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IS IT POSSIBLE TO SEND THE PATIENT

HOME AGAIN?

OT Treatment to create safe living environment for individual living

Nurse assist at home with some exercises also ensure safety

Social Worker organize regular family check up on patient

Possible: Permanent Nursing Home

Integrated Care

1)To increase the patients muscle strength in her shoulder to at least an MRC grade 4 in abduction, flexion, and extension. The patient receives daily treatments. There are no underlying conditions that would hinder her from regaining muscle strength in 4-6 weeks.

2)Prepare the patient to return home. Measuring her capabilities using the Bathel index, FES, TUG, MMSE. The patient should be able to return to her former level of health as she has no apparent incurable conditions. She was staying at home before injuring her shoulder. We aim to achieve this after 10 weeks.

Diagnostic Process

Hypotheses:

-shoulder contractures,

-global atrophy,

-inability to perform ADLs

First assessment done in the hospital

Shoulder function: AROM, PROM, MRC, VAS

Functional capacity: Barthel index

Long term goals:

Administering medication

Surveillance of Delirium

Doctors

D

Relearning of everyday activities

Help when possibly reintegrating her home

Occupational Therapist

(Helping with) self-care

Overall assistance

Feeding if necessary

T

Delirium + Subcapital humerus fracture

Nurses

MRS.

JOHNSON

Decrease hyperlipidemia

Weight-loss

Decrease further complications (cardio-vascular, GI, etc)

Nutritionist

M

Help her with administrative work

Coping strategy

other legal & personal matters

Social Worker

Short term goals:

1.)To have the patient out of the delirium. The CAM will be used to assess the delirious state. Within the given time of 4 weeks a delirium should subside and the patient is under medical supervision and receives treatment.

2.)To increase the patients range of motion in her shoulder to near full range. Using goniometry to measure improvements. The fracture showed no complications and the healing process should be almost done after 6 weeks. 4 weeks are enough to make the transition towards long term goals like muscle strength

Case Report Presentation

Case 2

Andreas Heck

Kealan Cahalane

Orla O'Mahony

Description of Case

Patient:

Mrs. Johnson, 82

Housewife

Widow

lives alone at home

Diagnosis:

Subcapital humerus fracture (6 weeks ago)

Transferred to nursing home a week later.

Delirium developed (5 weeks ago)

Current problems: Confusion, disorientation, hallucinations, movement restrictions in shoulder

Discussion

Delirium >7-10 days indicates possible Dementia (NICE,2013)

--> return home questionable

82 y.o patient, griefs, is multi-morbid, and lives alone

--> not the best indications

The patient will need multidisciplinary assistance and

have proper cognitive as well as physical functions.

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