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Based on an actual patient, this case is described using the patient care management model; it was developed to fulfill the requirements for a course in the DPT (transition) program at MGH Institute by Dr. Hack, with thanks to the instructor in the course, Cynthia Coffin Zadai, PT, DPT, MS, CCS, FAPTA for her guidance in its development.


1. History

General Health Status at Time of Admission

Sam Ketterman is a 90-year-old Caucasian male (DOB: 6/24/14), who was sent via ambulance for sudden onset of shortness of breath and pervasive weakness. He was subsequently admitted to the hospital through the Emergency Department with a diagnosis of congestive heart failure (CHF) and atrial fibrillation, both of new origin and unknown etiology. After an 8-day hospital stay (9/9/04–9/16/04), he was discharged from the hospital back to the assisted living facility where he previously resided. He lives in the Alzheimer's unit of that facility. Physical therapy was requested to see him to ensure safety and improve function.

Social History/Environment

Mr. Ketterman has been married for 65 years to his 92-year-old wife, who resides in the same assisted living facility in a nearby one-bedroom apartment. He is a college graduate who spent his entire career as a manager for AT&T in northern Illinois. The Kettermans retired in 1976 and moved to the western coast of Florida, where they moved to a life care community in 1990. A few years after Mr. Ketterman's diagnosis with Alzheimer's disease, Mrs. Ketterman developed severe depression and anxiety leading to paranoia. Because of this, the couple moved in 2003 to the assisted living facility in the Boston region to be closer to their family. Mr. Ketterman has bilateral hearing aids, a partial denture, and bifocals. He has a raised toilet seat and standard folding walker that were in use prior to this hospital admission. Hospital bed added post-discharge for shortness of breath. Both Mr. and Mrs. Ketterman have signed advanced directives indicating that only comfort measures should be used in the event of imminent death and have requested and received do not resuscitate orders from their physician.


Mr. and Mrs. Ketterman have two sons. One lives in the Boston region with his wife. Because of their proximity to them, this son and daughter-in-law have primary responsibility for the couple's care. This son is the durable power of attorney. Their other son lives in Illinois. They have three grandchildren and a great-grandchild.

Social/Health Habits

Mr. Ketterman has never smoked and used alcohol only on social occasions. His primary activities during retirement were community service, golf, and bridge. He participated regularly in the structured exercise program at the life care community in Florida and at the assisted ...

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