Medically complex Patients

Patients who have several comorbid
conditions often with cardiopulmonary
overlay that significantly compromises their ability to function

COPD ARF CRF
Pneumonia/ Double pneumoonia
CHF
DM
HTN
ESRD

Acute Illness if often caught early
lead to lesser problems or minimal Impairments.
example- TIA, angina,

When the problems of acute Illness
are not resolved it may lead to
chronic state.
Example - acute Airway diseases
acute renal failure

Chronic Illness puts our body in a DEMAND state means needing
attention/monitoring/maintainance
Frequent Labs
Frequent consults
Frequent Therapy /Interventions
Frequent Hospitalisations
Poly pharmacy may be required
One drug to offset the Adverse effects of the other.
For example Cancer and chemo patients are often on Morphine
and Ondasetron

A disease may have its own way of
Onset
Duration
Course- Remission/Relapse/Exacerbation
Acute =subacute= chronic = end -stage/terminal

Chronic Illness = Demand state=
May need Skilled Nursing
Skilled Rehab
Special challenges in tx
Low tolerance
Low Motivation
Refusals
Little -documented/measurable outcomes

Very ill or critical patients don't make too
great of a Progress.
Hence Documentation of Improvement
is done in small increments
pt will decrease his fall risk by 50 %by following safety precautions 50% of the time
pt will attempt to walk the length of the( parelell bars/bed to bathroom) x 3 reps
with minimal assist

Need to Understand the disease process
Incubation period (If Infectious)
Mode of onset
Duration of illness
complications
treatment recieved
Past status/current status
current difficulties/ problems/impairments
prognosis /goals/outcomes

Case management is the best way
to deal with the management of the
medically complex;