Interdisciplinary Team Care: Case 1
Summary
TLDRMr. Appleton, a geriatric patient with a history of strokes and cognitive impairment, is admitted to the hospital after a failure to thrive episode. He's showing signs of depression, possibly due to his wife's absence. The medical team plans to stabilize him and reunite him with his wife, who is at a different facility. They are also considering adjusting his medication for his depressive symptoms and exploring financial resources for his care, as Medicare benefits have been exhausted.
Takeaways
- 👨⚕️ Mr. Appleton is a geriatric patient admitted from Silver Lake Nursing Home due to failure to thrive, having stopped eating for three days.
- 🏥 He is under the care of Dr. Abel and Dr. Kota and is currently staying in room 4242.
- 💊 Mr. Appleton has a history of two strokes and cognitive impairment, and he is experiencing depressive symptoms, including expressing a desire to die.
- 🍲 Despite his condition, he managed to eat 80 percent of his breakfast on the day of the discussion.
- 👥 The care team is understaffed, which may affect the frequency of patient check-ins.
- 👵 His wife, who he believes to be dead, is actually alive and staying at West Harvard Convalescence Center.
- 📞 The contact number for Mr. Appleton's wife is 310-55-1112, provided by Dr. Mitchell.
- 🤔 There is a plan to potentially get Mr. and Mrs. Appleton together to improve his condition.
- 💼 Mr. Appleton was previously an author and worked in software, suggesting he might have financial resources.
- 🏥 The discussion includes the possibility of transferring Mr. Appleton to a lower care facility at University Hospital if Medicare coverage runs out.
- 📝 The wife is the DPOA (Durable Power of Attorney) and has been managing Mr. Appleton's affairs since his stroke, but she has recently fallen ill.
Q & A
What is the room number of Mr. Appleton?
-Mr. Appleton is in room 4242.
Who are the attending physicians for Mr. Appleton?
-Mr. Appleton is a patient of Dr. Abel and Dr. Kota.
What was the reason for Mr. Appleton's admission to the hospital?
-Mr. Appleton was admitted due to failure to thrive, specifically, he stopped eating for three days.
What was the plan for Mr. Appleton's care after his admission?
-The plan is to get him up and start with a cardiac chair until BT sees him.
What mental health issues is Mr. Appleton experiencing?
-Mr. Appleton is showing signs of depression, including expressing a desire to die.
Why does Mr. Appleton believe his wife is dead?
-Mr. Appleton's wife has stopped visiting him, leading him to believe she is dead.
Where is Mr. Appleton's wife currently located?
-Mr. Appleton's wife is at the West Harvard Convalescence Center.
What is the phone number to contact Mr. Appleton's wife?
-The phone number to contact Mr. Appleton's wife is 310-55-1112.
What is the current status of Mr. Appleton's pain?
-Mr. Appleton does not seem to have too much pain, but it is difficult to pinpoint due to his Aphasia.
What is the plan to address Mr. Appleton's depression?
-The plan includes getting him on the phone with his wife, potentially adjusting his medication, and considering a referral to the psychiatric department.
What is the financial situation regarding Mr. Appleton's care?
-Mr. Appleton has used up his Medicare days and is now considered self-pay. He is believed to have resources due to his past work as an author and in software.
What is the role of Mr. Appleton's wife in his care?
-Mr. Appleton's wife is the DPOA (Durable Power of Attorney) and has been managing his care since his stroke.
Outlines
👨⚕️ Geriatric Patient Care Overview
The paragraph discusses the care plan for a geriatric patient, Mr. Appleton, who is a patient of Dr. Abel and Dr. Kota. Mr. Appleton has a history of two strokes and cognitive impairment. He was admitted due to failure to thrive after not eating for three days. The current plan is to get him out of bed and into a cardiac chair until he can be seen by a physician. The staff is under capacity, which may affect the patient's care. Mr. Appleton expressed a desire to die, indicating signs of depression, possibly due to his wife's absence as she is in another facility. Efforts are being made to reunite them. The patient's wife is at West Harvard Convalescence Center, and the staff is considering transferring Mr. Appleton there after stabilizing his condition. The patient's financial situation is discussed, as he has used up his Medicare days and may need to self-pay for further care. The patient's son is also mentioned, but attempts to contact him have been unsuccessful. The paragraph concludes with a plan to stabilize the patient and potentially transfer him to the same facility as his wife.
Mindmap
Keywords
💡Geriatric service
💡Cognitive impairment
💡Failure to thrive
💡Cardiac chair
💡Understaffed
💡Depression
💡Aphasia
💡Bladder scan
💡Psych meds
💡Self-pay
💡DPOA
Highlights
Patient Mr. Appleton is in room 4242 under the care of Dr. Abel and Dr. Kota.
Mr. Appleton has a history of two strokes and cognitive impairment.
Admission was due to failure to thrive, having stopped eating for three days.
Patient had 80 percent of his breakfast on the day of the transcript.
The plan is to get Mr. Appleton up and use a cardiac chair until a doctor sees him.
There is a staffing shortage this week, which may affect patient care.
Patient expressed a desire to die, indicating signs of depression.
Mr. Appleton's wife, who he believes to be dead, is actually at West Harvard Convalescence Center.
Dr. Mitchell provided information and contact details for Mr. Appleton's wife.
The team is working on reuniting Mr. Appleton with his wife.
Mr. Appleton has a history of depression and may require psychiatric evaluation.
Mr. Appleton has been improving, now eating a little and not in much pain.
The patient has aphasia, making it difficult to express himself.
A bladder scan is planned to check for any issues.
Mr. Appleton's pain is ill-defined, and he has difficulty pinpointing it.
The team is considering calling West Harvard to have his wife speak to him over the phone.
Dr. McNeil might see the patient tomorrow to discuss psychiatric medications.
Mr. Appleton is perceptive and understands everything said around him.
The goal is to stabilize Mr. Appleton and move him to where his wife is.
Medicare will not cover further days, and the team needs to find out who will pay for his care.
Mr. Appleton is financially well-off, possibly having resources to cover his care.
The wife is the DPOA and may have been managing Mr. Appleton's affairs.
There is also a son involved, but attempts to contact him have been unsuccessful.
The medical team is considering low-care beds at University Hospital if Medicare stops paying.
Transcripts
I have two patients on the geriatric
service the first one is in room 4242 Mr
Appleton patient of Dr Abel and Dr Kota
so he's had two strokes in the past and
has some cognitive impairment the reason
he was admitted yesterday from Silver
Lake Nursing Home was essentially
failure to thrive
stopped eating for three days but he did
just have 80 percent of his breakfast
today the plan is to get him up and
start with a cardiac chair until BT sees
him we're under staff this week so I
probably won't be able to see him today
that should be fine yeah
on the other hand the care partner said
he was saying this morning I want to die
I want to die he did not say this to me
but he definitely have signs of
depression
yeah apparently his wife is in another
Sniff and she stopped visiting him so
he's convinced that she's dead
so Dr Mitchell called me this morning
and gave me the information where the
wife is so we needed to figure out how
to get them together in the same in the
same place okay where is his wife uh
West Harvard convalescence Center oh
that's fine and the phone number I got
from Dr Mitchell is
310-55-1112-55-1112 yeah I think she was
admitted for an SQL but I'm not 100 sure
so he has this history of depression in
the past apparently based on what Dr
Mitchell told me he just seems to be
and I'll have sexy and see if Jerry
psych has any suggestions for his
medication but in general he seems to be
improving because based on what they
told me he wasn't eating at all and now
he's eating a little bit he seems to not
have too much pain but I can't really
just have pain
I don't know were you able to figure out
what he was saying about his thigh he
didn't say thigh to me but I asked him
to pinpoint
for me and he pinpointed somewhere I
guess where his bladder should be
so I'm going to do a bladder scan to see
if maybe he's got some receipts I just
saw him and he said his pains from here
to here it's kind of ill-defined huh
okay he also has Aphasia from the stroke
so it's very hard for him to express
we're going to need to rely on verbal
cues yeah a lot of it's hard because
apparently speak to us well maybe I can
call West Harvard convalescent and get
his wife on the phone and if he hears
her voice he might feel a little more
relieved that would be really really
really nice I think that's going to help
a lot yeah
so I'll call there and I'll go to his
room now and I'll talk to Dr McNeil and
see if maybe she can see him tomorrow
and see if she has any suggestions for
psych meds
but a lot of this I mean he's had a
massive stroke so it's not surprising
that he's got all these depressive
symptoms he's very perceptive and that's
the thing that everyone needs to know he
understands everything that we're saying
okay so ultimately you want to stabilize
him and send him to where his wife is so
we need to find out if they're able to
take him but he'd go as a self-pay he
has to he has no more Medicare days left
so he's used them all up so we're going
to need to find out who's going to pay
for him now
apparently he has resources when you say
resources do you mean Social Security no
he was financially well off I kind of
researched him and it seems he was an
author and he worked for software so
that's why we thought he probably has
some resources but because of his
Aphasia we can't confirm okay so we need
to find out from the family University
Hospital does have some beds at a low
care that they might want to look at if
you know Medicare stops paying for this
admission
so the wife's the dpoa and in charge we
don't know I don't have any more
information I mean Dr Mitchell thinks
that she was the one who was managing a
lot of this since he has his stroke but
she got sick herself recently so and
there's a son too I tried calling I did
not get an answer I can call him too
okay uh the numbers are on the chart if
you go to the Chart there's a cover
sheet and all the numbers are listed
underneath okay good so from a medical
standpoint we're thinking in a day or
two maybe we'll stabilize them
we need to make sure there's nothing
that we're missing so we can't be 100
sure so not today then
today but maybe tomorrow I think
tomorrow we could easily get him out and
I don't think there's anything too
serious going on do you think you'd want
to speak to a chapel too or no
you can ask he'll say yes and knows he
can do that he'll try to talk to you but
nothing comes out
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