Examkin

Soru

Zorluk: KolayDisposition and Care Setting Transitions

A 78-year-old woman is evaluated by the multidisciplinary team to determine her next site of care. She was admitted five days ago for treatment of acute pyelonephritis. Her infection has fully resolved on intravenous antibiotics, and she has been transitioned to an oral antimicrobial regimen. Her vital signs are within normal limits. Prior to admission, she lived independently in a two-story house. However, physical therapy evaluation indicates she currently requires significant assistance with transferring from bed to chair, bathing, and dressing due to profound hospital-associated deconditioning. She can actively participate in 1 to 2 hours of therapy daily but fatigues quickly. She does not require continuous physician monitoring or complex nursing care. Which of the following is the most appropriate next step in the care transition for this patient?

  1. A
    Discharge home with scheduling for outpatient physical therapy clinic visits
  2. B
    Transfer to an inpatient rehabilitation facility
  3. Transfer to a skilled nursing facilityCevap
  4. D
    Transfer to a long-term acute care hospital
  5. E
    Continue acute inpatient hospitalization for ongoing physical therapy

Cevap

Transfer to a skilled nursing facility
The correct disposition is a skilled nursing facility (SNF). This patient is medically stable and no longer requires acute hospital care. However, her profound deconditioning and inability to transfer independently make discharging her to live alone in a two-story house unsafe. She requires subacute rehabilitation to regain her baseline function. Because she can only tolerate 1 to 2 hours of physical therapy per day, she does not meet the strict functional criteria for an inpatient rehabilitation facility (IRF), which requires patients to tolerate at least 3 hours of intense therapy daily. An SNF will provide the required nursing assistance for her activities of daily living while administering a paced physical therapy program appropriate for her endurance level.

Adım Adım Çözüm

1
Assess the patient's current medical stability and acute care needs.
The patient's infection is resolved, vitals are normal, and she is on oral antibiotics. She no longer requires acute hospital-level medical or nursing care.
Determines if the patient is ready for discharge from the acute inpatient setting.
2
Evaluate the patient's functional status and home support environment.
The patient lives alone but now requires significant assistance with transferring and ADLs.
Determines if a direct discharge to home is safe and feasible.
3
Determine the patient's rehabilitation capacity.
The patient can only tolerate 1 to 2 hours of physical therapy daily due to fatigue.
Differentiates between the need for an inpatient rehabilitation facility (requires 3+ hours/day) and a skilled nursing facility (suitable for lower intensity therapy).

Anahtar Kavram

Patients who are medically stable but require assistance with ADLs and lower-intensity rehabilitation (less than 3 hours daily) following an acute hospitalization should be transitioned to a skilled nursing facility.
Bu soruyu puanla

Konular

Disposition and Care Setting Transitions

Bu konudan daha fazla soru