My father was hospitalized for a month and spare change for pneumonia, secondary to pre-existing CHF that was well managed and kidney dysfunction that finally had reached the point where a fistula should be created for dialysis.
The next day, all lung fields had a nightmare textbook example of rales and rhonchi. Bad enough that I interrupted my scoop and swoop briefly to hand my non-medically skilled wife the stethoscope to briefly hear the sounds.
I’m a retired SF medic and some sounds one never forgets, but never truly understands until one hears them. As we were less than 5 minutes from our local hospital, it was a no-brainer. Don’t do a sPO2, don’t do a BP, don’t do anything beyond scoop and swoop.
Care was mildly complicated by a degree of lack of interest at the local hospital in maintaining control of body fluids and the reduction of them, so he was transferred to a hospital that is noteworthy for the level of care of such patients in our nearby city of Philadelphia.
After a handful of days beyond a month, with BiPAP, later, with >50LPM O2 flow, which was gradually weaned to 2LPM O2, he was discharged to rehabilitation.
A month and a half later, after significant improvement that shocked the staff, he was discharged due to insurance limitations, but at an ambulatory level that we can help rehabilitation.
There are a handful of other medical issues that are not noteworthy for this question.
On discharge, I received the usual sheaf of instructions and a fair amount of an RX pad with further RX’s and instructions.
Got the entirety of over 25 pages, save one.
VAN
RN
PT/OT-evaluate and treat
Dx line is largely what I described above and further information. Of import, “ambulatory dysfunction”.
Know what that means.
What I don’t get is, what is “VNA”?
Visiting Nurse Aide?
Visiting Nurse Assistant?
Visiting Nonsense Abbreviation?
For the medically curious, in this context, HIPAA is happy, as nobody has PII.
Complete Dx is ESRD, CHF, ambulatory dysfunction, DM and missing is T2D.
The facility wanted to discharge with a two forms of long lasting insulin, but his PHx showed excellent control on Saxagliptin, with good A1C results.
What he said. If it was VAN, then it was most likely literally Van, as in, “this guy needs a ride to take him out of here, but it doesn’t have to be an ambulance, a medical transport van will do.”
If it is VNA, I’d have to call the discharge nurse or case manager to find out. No idea. Is it handwritten or typed? If typed, I wonder if it was a typo and they meant CNA - Certified Nursing Assistant. Does he need someone to help him bathe, get dressed and/or eat?
*Here’s an illustration of a typical afternoon in the post-discharge clinic: A schizophrenic patient presents with renal failure, hypoglycemia, and confusion. Her home visiting nurse (VNA) administers her medications; the patient cannot tell you any of them. *
Huh. I’ve not yet run across that one, and I *am *a “VNA,” apparently! ETA: On all the discharge forms I see, they note “SN” or “SNV” for “Skilled Nursing” or “Skilled Nursing Visits”.
One would think that an RN should visit to evaluate first, then a CNA after, as needed.
But, with insurance companies and various state regulations, one never can tell when the cart ends up before the horse.
Again, thanks all for the quick reply.
And apologies for the confusion due to late night dyslexia, it was VNA throughout, not VAN.
By Medicare guidelines (which most insurance companies follow, too), the Start of Care Assessment for home health must be done by a RN or a Physical Therapist. Then we can order the CNA, the LPN (Licensed Practical Nurse) the OT, the ST, the PT (if she’s not the one doing the SOC assessment), the MSW, the homemaker, the durable medical equipment guy (the butcher, the baker and the candlestick maker… )
I checked around the office out of curiosity. No one’s heard “VNA” yet. Isn’t it fun when they change the alphabet soup?
How’s your dad doing, Wizard One? Settling in okay?
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