Adult-Geriatric Patient Experiencing Acute or Chronic Immobility Essay

Adult-Geriatric Patient Experiencing Acute or Chronic Immobility Essay

Adult-Geriatric Patient Experiencing Acute or Chronic Immobility Sample Essay

The adult-geriatric patient with acute or chronic immobility should be referred to a physical and occupational therapist. The physical therapist conducts mobility assessment, transfer and gait assessment, and determines the patient’s need for skilled services. The occupational therapist assesses the patient’s need for ADL devices/aids and evaluates physical functioning. The requirements for acute rehabilitation include the patient being able to tolerate a minimum of 3 hours of therapy per day for 5 to 7 days a week. Services include intense, multidisciplinary therapy for patients with functional loss (Saenger et al., 2022). A patient must be medically stable to qualify for skilled care and should have a need that a skilled, licensed professional must perform daily. Skilled care offers 24-hour skilled nursing and personal care, and rehabilitation services.

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In addition, a patient qualifies for long-term care if they have more than one serious health condition but whose condition may improve with time and extra care and return home. Patients stay in long-term care facilities for over 25 days (Makam et al., 2020). Services provided in long-term care include comprehensive rehabilitation, head trauma treatment, respiratory therapy, and pain management. The requirement for hospice care is for a physician to document that if the disease follows its normal course of progression, the patient’s life expectancy is less than six months. It includes providing end-of-life care to patients with a terminal illnesses and supporting their families.

An acute-care adult-geriatric patient can be transferred to home health care as a bridge to independent living. This system of care is provided by skilled practitioners to patients in their homes under a physician’s direction. Requirements for admission include a patient living at home but cannot travel to obtain treatment and has rehabilitation and nursing needs (Saenger et al., 2022). The services offered include nursing care, occupational, physical, and speech-language therapy, and medical social services.

Part 2

Pressure ulcers are a common immobility and wound management condition. Impaired mobility is the most common risk factor for pressure ulcers due to prolonged uninterrupted pressure. Patients with the highest risk include neurologically impaired, heavily sedated or anesthetized, demented, restrained, and those recovering from a traumatic injury (Mervis & Phillips, 2019).

During the assessment of a patient with pressure ulcers, the clinician should obtain information regarding pain, foul odor, or discharge, the period the ulcer has been present, the circumstances under which the ulcer developed, and the associated medical cause for the ulcer. Besides, a complete review of systems, including night sweats, fevers, rigors, weight loss, loss of appetite, and weakness, should be conducted. Diagnostic workups include a complete blood count to assess for inflammation or invasive infection (Mervis & Phillips, 2019). In addition, nutritional parameters should be evaluated to assess adequate nutritional stores required for wound healing with tests like Albumin, Prealbumin, Transferrin, and Serum protein levels.

The mainstays of pressure ulcer treatment include offloading the offending pressure source, adequate drainage of any areas of infection, debridement of devitalized tissue, and regular wound care to support healing (Boyko et al., 2018). Treatment interventions for pressure ulcers include innovative mattresses, creams, solutions, ointments, dressings, ultraviolet (UV) heat lamps, sugar, and surgery. Empiric antibiotics should be initiated immediately. Initial antimicrobial therapy should be broad-based to cover aerobic gram-positive and gram-negative organisms and anaerobes. The recommended antibiotics include Silver sulfadiazine and Mafenide.

References

Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the Current Management of Pressure Ulcers. Advances in wound care, 7(2), 57–67. https://doi.org/10.1089/wound.2016.0697

Makam, A. N., Nguyen, O. K., Miller, M. E., Shah, S. J., Kapinos, K. A., & Halm, E. A. (2020). Comparative effectiveness of long-term acute care hospital versus skilled nursing facility transfer. BMC health services research, 20(1), 1-10. https://doi.org/10.1186/s12913-020-05847-6

Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Prevention and management. Journal of the American Academy of Dermatology, 81(4), 893–902. https://doi.org/10.1016/j.jaad.2018.12.068

Saenger, P. M., Ornstein, K. A., Garrido, M. M., Lubetsky, S., Bollens-Lund, E., DeCherrie, L. V., Leff, B., Siu, A. L., & Federman, A. D. (2022). Cost of home hospitalization versus inpatient hospitalization inclusive of a 30-day post-acute period. Journal of the American Geriatrics Society, 70(5), 1374–1383. https://doi.org/10.1111/jgs.17706

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This is a two-part discussion question. Please respond to both questions below in your post. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.

Part 1

Discuss appropriate referrals and consultations for the adult-geriatric patient experiencing acute or chronic immobility. Differentiate the requirements for acute rehabilitation, skilled care (transitional care), long-term care, and hospice patients who are preparing for discharge from the acute care setting and may require bridge therapy to increase strength, balance, and conditioning prior to transitioning to a safe independent living environment. Discuss general admission criteria, including number of modalities of therapy, number of hours of therapy per day in which the patient must participate, and any restrictions such as renal dialysis. Identify at least one restorative level of care that an acute care adult-geriatric patient can be transferred to as a bridge to independent living and briefly describe the criteria for admission (e.g., number of hours of therapy and number of different modalities of therapy–speech, PT, OT, skilled nursing) within skilled or transitional care, home health, acute rehabilitation, long-term acute care, hospice, or other.

Part 2

Discuss important risk factors, etiology, presentation, assessment, diagnosis, and evidence-based therapy for common acute immobility and wound management conditions and disorders for complex acute, critical, and chronically ill adult gerontology patients. Explain the presentation, etiology, risk factors, common differential diagnosis, typical diagnostic work-up, treatment plan (based on current clinical guidelines and evidence-based therapy).