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“I was terrified when I woke up in the ICU with a tube down my throat and my arms tied down. I didn’t believe it when they told me I had a massive stroke. I was devastated at the thought of never holding my granddaughters again, or singing in church. You believed in me, you pushed me, you showed me what was possible, even when I was so sick. You were just as excited as I was when I moved my arm again! It was the simple things like brushing my teeth. You gave me hope for so much more.”
— A 74-year-old woman admitted to the ICU with a large right middle cerebral artery cerebrovascular accident
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LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
24-1. Distinguish between healthcare provided in the acute care and intensive care settings.
24-2. Explain the occupational therapist’s role in delivering integrated care in the acute care setting.
24-3. Explain how an occupational therapy assessment is conducted in the acute care setting, including the psychosocial impact of the setting.
24-4. Assess common comorbidities older adults often present with while in the hospital.
24-5. Implement interventions for the hospitalized older adult beginning with discharge planning and addressing the patient’s care in the hospital and in the future.
24-6. Discuss how acute care services are documented and reimbursed in the United States and the occupational therapist’s role in ensuring payment.
24-7. Support the role of occupational therapists in advocating for patients and occupational therapy services.
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Mini Case Study
Robert Iglesias, 78 years old, was struck by a car while walking in a parking lot carrying groceries to his car. His wife, who uses a walker, and 10-year-old grandson were with him but were unharmed. He was admitted to the surgical intensive care unit (ICU), with status post-open reduction external fixation of the right tibia, and right subdural hematoma.
Provocative Questions
What additional medical information or precautions would you want to know before completing Robert’s occupational therapy evaluation?
What information would you assume and verify about Robert’s prior level of function based on the information you have?
At the start of your evaluation, Robert is not responding to your questions. His eyes open briefly then close. What should you do to assess further?
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Acute care is the level of care in a hospital setting after a sudden illness, injury, or surgical recovery. Within the acute care setting, older patients are often faced with a devastating new condition or progression of a diagnosis that leaves them feeling fearful and uncertain about their ability to engage in life as they knew it. The acute care hospital setting is fast paced. The focus is on medical management and stabilization in order to progress the older adult to the next level of care, be it rehabilitation or home. Acute care occupational therapists have the unique opportunity to ...