Interdisciplinary Team Care: Case 1

Summary

Mr. 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

00:00

👨‍⚕️ 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.

Keywords

💡Geriatric service

Geriatric service refers to the specialized healthcare provided for elderly patients, often addressing age-related health issues and providing comprehensive care to improve their quality of life. In the script, the geriatric service is central as it discusses the care of elderly patients like Mr. Appleton, who is under the care of Dr. Abel and Dr. Kota.

💡Cognitive impairment

Cognitive impairment is a decline in cognitive abilities such as memory, thinking, and reasoning that can interfere with daily life. It is mentioned in the script in relation to Mr. Appleton, who has experienced two strokes and is now showing signs of cognitive decline, affecting his ability to communicate and express his needs.

💡Failure to thrive

Failure to thrive (FTT) is a condition where a patient experiences a lack of growth or development, often due to inadequate nutrition or emotional neglect. In the context of the script, Mr. Appleton was admitted due to FTT, as he had stopped eating for three days, highlighting the need for immediate medical attention and nutritional support.

💡Cardiac chair

A cardiac chair is a specialized chair designed to provide support and comfort for patients with cardiac or respiratory issues. The script mentions the plan to get Mr. Appleton into a cardiac chair, indicating a need for his comfort and potential respiratory support as part of his treatment plan.

💡Understaffed

Being understaffed means that there are not enough healthcare professionals available to provide adequate care. In the script, it is mentioned that the facility is understaffed, which could impact the quality of care and the ability of the staff to attend to Mr. Appleton's needs.

💡Depression

Depression is a mood disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. The script discusses Mr. Appleton's signs of depression, including his statement 'I want to die,' and his belief that his wife is dead, which are indicative of his mental health struggles.

💡Aphasia

Aphasia is a language disorder that can result from brain damage, often due to stroke, and affects a person's ability to communicate. Mr. Appleton has aphasia from his strokes, making it difficult for him to express himself, which is a significant challenge in his care as医护人员 must rely on non-verbal cues to understand his needs.

💡Bladder scan

A bladder scan is a non-invasive diagnostic procedure used to determine the amount of urine in the bladder. The script mentions a plan to perform a bladder scan on Mr. Appleton to check for any retention issues, which could be causing his discomfort.

💡Psych meds

Psych meds, short for psychiatric medications, are drugs used to treat mental health conditions such as depression, anxiety, and psychosis. The script discusses the possibility of adjusting Mr. Appleton's psych meds to address his depressive symptoms and improve his mental state.

💡Self-pay

Self-pay refers to a situation where a patient is responsible for paying their medical bills without insurance coverage. The script mentions that Mr. Appleton has used up his Medicare days and will need to self-pay for further care, which raises financial considerations for his treatment and potential placement.

💡DPOA

Durable Power of Attorney (DPOA) is a legal document that allows an individual to appoint someone to make decisions on their behalf, especially in matters of finance or healthcare. The script refers to Mr. Appleton's wife as the DPOA, indicating that she has the legal authority to make decisions for him, which is crucial for his care and financial planning.

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