2- Case Study

• Provide a clinical summary (see case scenario below)
COPD
Marcia is a 63-year-old white female who is being discharged from the hospital after a 4-day inpatient stay for treatment of Chronic Obstructive Pulmonary Disease (COPD). During the two weeks prior to hospitalization, Marcia noticed increasing shortness of breath that progressed from dyspnea with moderate exertion to dyspnea at rest, copious amounts of non-bloody sputum production, and a nagging, hacking cough that kept her up at night. Marcia was dropped off at the emergency department by a friend four days ago because she was not able to secure an appointment with her primary care provider due to the provider’s schedule being full for the next 3 weeks. This is Marcia’s second hospitalization for COPD in the past year.

While hospitalized, Marcia’s COPD medications were changed (she was managed with albuterol only), she used nicotine gum instead of smoking, and performed inpatient pulmonary therapy yesterday. Marcia will be discharged home today, with instructions to contact the pulmonology office to schedule an appointment at her earliest convenience. Pulmonary rehabilitation has been ordered, but no one has contacted her to initiate the service. Marcia was treated by a hospitalist while receiving inpatient care and does not have an appointment to see her primary care provider at the local community health clinic. Often Marcia must wait 3-5 weeks to get into the clinic when she calls for an appointment.

Marcia’s other history is as follows: Ht: 5’3” WT: 165 BP: 125/88 Temp: 98.6 F O2 sats: 95% on RA Pain: 0/10.
Insurance: Medicaid.
Past Medical History: COPD for 12 years. Overweight (BMI 29 kg/m2). Hypertension-Lisinopril 20mg. Total hysterectomy at 45 years of age. Osteopenia since 58 years of age.
Father History: Father deceased, 76, Lung CA. Mother deceased, 84, CHF. Son, 40, asthma. Son, 37, alive and well. Daughter 34, alive and well.
Social History: High School Diploma. Part-time cashier at a department store. Salary of $15,800 per year without benefits. Divorced, living alone, three children live within 45 minutes of her home. Marcia lives in a 55 and above low-income apartment complex that is poorly maintained. The neighborhood is located in a downtown urban area with broken sidewalks, no nearby parks, and the nearest grocery store is 3 miles away. Marcia eats canned and processed frozen foods at home. Does not exercise. Smokes ½ pack a day, with a 25-pack- year history. Drinks wine rarely, once or twice a year at holiday functions. Does not drink coffee. Drinks 2-3 cans of diet Pepsi daily. No illicit drug use. Marcia does not interact with any social groups outside of work and her family. Marcia does not own a car and takes public transportation to work and to run errands.
Meds: Lisinopril 20 mg tab, 1 tab daily by mouth. Vit-D 1000 U tab, 1 tab daily by mouth. Doxycycline 100 mg tab, 2 tabs by mouth daily x 7 days (2 days remaining). Prednisone 20 mg tab, 2 tabs daily by mouth for 10 days (5 days remaining). Tiotropium 18 mcg capsule, 1 capsule inhaled once daily. Albuterol 90 mcg/actuation, 2 puffs by mouth every 4-6 hours as needed for shortness of breath.
Allergies: Penicillin-itchy rash, no food or environmental allergies.

list points to explain how you will prevent readmission based on your assessment findings.
• *Assess the following BEFORE discharge to prevent this patient’s
readmission:
• Discharge destination (home, inpatient rehabilitation, skilled nursing
facility)
• Discharge activity
• Discharge instructions
• Discharge medications
• Discharge follow-up appointments
• Ancillary services (home health, social work, outpatient
rehabilitation, etc.)
Additional Resources

PLEASE USE THESE REFERENCES

Agency for Healthcare Research & Quality. (2016). Chartbook on care
coordination: Transitions of care.

https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/carecoordination/meas
ure1.html
• The Joint Commission. (2012). Transitions of care: The need for a more effective
approach to continuing patient care. https://docplayer.net/98