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It is a significant change, but I would evaluate him for
30 days, not 14, to ensure that he will not just go right back down, which is
what they usually do. If this guy was comatose for two weeks and is now
climbing back into sanity, it is very likely that his ammonia levels are not
going to be controlled, and he's going to tank again. I would make a note
in the chart what you believe will happen, and that you expect this improvement
to be temporary. I WOULD definetly update the care plans for the CNA's
though. I had three patients, none of whom came in comatose, who were on
enulose (or those other names for generic) who had pretty bad labs, and all of
them died within 90 days. Good luck. Be careful to do scrupulous
cognitive testing every week and document the results, as well as c/o itching,
skin condition, etc.
Corey
----- Original Message -----
Sent: Tuesday, February 24, 2004 1:24
PM
Subject: RE: sign change or not need
help
I would not do a
significant change until he plateaus, and one would hope he will continue to
improve r/t rehab. I usually just make sure the expected improvement is
care planned.
-----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of
[EMAIL PROTECTED]
Sent: Tuesday, February 24, 2004 12:52
PM
To:
[EMAIL PROTECTED]
Subject: sign
change or not need help
i have resident who has end stage cirrhosis. when he was admitted approx 20 or
more days ago his was semi comatose. in the past 2 wks he came around and is
receiving pt 5 x wks. his 30 day is pending shortly do i have to code this 30
day an sign change also because his rug changes for payment his last mds was
cbi ?
it sounds like it to me for an improvement. OR not since it
is expected that his condition will flucutate due to his dx and NH4 levels go
up and down? please guide me. thanks
nancy
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