Mini Case

Geriatric Division
Rehabilitation of elderly female with alter of consciousness
and respiratory disturbance et cause CAP , Bilateral pleural
effussion & CKD stage V due to DKD

Supervised by:
Dr. Med. Sc. dr. Irma Ruslina Defi Sp.KFR-Ger ((K)
dr. Istingadah Desiana. Sp.KFR-Ger (K)
IDENTITY
Date Of Examination : 30/6/2023

Name • Mrs. MM Referred by Internist

Medical Record • 0000414445 - Unconsciouness

- CAP
• August 21th, 1955 (78 years - Effusi pleuara bilateral
Born date -
old) Referral
End stage renal disease due to DKD
- Anemia
Address • Sumedang diagnosis

Marital Status • Married

Tribes • Sundanese

Religion • Moslem Date of Referral July 17th 2023

Occupation • Housewife

Education • High school graduated

 HISTORY TAKING (18/07/2023)
Chief complaint : Alter of consciousness

Present illness
• The patient is in inpatient care day 4
• Patient got alter of consciousness since 4 days ago. She just got dialysis treatment in
Habibie Hospital. Due to the worsen condition she reffered to Hasan Sadikin Hospital 4
days ago. Patient now able to open her eyes when being called, but unable answer
properly and locate the pain properly.
• She had shortness of breath that felt continuously since 9 days ago. Wheezing (-), Cough
(+) but unable to expel sputum. Fever (+) at 1 st and 2nd day of hospitalization but now
fever already gone.
• She use wheelchair, wheeled by caregiver to ambulate since 2 months ago. Previously
she still able to walk using walker at February - Mei 2023. ADL are partially dependent.
• She voiding and defecate normally on diaper. Diaper were changed 5 times/day.
Past Medical Condition

ORIF ar right tibia dextra due to closed fracture in 2021

Comorbidity
• Hypertension since one year ago, took medicine regularly
• DM since 15 years ago , took medicine regularly (metformine &
• Dialysis routinely twice a week in Habibie Hospital since 2022.
• History of stroke is unknown.
History of Habit
• Smoking (-)
• Alcohol (-)
• Drug abuse (-)
Recent Medication

• Furosemide IV 2x40 mg
• CefriaxonIV 2x1gr
• Levofloxacine IV 1x500mg
• PCT IV 1 gr PRN
• Asam folat 1x5 mg NGT
• Natrium bicarbonat 3x500 mg NGT
• NAC 3x400 mg NGT
• Calos 3x1 tab NGT
• Amlodipine 1x5mg NGT
• Candesartan 1x8mg NGT
• Nebulization Nacl 3% 3 times a day
Nutrition
History of nutrition
• Before illness, patient still able to eat 3 times/day, with rice, egg,
sometimes vegetable, finish her food only half of portion, drink 5-6
glass of water

During hospitalization
• Liquid food via nasogastric tube/ 6hr
Physical Activity Before and After Illness
Time Activity before hospitalization METs
05.00 – 05.30 Waking up 1.3 METs
Recent activity
06.00 – 07.00 Take a bath 2.0 Lie down 1.0-1.3
07.00 – 07.30 Breakfast 1.5
07.30 – 12.00 Sitting (play with her 2.5
grandchildren, watch TV)
12.00 - 12.30 Lunch 1.5
12.30 – 17.00 Sitting (watch TV) 2.5
17.00 – 18.30 Take a bath 2.0

16.30 – 18.00 Sitting (watch TV) 2.5

18.00 - 19.00 Dinner 1.3
19.30 – 05.00 Sleep 1.0
History of Psycho and Socioeconomic Status
PSYCHOLOGICAL CONDITION

• Patient was an active and extroverted person. She loves to go to

recitation when she still able to walk by herself. After walk by assistive
device she love to spend her time with her children and grandchildren.
• She has good relationship with his children and nieces and
grandchildren.
• Family hopes that patient can recover and do his daily activities as
before she was hospitalized.
History of Psycho and Socioeconomic Status
SOCIAL CONDITION
•
She lives with her husband (84 years old), her daughter (53 years old)
and son-in law (53 years old) with two granddaughters.
•
She had two children (one daughter and one son). Her son had married
and live in Kalimantan.
•
The patient is the first daughter in her family and she love to help her
brother and sister. She also taken care one of her niece when she was
young.
•
His main caregiver at home is her daughter.
•
During hospitalization, she was taken care by her niece that used to be
live with her.
History of Psycho and Socioeconomic Status

ECONOMIC CONDITION
• Patient lives from husband retirement and money
that were sended by son with total about 4
million/month.
• The patient uses BPJS as health insurance.
Genogram
Physical Examination
Consciousness : Somnolen
Blood Pressure : 130/80 mmHg
Heart Rate : 103x/minutes, reguler
Respiratory rate : 30x/minutes
Temperature : 36.8 0C
SpO2 : 98% on O2 10 lpm on non rebreathing
mask

Nutritional status
Body weight : 50 kg
Height : 160 cm
BMI : 19,14 (normoweight)
a.r Head and Neck: a.r Upper Extremities:
Deformity (-) - Look : Deformity (-), pitting edema +/+,
Conjunctiva anemic +/+ , Scleral icterus -/- hyperemic (-)/(-)
- Feel : warmth (-), CRT <2”
a.r Thorax: - Move :
Shape and movement symmetric, retraction (+)
ROM full/full
Lung : VBS Sinistra = Dextra, ronchi +/+, wheezing -/-, secrete +/+
MMT : fungsional/fungisonal (by
Cor : BJ SI-II regular, Murmur (-), Gallop (-)
impression)
a.r Abdomen:
- Physiological reflex : BTR ++/++
Soepel, ascites (+), bowel sound (+)
- Pathological reflex : Hoffman tromner -/-
•a.r Lower Extremities:
Physiological reflex : APR,
- Look : Deformity (-), pitting edema (+/+) hyperemic (-)/(-) KPR ++/++

- Feel : warmth (-), CRT <2” - Pathological reflex :

- Move : Babinsky -/-

ROM limited a.r Meningeal Sign

Hip flexion 0-100/ 0-100 (empty end feel)
Laseque sign
Hip abduction 0-25/0-25 (empty end feel)
: (-)
Knee flexion 0-20/0-20 (empty end feel)
Kernig sign
Ankle dorsoflexion 0-10/0-10 (empty end feel)
: (-)
Ankle plantar flexion 0-20-0-20 (empty end feel)

MMT : non functional/nonfunctional (by impression)

 BODY FUNCTION
MENTAL FUNCTION

Emotional Function Geriatric depression scale Cannot be examined

Sleep Function Insomnia severity index Cannot be examined
Cognitive Function Mini Cog Cannot be examined
 BODY FUNCTION
SENSORY FUNCTIONS AND PAIN
Function Items Result Description

Seeing function Visual acuity Cannot be examined

Hearing function Whispering test Cannot be examined

Proprioceptive Joint position sense Cannot be examined
function
Light touch function Dermatomal Cannot be examined

Pain in body part Not clear

 BODY FUNCTION
FUNCTION OF THE CARDIOVASCULAR SYSTEMS

Function Items Result Description

Heart functions Heart rate 103 x/minute

Heart rhythm Regular
Contraction force of Adequate pulse
ventricular muscles

Blood vessel functions Function of arteries No data

Function of capillaries CRT<2 sec

Function of veins JVP 5+2 cm H2O

Blood pressure functions 130/80 mmHg
 BODY FUNCTION
FUNCTION OF THE RESPIRATORY SYSTEM

Function Items Result Description

Respiratory function Respiratory rate 30 x/minute
Respiratory rhythm Abdominothoracal

Depth of respiration Shallow

Respiratory Muscle Respiratory muscle function Chest Expansion, inadequate

function by impression
Additional respiratory function Single breath count test : cannot
be examined
Cough ability : inadequate by
impression
 BODY FUNCTION
SENSATION AND THE CARDIORESPIRATORY FUNCTION

Function Items Result Description

Cardiorespiratory Oxygen saturation 98% with

function non rebreathing mask 10 lpm

Exercise tolerance General physical endurance Not tested

function
Aerobic capacity Not tested

Fatigability Fatigue Severity Scale :

Cannot be examined
 BODY FUNCTION
FUNCTION OF THE HEMATOLOGICAL AND IMMUNOLOGICAL SYSTEMS

Function Items Result Description

Hematological Production of blood Erythrocyte 3.11 mill/uL

system functions Thrombocyte 29 /uL

Oxygen-carrying functions of the Hemoglobin 7,7 g/dL

blood

Immunological Immune response Leukocyte 10.32 /uL

system functions
 BODY FUNCTION
FUNCTION RELATED TO THE DIGESTIVE SYSTEMS

Function Items Result Description

Swallowing Oral Swallowing Not tested

function Pharyngeal swallowing
Defecation Elimination of feces Spontaneous
Function
Fecal consistency Bristool type 3-4

Frequency of defecation Once a day

No incontinence
Fecal continence
Weight maintenance functions MNA - 13,5 (malnourished)

Sensation associated with the Sensation of nausea cannot be examined

digestive system Loss of appetite Present since 2 months ago
 BODY FUNCTION
GENITOURINARY FUNCTION

Function Items Result Description

URINARY FUNCTION
Urinary filtration Filtration of urine Ureum: 77,4
function Creatinine: 1.37

Urinary function Urination

Frequency of urination

Urinary continence
Use indwelling catheter
Sensation associated
with urinary function
 NEUROMUSCULOSKELETAL AND MOVEMENT RELATED FUNCTION BODY FUNCTION

Functions of the Joints and Bones

Function
Mobility of joint functions
Stability of joint functions
MUSCLE FUNCTIONS
Muscle power functions
Items
Mobility of joint functions
Stability of joint functions
MMT
Result Description
ROM full/full
Normal
Upper extremity functional by impression
Lower extremity non functional by impression

Muscle tone functions normal tone

Muscle endurance functions Handgrip Strength Not tested

MOVEMENT FUNCTIONS

Motor reflex functions Physiological reflex KPR +2/+2, APR +2/+2

Pathological reflex Babinski -/-

Morse Fall Scale Risk of Fall 55 - high risk of fall

 BODY FUNCTION
FUNCTIONS OF THE SKIN AND RELATED STRUCTURES

Functions of the Skin

Function Items Result Description
Protective Protective function of the skin Ulcer (-)
functions of the Dry skin at extremities (+)
skin
 BODY FUNCTION
SCREENING SARCOPENIA

TOOLS Result Interpretation

SARC-F 8 Suggestive sarcopenia
 BODY FUNCTION
SCREENING FRAILTY

TOOLS Result Interpretation

Fried Frailty Phenotype 5 Frailty

Clinical Frailty Scale 8 Terminally ill

 BODY FUNCTION

Skoring Paliatif
TOOLS Result Interpretation
Palliative Performance 20%
Scale

Palliative Prognostic 11 Survival < 3 weeks

Index
 GERIATRIC GIANTS BODY FUNCTION
ADA TIDAK ADA
Isolation √
Instability √
Impecunity
Intellectual impairment Cannot be examined
Impairment of vision Cannot be examined
Impairment of hearing √
Immobility √
Infection √
Immune deficiency √
Inanition √ MNA (13,5)
Insomnia Cannot be examined
Impaction √
Incontinency √
Iatrogenic V
 BODY STRUCTURE
Thorax Xray

Foto thorax 14/07/23 Foto thorax 17/07/23

- Efusi pleura bilateral - Pneumonia bilateral
- Efusi pleura bilateral belum perbaikan
- Artherosklerosis aorta.
Video Klinis
AREA ACTIVITY ITEMS RESULT
Receiving Messages Spoken messages Not able due to unconscious
Nonverbal messages Not able due to unconscious
Written messages Not able due to unconscious
Producing Messages Speaking speech Not able due to unconscious
Nonverbal messages Not able due to unconscious
Writing messages Not able due to unconscious
ACTIVITY AREA ITEM RESULT
Changing basic Lying down Not able due to unconscious
body position
Sitting Not able due to unconscious
without support
Maintaining a Maintaining a lying position Not able due to unconscious
body position
Maintaining a sitting position Not able due to unconscious
ACTIVITY AREA ITEM RESULT
Transferring oneself While lying Not able
While sitting Not able

ACTIVITY AREA ITEM RESULT

Walking Short distances Not tested
Long distances Not tested
On different surfaces Not tested
Around obstacles Not tested
Moving around Crawling Not tested
Climbing Not tested
Running Not tested
Jumping Not tested
Swimming Not tested
Moving around in different Within the home Not tested
locations Within building outside the Not tested
home
Outside the home and other Not tested
buildings
Moving around using Walking aids Not tested
equipment Wheelchair Not tested
ACTIVITY AREA ITEM RESULT

Using transportation Using private motorized transportation Not tested

Using public motorized transportation Not tested

Driving Driving human-powered Not tested

transportation

Driving motorized vehicles Not tested

Carrying, Handling, and Moving Object

ACTIVITY AREA ITEM RESULT

Fine hand use Picking up Not able due to unconscious

Grasping Not able due to unconscious

Manipulating Not able due to unconscious
Releasing Not able due to unconscious
No. Activities Score

1 Bowel control 10
2 Bladder control 0
3 Grooming 0
4 Toileting 0
5 Eating 0
6 Transfer 0
7 Mobilization 0
8 Dressing 0
9 Stairs 0
10 Bathing 0
Total 10/100
 ACTIVITY AREA ITEM RESULT
Washing oneself Washing body parts Not Able
Washing whole body Not Able
Drying oneself Not Able

Caring for body parts Caring for skin Not Able

Caring for teeth Not Able
Caring for hair Not Able
Caring for fingernails Not Able
Caring for toenails Not Able

Toilet use Not Able

Bladder Regulating urination Cannot be evaluated (using catheter)

Bowel Regulating defecation Able

Dressing Putting on clothes Not Able

Taking off clothes Not Able

Putting on footwear Not Tested

Taking off footwear Not Tested

Choosing appropriate clothing Not Tested

ACTIVITY AREA ITEM RESULT

Eating Bringing it to the mouth Not tested

and consuming it in
acceptable ways
Cutting food into pieces Not tested
Using eating implements Not tested
Drinking Taking hold of a drink and Not tested
bringing it to the mouth

Opening bottles and cans Not tested

Pouring liquids for drinking Not tested
Looking after one’s health Ensuring one’s physical Not Able
comfort
Managing diet and fitness Not Able
Maintaining one's health Not Able
ACTIVITY AREA ITEMS RESULTS

Acquisition of goods and services Shopping

Gathering daily necessities

Preparing meals Preparing simple meals
Preparing complex meals
Doing housework Washing and drying clothes and garments
Not tested
Cleaning cooking area and utensils
Cleaning living area
Using household appliances
Storing daily necessities
Disposing of garbage
Participation Item Results

General interpersonal interactions She is an friendly and extrovert person

Particular interpersonal Formal relationships
relationships
Informal social relationships
Family relationships
She did not have formal relation.
She has good informal relationship with
neighbour
Close to her family.
PARTICIPATION ITEM RESULT

Community life Informal Association None

Formal Association None
Ceremonies None
Recreation and Sport None
leisure
Hobbies None

Socializing Patient sometimes socialized with her neighbors

Religion and spirituality Pray at home

Self-satisfaction EQ 5D : Not tested
Products and technology Result

For personal use in daily living Not able

For personal indoor and outdoor mobility and Not able

transportation

For communication Not able

For culture, recreation and sport Not able

For the practice of religion and spirituality Not able

Design, construction and building products and Not able

technology of building for public use
RELATIONSHIP RESULT
Immediate family Live with her husband and 2nd child

Friends has good relationship with friends

Personal care providers and 2nd child at home, his niece while in Hospital
personal assistants
Caregiver Burden No to mild caregiver burden
(Zarit Burden Scale : 15)

AREA ITEMS RESULTS

Health Health services Near health service

Health systems Use BPJS

Health policies No obstacle to use BPJS
Para
meter
14/07 15/07 16/07 17/07 18/07 19/07 Normal
Value
Supporting exam
Laboratorium result
Hb 8.7 7.7 10.6 14-17.4
Para 14/07 16/07 Normal
Ht 27.8 24.8 33.2 41.5- meter Value
50.4
E 2.95 2.61 3.66 kuning Kuning
Warna
muda
L 10.46 10.62 17.35 4.4- keruh jernih
11.3 kejernihan
Tr 250 240 234 150- Berat jenis 1.025 1.020 1.001-1.035
450
pH 7.5 6.0 5.0-8.0
Glukosa 68 197 365 <140
sewaktu Nitrit positif negatif negatif

Ureum 53.6 27.8 45.9 77.4 104.1 47.5 21-43 protein 3+ 3+ negatif
Creatinin 4.13 2.23 3.25 4.06 5.63 2.86 0.57-1.11
136 136 glukosa urin negatif negatif negatif
Na 135-145
K 4.1 3.1 3.6 4.8 4.5 3.5-5.1 Normal normal negatif
Urobilinogen
Ca 4.96 4.96 4.5-5.6 3+ 3+
Leukosit esterase negatif
2.3 2.2 3+ 3+
Magnesium 1.6-2.6 eritrosit negatif
Albumin 3.19 2.80 2.99 3.2-4.6 bilirubin Negatif negatif negatif

keton Negatif negatif negatif

 Blood gas analysis

14/07 15/07 16/07 18/07 19/07

Normal
Test Satuan
Value

Nilai gas darah

pH 7.35-7.45 7.420 7.370 7.370 7.350 7.400
34.2 43.2 44.2 41.8 38.6
pCO2 35-45 mmHg
68.6 84.3 85.4 52.2 135.4
pO2 80-105 mmHg

Status asam basa

22.2 25.1 25.5 23.5 24.0
HCO3 22-26 Mmol/L
23.2 26.4 26.9 24.8 25.2
tCO2 23.05-27.35 %
-1.3 0.3 0.7 -1.2 -0.1
Standar BE-b (-2)-(+2) Mmol/L
93.7 95.6 95.6 82.8 99.4
Satureasi O2 95-100 %
 Case Resume
Female, 78 years old, a house wife and high school graduated. Referred by internist with CAP, bilateral pleural
effusion, end stage renal disease due to DKD, anemia.
From anamnesis and physical examination we found that:
• Patient had of alter of consciousness with somnolent status while got dialysis
• She also has shortness of breath, cough, with retraction, ronchi, and slem and fever at first two days of
hospitalization.
• Mobilization and selfcare ADL are totally dependent.
• She has comorbid of controlled hypertension and DM
• She lives with her husband, daughter, and 2 grand daughters. The primary caregiver is her daughter and
secondary caregiver is her niece.
• She has mild-moderate income and use BPJS for insurance
• There is joint stiffness at hip, knee, and ankle due to immobilization. Pitting edema in all extremity,
MMT functional at upper extremity and non functional at lower extremity (by impression)
• She has anemia, sarcopenia, frailty, instability, immobility, infection, innanition, isolation
 Problem List

Medical Problem Rehabilitation Problem

Community Acquired Pneumonia Respiratory disturbance

Bilateral Pleural Effusion Mobilization disturbance
End stage renal disease due to DKD Immobility
Anaemia Instability
DM type 2 (controlled) Infection
Hypertension (controlled) Inanition
Geriatric syndrome (Immobility, isolation, frailty, sarcopenia)
Instability, infection, inanition,
isolation, frailty, sarcopenia)
malnutrition
Prognosis

Ad vitam : ad malam
• One and five years survival rate is 75% and 35% after the initiation of dialysis. The burden of the disease, mortality,
symptoms, and prognostic estimates in patients with CKD are similar to patients with cancer.
Sturgill D, Bear A. Unique palliative care needs of patients with advanced chronic kidney disease-The scope of the problem and several solutions. Clin Med

(Lond) 2019;19:26–9.

Among a cohort of 165,461 DKD patients, we found that 32.7% of them had mild to severe frailty based on a modified
FRAIL scale. After adjusting for a multitude of renal outcome-modifying factors, we revealed that frailty was associated
with an increased risk of developing ESRD, requiring chronic dialysis compared to non-frail ones, after 4.1 years of follow-
up. The risk was attenuated partially by mortality when these patients had a moderate degree of frailty. Frailty also
increased the risk of mortality, hospitalization, cardiovascular events, and ICU admission among DKD patients. Further
studies are needed to confirm our findings.
Chao CT, Wang J, Huang JW, Chan DC, Chien KL. Frailty Predicts an Increased Risk of End-Stage Renal Disease with Risk Competition by Mortality among 165,461 Diabetic Kidney Disease
Patients. Aging Dis. 2019 Dec 1;10(6):1270-1281. doi: 10.14336/AD.2019.0216. PMID: 31788338; PMCID: PMC6844590.
Ad sanationam : ad malam
The risk of hospitalization, Intensive Care Unit and ventilator requirement, in-hospital death is high in
pneumonia patients with chronic kidney disease. Infections are a major cause of morbidity and
mortality in Chronic Kidney Disease (CKD) patients. The relationship is mutual: not only infections
are severe and difficult to manage in CKD, but infections also contribute to the progression of CKD
and complicate its management.1 Lower respiratory tract infections e.g. Pneumonia are common
occurrences in CKD patients and are associated with increased risk of hospitalization, cardiovascular
events and mortality
Pant A, Prasai A, Rauniyar AK, Adhikary L, Basnet K, Khadka T. Pneumonia in Patients with Chronic Kidney Disease Admitted to Nephrology Department of a Tertiary Care Center: A
Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2021 Oct 15;59(242):1000-1003. doi: 10.31729/jnma.7074. PMID: 35199688; PMCID: PMC9107813.
Prognosis

Ad functionam : ad malam
• Mobilization : bed mobilization totally dependent
•
Respiration : Spontaneous breathing with O2 support
• Die with dignity
 Rehabilitation Goal
Rehabilitation Problem Short-term goals (<1 month)

Respiratory disturbance No slem retention

Lung infection improved

Immobilization disturbance No pressure ulcer and contracture

Instability No fall accident from bed

Inanition (MNA 13,5) maintaining MNA 13.5

Sarcopenia (Sarc Calf: 15) Maintaining Sarc-Calf: 15

Frailty (CFS 8) Maintaining CFS 8

 Target Oriented Rehabilitation Program
Rehabilitation Problem Short-term (<1 month)

Respiratory disturbance Bronchial hygiene

Gradual mobilization until sitting with support with
observe vital sign

Immobilization Same as respiratory disturbance program

Proper bed positioning
Turning per 2 hours
Moisturize skin using moisturizer
PROM exercise

Instability Place the patient in the middle of the bed

Always make sure bed railing is closed

Inaniation (MNA 13,5) Nutrition using NGT, change regularly, intake as nutrionist
suggestion

Sarcopenia (Sarc F:8) Same as immobilization program

Frailty Same as immobilization program

 Rehabilitation program
Respiratory disturbance
Clinical Target Obstacle Potency Program

• Dyspneu • Dyspnoe not •malnourished (MNA •Stable blood pressure, ●IRR at thorax
• Slem (+/+) worsening 13,5) heart rate, and oxygen region
• Ronkhi (+/+) • No slem retention •Inadequate cough saturation using ●Nebulization
ability oxygen followed by vibration
•DM type II supplementation and postural
• CKD Stage 5 •Educated caregiver drainage as
and supported family tolerated
●Gradual
mobilization until
sitting with support
●Educate the
caregiver and
physiotherapist
about : higiene when
train patient
 Rehabilitation program

Immobilization
Clinical Target Obstacle Potency Program

• Joint •no pressure ulcer and • Level of consciousness • Educated and • Gradual mobilization
stiffness • Dyspnoe no caregiver until sitting with
contracture • CKD stage 5 burden support (monitor vital
• Empty end feel ROM • No pressure sign)
injury • PROM exercise a.r
extremities
F: 2x/day, I: slight
uncomfortable, T: 1 set,
8-12 repetition, T: static
• Proper bed
positioning
• Turning per 2
hours
• Moisturize skin
using moisturizer
 Rehabilitation program

Instability
Clinical Target Obstacle Potency Program

• Morse score: 50 •No fall accident from • Level of •Has bed railing Place the patient in
consciousness •Educated caregiver the middle of the
bed • dyspnoe bed
Always make sure
bed railing is
closed
 Rehabilitation program

Inanition

Clinical Target Obstacle Potency Program

• MNA 13,5 ● Maintaining MNA • CKD stage 5 •NGT access for Nutrition using
• Level of nutrition NGT, change
13,5 consciousness •No pressure ulcer regularly, intake as
• Infection • Educated caregiver nutrionist
• Dyspnoe and supported family
suggestion
 Rehabilitation program

Sarcopenia & Frailty  tidak disatukan program dipisah

Clinical Target Obstacle Potency Program

• Sarc-Calf: 15 • Maintaining sarc calf • CKD stage 5 NGT access for •Same as
• CFS 8 15 • Level of nutrition mobilization program
• Maintaining CFS 8 consciousness •No pressure ulcer
• Infection • Educated caregiver
• Dyspnoe and supported family
• Hipoalbuminemi
a
Discharge planning
● Educate the family to prepare Oxygen, Suction machine, and Pulse
oxymetry
● Bed with bed railing or put on low level bed in the wall corner and
using bolster and pillow to prevent patient fall from bed
• Maintain and change NGT regularly
• Nutrition as suggested from nutritionist
• Educate and train caregiver to do the program as same as in hospital
THANK YOU
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