Wednesday, November 25, 2009

Case review

Yesterday, I had an interesting case that seems to be keep popping up in my head. Kind of a confusion - that i havn't quite figured out why the patient was like he was.

This patient was in his 50's, prev very fit man, with little medical hx. He lived alone and worked full time.
He had # his foot, quite a nasty crush injury that required surgery and grafting.
When i went to see him, he was mobilizing quite well, however PT notes had reported some anxiety about thinking he was going to fall.

When i went to meet this patient he appeared to be quite onto it, new exactly what he wanted and was very direct with his discharge "needs".
When talking to him about returning home he was very insistent that i sent someone out to look at his stairs. He described this come as a stable, and he lived in the top of it, like an attic. He was determined that he was not going to be able to access his house, however when asked he had no other solutions and no other places to stay. Was he providing a barrier to return home or was he sincerely concerned?
The PT was trying the stairs with him later that day- on his bottom also.
One would expect a person of his age, structure and his previous function to be able to get up stairs on his bottom.
So I had come across a break in the road towards discharge. This demonstrates why OT should have become involved with the patient prior to the expected day of discharge. However, who would have thought that this would have happened. The PT only started working with the patient the day prior, i guess they had expected it to be a straight forward case also. But essentially we were delaying the discharge.
I decided to ask our therapies assistant to do an environmental visit, and to install the equipment he required all in one as he had "no-one" who could take the equipment home.
As it turned out, the stairs were steep, but not unsafe or inaccessible on his bottom or holding the rail and ledge. I handed this information over to the PT, and they had no concerns about the patients ability to get up and down the stairs on his bottom or on his crutches. PT had discharged the patient, as he was independent mobilizing on the ward and going up/down stairs.
So together, we had sorted out this discharge, and the ACC package of care was being processed.
The only thing left now, the patients anxiety or was it anxiety? This is hard to know...
Was there anything else i could have done with this case? Something id like to talk about with a senior...


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