Hospital D/C and Short Term Rehab Flashcards
List Possible Discharge Dispositions
- discharged to Home
- Home with VNA services
- Short Term Rehabilitation
- Long Term Acute Care
- Hospice facilities
Patients who need part time nursing services or rehabilitative services and cannot get out of the house to go to clinic, provider, outpatient facilities.
type of d/c
Hospital to HOME with VNACare
possible reasons pt could be d/c to
Hospital to HOME with VNA Care
- Consider a patient post op from TKR
- Cancer patient with PE and starting on Lovenox for the 1st time
- Afib patient starting on coumadin
- New Tube Feeds
how long can pts recieve VNA
Patients can receive VNA until you meet the goals which are set forth by the PT/OTs/RNs
define Skilled Nursing Facility(SNF)
criteria?
no longer need acute care but not ready to go home
Criteria:
- •Must have a 3-day qualifying hospital stay within 30 days of going to a SNF
- •Few days to several weeks
An elderly patient requiring continued IV antibiotics but unable to take care of themselves at home.
Skilled Nursing Facility(SNF
You must be able to take part in 2-3 hours of therapy a day, this is crucial to meet the goals
Acute Rehabilitation/ Short Term(STR
criteria for Hospice Care
Only true criteria is
- a diagnosis of a terminal illness
- life prognosis <6 months.
If patient lives past 6 month, eligible to renew benefit
Long Term Acute Care(LTAC)
define & give an example of a pt who may qualify
Condition has stabilized, but require greater care than what can be given at home, STR, or SNF
- Medicare designated level of acute care
Possibly on a Ventilator long term.
Alc withdrawl syndrome:
Can occur as early as ______ after Alcohol cessation
peaks after ____days
but can persist up to____days after alcohol cessation
•Can occur as early as 6 hours after Alcohol cessation,
peaks after 2-3 days,
but can persist up to 7 days after alcohol cessation
Pathophysiology of Alcohol Withdrawal
NORMALLY:
- (GABA) - inhibitory neurotransmitter
- (NMDA) - excitatory neurotransmitter
ETOH
↑ effects of GABA = ↓ excitability (downregulation og GABA recpetors)
↓ NMDA neuroreceptors = ↑ upregulation of the receptors
Abrupt cessation of ETOH = brain hyper excitability,
- because receptors previously inhibited (NMDA) are no longer inhibited
Gamma-amino-butyric acid (GABA) - _____ neurotransmitter
N-methyl-D-aspartate (NMDA) - ______ neurotransmitter
Gamma-amino-butyric acid (GABA) - inhibitory neurotransmitter
N-methyl-D-aspartate (NMDA) - excitatory neurotransmitter
si/sx of alcohol withdrawl
Alcohol Cessation = Days 0-1
Days 2-3
Days 5-7
Alcohol Cessation = Days 0-1
- Anxiety
- Headache
- Palpitations
- Insomnia
- GI Upset
Days 2-3
Seizures = As early as 2 hrs after last drink
- Generalized Tonic Clonic Convulsions
Hallucinations: Visual, Auditory & Tactile
Delirium Tremens= Peaks on Days 5-7
- Agitation
- Disorientation
- Tachycardia & Hypertension
- Diaphoresis
- Fever
indications for inpatient management of alc withdrawl syndrome
- Abnormal Lab Results
- Lack of social supports
- Comorbid illnesses such as DM, CHF, COPD
- High risk of DTs
- Long term intake of large amounts of alcohol
- Serious psychiatric conditions
- SI or HI
- Severe alcohol withdrawal symptoms
- Urine drug screen positive for other substances
Tools for Predicting Severity of Alc withdrawl syndrome
(PAWS)
- Part A – threshold criterion (ex. last drink, BAH at time of admission)
- Part B – patient interview
- Part C – physiologic (ex. BAL, ANS activity)
Clinical Institute Withdrawal Assessment for Alcohol
(CIWA-Ar)
Validated 10 item assessment tool that can be used to quantify the severity of etoh withdrawal
- Scores <8 = mild withdrawal
- Scores of 9-15 = moderate withdrawal
- Score >15 = severe withdrawal and increased risk of DTs and Seizures
Goals of Care for Patient in Alcohol Withdrawal
- “To provide a safe withdrawal from the drugs of dependence and enable patient to become drug free”
- “To provide withdrawal that is humane and thus protects the patient’s dignity”
- “To prepare the patient for ongoing treatment of their dependence on alcohol and drugs