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Intermountain Medical Group FPA, Rae Ann Malak, RN, CM

Intermountain Medical Group FPA, Rae Ann Malak, RN, CM. The challenging obstacles of Care Management Interesting to say the least----- care management study 69 year old white female Lives alone one floor structure 4 steps to get to house door 2 grown, married sons, within 15 mile radius

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Intermountain Medical Group FPA, Rae Ann Malak, RN, CM

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  1. Intermountain Medical GroupFPA, Rae Ann Malak, RN, CM • The challenging obstacles of Care Management • Interesting to say the least----- care management study • 69 year old white female • Lives alone one floor structure • 4 steps to get to house door • 2 grown, married sons, within 15 mile radius • Sister living in IDAHO MEDICAL HISTORY: • DIABETES, CHF,IRON DEF ANEMIA, OBESITY, SLEEP • APNEA,DJD,COPD,CAD,LEFT ENDARTECTOMY 2008 • RENAL DISEASE WITH STENT AUGUST 2010

  2. The beginning of Care Management • 08/18/2010 ED visit for right knee osteoarthritis/pain total Right Knee replacement followed with blood conservation at hospital for chronic anemia and anticipation of surgery. • Treated with pre-post op meds. • No complications with surgery • Went to Rehab 8/20---8/27 • Labs at DC– 8/20 8.2 • 8/23 7.4

  3. Cm call- doing well, denies any complaints Spoke to daughter-in-law not telling the whole story Meals on wheels Due for P.T.– added CBC MED REC done, will do pill box Encouraged to start checking Glucose BID Has heart scales, not able to get on Home health’s on Board!

  4. Unremarkable124/64 Pulse 64 CBC /1 week HOME HEALTH discontinued 09/08 LAB 09/09 Hmg7.3 CM call 09/09 SOB while talking 09/10 sent to ED dept Out-pt transfusion Hema + stool GI consult ordered/admitted transfused with 2 units RBC’S 09/11 Hmg 9.7 GI ordered EGD 09/13- EGD completed-NORMAL 09/14-discharged Home Health called in CM call-09/15—09/17 No Complaints PCP appt. 09/03/10

  5. Hypoglycemic reaction!!! • Found unresponsive by son, taken to ED • Glucose on arrival was 17 • Later, states she had not been eating for a few days, yet continued meds • Also found glipizide at home, currently taking metformin only • 09/21 patient stable and D/CED • Cm call 09/22 discussed meds, • accu check • Diet, also addressed weakness, denied! • PCP Appt 09/23

  6. Can it get any worse? • 09/24 patient to ED for Right fx of femur • Twisted leg in kitchen and heard pop! • 09/28 DC to REHAB • 10/12 DC from Rehab • Home Health on Board—hurray!!!!!!! • 10/13 med rec completed • 10/13 CM call doing fine, no complaints • Going to son’s house for weekend • 10/20 sister flying in from IDAHO

  7. TLC with Idaho Sister • Cooking, cleaning, chores all being done • No complaints • GI appt. 10/20 • Hmg of 6.4 on no! • GI Dr. called– direct admit • Pt hypotensive • 10/21 CM call to hospital received 2 units • Diagnosed with Angiodysplasia • D/CED Antiplatelet therapy • Scheduled for an IVC filter on 10/25

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