Significant change or not?

[jessie26]

Med A resident readmitted from hospital had surgery AKA on the Left leg, is this a SCSA although already bedbound and totally dependent of ADLs before the amputation, thanks for any reply.

[Double O7, BSN, MSN, RN]

Med A resident readmitted from hospital had surgery AKA on the Left leg, is this a SCSA although already bedbound and totally dependent of ADLs before the amputation, thanks for any reply.

(Please note this is not an exhaustive list)

Guidelines for Determining Significant Change in Resident Status

Decline in two or more of the following:

• Resident's decision-making changes
  
• Emergence of sad or anxious mood pattern as a problem that is not easily altered
  
• Increase in the number of areas where Behavioural Symptoms are "not easily altered"
  
• Resident's continence pattern changes, or there was placement of an indweling catheter
  
• Emergence of unplanned weight loss problem (5% change of in 30 days or 10% change in 180 days)
  
• Emergence of pressure ulcer at Stage II or higher, when no ulcers were previously present at Stage II or higher
  
• Resident begins to use trunk restraint or a chair that prevents rising when it was not used before
  
• Overall deterioration of resident's condition; resident receives more support
  
• Emergence of condition or disease in which resident is judged to be unstable
  

While your client / resident is already a total care / dependent on ADL, please carefully considered other areas that might contribute to changes in his / her overall status. e.g. Pain will be obvious factor following surgery, whether it is experienced minimally or to excruciating level. Pain is very subjective and although it is a non-triggered item, it does impact resident's in many ways. You may or may not observe the significant change during the observation period, however, I trust you will use your best clinical judgment on this query.

Hope this helps.

[jessie26]

Thank you so much for your help!!

[Nascar nurse, ASN, RN]

The overall intent of a significant change is to trigger an updated plan of care for the resident when needed. Although his ADL score will remain the same, he will have probably had a significant weight loss (due to loss of limb), he probably has a surgical wound that will require monitoring and care, as someone else said.. he will have pain issues which will need addressed.

I would do a significant change

[rapkeygurl]

A “significant change” is a decline or improvement in a resident’s status that:

1. Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, is not “self-limiting”

2. Impacts more than one area of the resident’s health status; and

3. Requires interdisciplinary review and/or revision of the care plan.

That comes straight from Chapter 2 RAI manual. Plus I am sure the resident would have grief issues possibly causing depression r/t the loss of the limb.

I agree a sig change I would do also.

[golflinda2214]

Lets look at this another way. For instance, what if the patient has had severe pain in the limb from gangrene? Pain after the surgery could actually be LESS than when he had his leg. Also, emotionally he may be BETTER off now that he is out of pain. And for some, this amputation could lead to a prosthesis that will now make him less dependent than before.