TP3: IPE CASE STUDY
The following case study was developed to help students more accurately
understand the importance of interdisciplinary care in the treatment of a patient.
Read through the following case study about an older African American female
following a CVA and answer the case study questions.
Objectives:
1. Develop an interdisciplinary plan of care for this case, including caregiver and
client education
2. Explain the advantages of interdisciplinary care
3. Describe services available from physical therapy and occupational therapy that
would assist this patient
4. Identify services offered in the various health care settings
5. Identify potential areas of miscommunication among disciplines
6. Describe appropriate forms of payment
7. Identify potential barriers to care Case Study:
Mrs. Z is an 81 y.o. African American female (5’5”, 115lbs) admitted to the
Emergency Department at Cares Medical Center yesterday with complaints of
altered mental status (ams). Daughter stated patient mental status worsened with
generalized weakness and confusion beginning two days ago.
Dx: CVA, R occipital infarct
Comorbidities/Complications: A-Fib, bradycardia, hyperlipidemia, orthostatic
hypotension, right visual field cut, lung cancer, diabetes, low back pain.
Patient Location: Downtown Richmond
Social History: widowed; has 4 children (3 boys, 1 girl). Mrs. Z attends church
functions 3 times a week and would like to speak to the hospital’s chaplain.
Living Situation: Lives with daughter in a 2-story home. There are 3 steps to get into
the house with railings on both sides. There are 12 stairs inside with railings on
both sides. Her bedroom is located downstairs.
DME: patient owns a rollator.
Prior to admission, Mrs. Z daughter reported that her mother had become severely
deconditioned over the last year after being diagnosed with lung cancer. She was a
previous smoker but quit 10 years ago. She was a painter for 30 years. The daughter
expressed concerns about financial issues related to ongoing treatment for the lung
cancer.
Initial Evaluation:
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Observation: A&O x 1; can follow commands; visual field cut on R
Vitals:
59 bpm, 90% O2, 145/72 in supine before activity
66 bpm, 93% O2, 153/85 sitting in chair after activity
Sensation: intact MMT: 4/5 LUE, 2/5 RUE, 4/5 B LE
Bed mobility: supine to sit: Min A
Transfers:
Sit to stand: Min A
Stand to sit: Min A
Bed to chair: Min A
Balance:
Static sitting: intact
Standing static: good
Standing dynamic: fair
Ambulation: distance: 50 ft reports SOB and required 2 seated breaks
Assistive device: gait belt, rolling walker
Ambulation: level of assistance CGA. Noted abnormal gait deviations due to a
visual field deficit. Stairs: NT
Activity Tolerance: Fair – dyspnea with activity, needs to slow pace with
RW for better tolerance
Healthcare Organization
Cares Medical Center is a new urban multihospital system offering acute and postacute services in central Virginia. Cares Medical Center offers 5 acute care hospitals
with 24/7 nursing staff located throughout the city and surrounding counties of
Richmond.
Geographic locations:
Cares is in Downtown Richmond with capacity of 450 beds
Cares in Henrico with capacity of 300 beds
Cares in Midlothian with capacity of 350 beds
Cares in Mechanicsville with capacity of 250 beds
Cares in Northside with capacity of 200 beds
General medical services offered:
Cares Cancer Center
Cares Heart and Lung Center
Cares Neurosurgical Center
Cares Transplant Center
Specialties:
Anesthesiology
Dentistry
Dermatology
Emergency Medicine
Family Medicine
Human Genetics
Internal Medicine
Neurology
Neurosurgery
Obstetrics and Gynecology
Ophthalmology
Orthopedic Surgery
Otolaryngology
Pathology
Physical Medicine and Rehab
Psychiatry
Radiology
Surgery
Current Situation...
Mrs. Z will spend 3 days in the hospital in downtown Richmond in acute care
receiving 24 hour nursing care and physical therapy once a day until discharge. Her
care will also include services from many other disciplines.
Upon Discharge from acute care... Mrs. Z will attend inpatient rehab services at the Rehabilitation Center located on
the first floor of the hospital. The Rehab Center offers 45 beds, providing 3
specialized (spinal cord injury rehab, brain injury rehab and general rehab)
inpatient physical rehab care to adults and adolescents with complex needs. If Mrs.
Z has complications that prevent her from performing inpatient rehab of at least 3
hours a day, 5-7 days a week of at least 2 different types of therapy, then she has the
option to continue rehab at a Skilled Nursing Facility in a nursing home. Cares
Medical Center offers 3 skilled nursing facilities all offering low to moderate
intensity care with 24 hour nursing staff.
Upon discharge from inpatient rehab/SNF...
Mrs. Z will probably discharge home. If she is in need of more therapy, she could
attend day rehab services performed at the Rehab Center. She could attend daily
rehab at the Rehab and Research Center. She could also consider outpatient rehab
located on the second floor of the hospital or consider 3 other outpatient facilities
located throughout the city of Richmond. If transportation is an issue and Mrs. Z.
requires low intensity treatment then home health would be recommended at her
home.
Discussion Questions
1. What types of disciplines will Mrs. Z work with in each of the following settings:
acute care, inpatient rehab, outpatient rehab and home health?
a. In the acute care setting, Mrs. Z will be examined by a hospital doctor and will
come under the care of a consulting doctor. The consulting doctor will oversee
the care provided to Mrs. Z while she is in the hospital and will work with other
members of the multidisciplinary team. Nursing staff will be critical as they will
be with the patient 24 hours a day. They will help plan and coordinate along
with the other members of the hospital team and will encourage Mrs. Z to
practice any exercises or activities that the therapists recommend. The hospital
nurses will help manage daily activities such as washing and dressing. A physical
therapist will help Mrs. Z to achieve her highest level of functional mobility. The
occupational therapist will work with Mrs. Z to help her achieve as much
independence as possible in her normal daily activities. A speech and language
therapist will also play a role in Mrs. Z’s care. A speech therapist will assess,
diagnose and treat problems related to swallowing; and assess, diagnose and
treat problems related to communication. A clinical nutritionist and dietician
may also work with Mrs. Z to assess her nutritional status and provide education
on her dietary needs. A medical social worker will counsel Mrs. Z and her family
on future planning including finances, employment, housing, care for family
members, and with appropriate referrals to services available in the community.
A clinical psychologist may investigate Mrs. Z’s cognitive function and how she
will adjust to changes following her stroke. A respiratory therapist can work
with Mrs. Z if she is experiencing breathing problems.
b. In the inpatient, outpatient, and home health setting, members of the
interdisciplinary team will include nursing, OT, PT, speech therapy, a dietician,
and a social worker.
2. In Cares Medical Center, what opportunities does Mrs. Z have if she is unable to
pay in full for her care? Do all the facilities accept Medicare?
a. If Mrs. Z is unable to pay for her care, the Cares Medical Center can work
alongside Mrs. Z to form an appropriate payment plan. CMC can provide financial
assistance to Mrs. Z based on her income, assets and needs. It is possible for CMC
to provide free or low-cost health insurance. All of the Cares facilities accept
Medicare.
3. What are some potential areas of miscommunication among disciplines?
a. All disciplines must establish a culture of open communication and team
collaboration to insure the accuracy of patient information. With
miscommunication, there is the potential for missing critical information,
misinterpretation, unclear orders, and unnoticed changes in patient status.
Patient safety is at risk when any of these medical errors occur. In this case,
miscommunication could affect where Mrs. Z would go next and thus delaying
her recovery or impeding her safety.
4. What specialty areas does Cares Medical Center offer for Mrs. Z?
a. The Department of Physical Medicine and Rehabilitation can offer Mrs. Z the
rehabilitation services that she needs following her stroke. Special outpatient
clinics for spasticity and ortho/prosthetics are available. Additional outpatient
programs are offered for musculoskeletal treatment. Because of Mrs. Z’s ongoing
lung cancer treatment, she can also take advantage of the Cares Cancer Center
after she discontinues rehab.
5. How would physical and occupational therapy assist Mrs. Z in her recovery in
both the acute care hospital and outpatient rehab?
a. A physical therapist will help Mrs. Z to try to achieve her highest level of
functional mobility with transfers and gait using a rollator. Mrs. Z will learn
range of motion exercises for her RUE as well as functional strengthening
exercises for her extensors. The PT will also work on balance and positioning
with Mrs. Z. The PT will assist Mrs. Z and her family with goal setting and will
provide education on ways of managing her condition.
b. Occupational therapy will work with Mrs. Z on her ability to care for herself
independently. OT will focus on energy conservation and the use of assistive
devices to increase Mrs. Z’s ability to perform her ADLs and IADLs.
6. Are there any other barriers to Mrs. Z receiving care?
a. Barriers for Mrs. Z receiving care are: any potential cognitive deficits that
would prevent her from learning rehabilitation strategies, a lack of endurance
from her pre-existing conditions, deep vein thrombosis and thromboembolism
due to immobility, depression, balance and risk for falls, skin integrity, family
understanding and level of cooperation, and Mrs. Z’s access to medical services.