March31,2016

PatientAssessmentDataUtilizing–MDS,OASIS,andIRF-PAI

PreparedbyPamelaG.Castle,NHA,MBAandJeffF.Lewis,LVN.NHA,MAAdmissionAssessment1:13yearoldfemalewithadiagnosisofLennox-GastautSyndromewithintractableepilepsy,intermittenthypoxia,spasticquadriplegia,severeintellectualdisabilitythatisfedviaagastrostomytube(ketogenicdiet)andtotallydependentforallaspectsofcare.ShewasadmittedtotheSkilledNursingunitfromhomefollowingmultiplehospitalizationsforupperrespiratoryinfectionsandpneumonia.Requiresongoingpreventativerespiratorytherapytreatments,seizuresarecontrolledbymedicationandattendsmiddleschoolincommunityonaregularbasis.Patienthashadoneacuteillnessrequiringtransfersinceadmissionin2012.

1. OASISScore:NotScored–Patientunder18yearsofage2. RUGCaseMixGroup:HD1SpecialCareHigh3. TherapyReceived:OTandPTexercises—noactivetherapyplan4. DischargePlan:Parentsrequestcontinuedplacementatthistime

AdmissionAssessment2:14-month-oldprematurefemaleadmittedfromacutecarehospital—patientinacutehospitalsincebirth.Childdiagnosedwithshortgutsyndromeandahistoryofdistalilealstenosisrepairedshortlyafterbirth.Cardiacarresteventrequiredemergencysurgeryforischemicbowel,whichwasresected,andileostomycreated.Childrequirestotalparenteralnutritionhasmucousfistulawithileostomyandstoolre-feeding;furthersurgeriespending.Nutritionprovidedviagastrostomytube.Developmentallydelaydiagnosesunspecifiedduetochild’sageandextensivehospitalizationstay;grossmotordelay,rightearhearinglossandrighteyeretinalscaring.Requiresweeklylabworktodeterminechild’sclinicalstatusandadjustTPNmenuforfollowingweek—monitorelectrolytes;multi-vitaminlevels;clotting/coagulation;andassessstoolingtodetermineneedforoctreotide.Attendsinfantprogramon-site,receivingactiveOTtherapy,PTexercisesandislearningtocrawl.

1. OASISScore:NotScored–Patientunder18yearsofage2. RUGCaseMixGroup:HD1SpecialCareHigh3. TherapyReceived:ActiveOTwithPTexercises;attendsdevelopmentalinfantplayMonday

throughFriday4. DischargePlan:Transitionhomewithparent(Minor)onceastableenvironmentisfound.Mom

currentlyresidinginGroupHomeforteenagers.AlsoexploringmedicallyfragilefosterhomeforchildwithplantotransitionhomewithMominthefuture.

AdmissionAssessment3:19yearoldmale,unrestrainedasleeppassenger,sufferedsubarachnoidhemorrhage,facialfractures,depressedskullfracture,frontallobecontusion,diffuseanoxicbraininjuryandC-Spineligamentousinjury.Alsodiagnosedwithcervicalspineinstabilityandrespiratoryinsufficiency.WentunderatracheostomytubeandPEGG-Tubeplacement.

1. BIMS:scoreof092. RUGCaseMixGroup:RMX3. TherapyReceived:PT,OT,andSP4. DischargePlan:DischargetoAcuteHospitalInpatientRehabAfter23daysSkilledNursing

stay5. DischargedHome:WenthomeafterRehabTherapyHospitalTreatments

AdmissionAssessment4:23montholdmalewasadmitted6/5/15,ventilatordependentonpressurecontrolwithhigherrespiratoryrateandoxygenrequirementof0-3Ltomaintainorderedsaturations.HehadahistoryofHypoxicIschemicEncephalopathy(HIE)andPulmonaryHypertension.DailyvitalsignsrevealedsaturationsandheartrateremainedrelativelystablebutpatientwasaCO2retainer,withbaselinerangesfrom65-75mmHg.VentilatorweaningdidnotprogressuntilCO2rangescouldbemaintainedfrom45-60mmHg.Ventilatorweaningstartedfivemonthsafteradmissioninverysmallincrements:1hour/day.CO2wascheckedpriortoplacingbackonventilatortoassuretherewasnoretention.Afterthreeweeks,ventilatorweaningincreasedto2hour/day.Duringthistime,theCO2remainedwithin45-60mmHgrange,butalwaysnear60mmHg.Patientcontinuedtoweanwithtimeofftheventilatorintheamandpm.ThisallowspatienttobeontheventilatorduringnaptimeandtheCO2willremainwithinorderedparameters.Thegoalistoeventuallyallowcontinuoustimeofftheventilator,astolerated.Thecurrentweaning,whichisspecifictothepatient,allowstimeoffforschool,nursingcareandtimewithparents.

1. OASISScore:NotScored–Patientunder18yearsofage2. RUGCaseMixGroup:Non-therapyRUGES3,StateRUGRMX3. TherapyReceived:PT,OT,ST2x/weekx30minutes4. DischargePlan:Dischargehomewhenmedicallystable/weanedoffvent

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