Outline   the   important  problems   encountered  by  the   patient   following  hospital discharge after a prolonged period of stay in the Intensive Care Unit.  List two (2) tools available to assess the functional  status of such a patient.

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College Answer

Many problems are encountered after hospital discharge. The important problems include:
•    Patients have usually had a tracheostomy (and/or prolonged endotracheal intubation) - complications associated with these include laryngeal pathology [eg. polyps, ulcers], aspiration, difficulty with swallowing etc.
•    Limitation of mobility for some time – muscle tone, joint stiffness, Chronic Inflammatory
Polyneuropathy
•    Skin – hair loss, itching

•    Sexual dysfunction
•    Psychological problems – loss of memory, stress, nightmares, Post Traumatic Stress
Disorder, depression, chronic fatigue syndrome
•    Infectious: colonisation with resistant organisms (eg. MRSA)
•    Miscellaneous (loss of taste, loss of appetite, ocular trauma, scarring near region of tape fixing for ETT)
Tools to assess quality include: Quality Adjusted Life Years (objective measure), HAD – Hospital Anxiety & Depression, SF 36, PQOL (perceived quality of life), EuroQOL – European tool Simpler measures include Glasgow Outcome Scale. Some hospitals utilise follow up clinics. Eighteen out of twenty-six candidates passed this question.

Discussion

This question closely resembles Question 30 from the first paper of 2009.