensive programs) and 24-hour nursing support until she recovers enough function to return home.
Provides a safe environment with appropriate rehabilitation intensity for a severely deconditioned elderly patient.

Anahtar Kavram

Disposition to a subacute nursing and rehabilitation facility is appropriate for medically stable patients who require ongoing nursing care and physical therapy but cannot tolerate the rigorous 3-hour daily therapy requirement of intensive inpatient rehabilitation.
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Konular

Disposition and Care Setting Transitions

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