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CASE STUDY: Anita is admitting a 76-year-old patient with severe cardiomyopathy for recurrent pneumonia. During the admission, the patient, who is on Medicare, tells Anita that she lives alone with her two cats but has been having trouble lately going up the stairs to the only bathroom in the house. Knowing that the patient’s heart condition will only get worse, Anita questions the patient about the type of house she lives in, how many stairs are in the home, whether any family members or friends live nearby, and how she feels about her ability to care for herself living alone. The patient states that it has been hard and adds that she has never been married and has no children. She has some friends who live nearby, but the youngest ones are in their late 70s. Anita is concerned about the patient’s ability to care for herself after discharge, and she informs the physician when he makes his rounds. The physician orders extended care placement for the patient after discharge, full lab work, bronchoscopy, sputum sample, echocardiography, CT scan of the chest, and daily chest x-rays for 3 days.
 

How did Anita ensure fiscal responsibility to the patient?

 

What concerns should Anita have regarding the information obtained during admission?

 

Which issues of fiscal responsibility are raised by the physician’s orders?

 

During discharge, Anita reviews the list of new medications prescribed for the patient.

Almost every medication the patient was previously taking has changed in dose or has been replaced by a different medication.

What can Anita do to ensure that the patient has the means to obtain the new medications and that she understands how to take them?

 

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