Mr. R. J. 67 years old male, was admitted to Jewish General Hospital with progressive shortness of breath, high fever, dizziness, nausea, pallor and general weakness. On admission patient had a blood pressure of 50/35 mmHg and few abnormal laboratory results (Hemoglobin
68, Creatinine 561, Platelets 51). Chest X-ray revealed pneumonia, moderate pulmonary edema with small pleural effusions and cardiomegaly. Patient’s medical history includes chronic kidney disease, restrictive cardiomyopathy, hypertension and myelofibrosis.
To improve respiratory status patient was put on Bilevel positive airway pressure machine, given Lasix and Antibiotics intravenously. He was transfused with few units of blood and platelets, and later was put on permanent hemodialysis 3 times/week,
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On the day of assessment Mr. R. is medically improving, as per treating medical team.
Physically he appears very weak, pale and fatigued. He gets tired and short of breath upon minimal exertion and cannot accomplish simple physical activity tasks. Therefore, he has difficulty performing activities of daily living (ADLs) and instrumental activities of daily living
(IADLs). As a result, patient stays in bed most of the time and doesn’t ambulate on daily basis.
Patient’s baseline and social situation
At his baseline patient lives at his condo with his wife (see Appendix A). Patient is retired, but goes out for shopping and social gatherings with his friends 3-4 times/week. His wife works part-time as a nurse and occasionally can drive him to his medical appointments. In a last few years their relationship became more strenuous, as Mr. R. got more ill and required
CLINICAL CASE STUDY
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more help and care.
OPAT assessment revealed that patient is very concerned with his physical mobility status. He neither has enough physical strength nor possess required means of transportation