SN provided skilled education to patient and caregiver regarding multiple chronic disease processes, including chronic kidney disease (CKD), coronary artery disease (CAD), anemia, peripheral vascular disease (PVD), and obstructive sleep apnea (OSA). Baseline: patient and caregiver report limited understanding of how these conditions are related and when to seek medical attention, stating they “are not sure what is serious and what can wait.”

Teaching focused on symptom recognition, daily monitoring, and when to contact the healthcare provider or seek emergency care.

SN reviewed:

• Chronic kidney disease (CKD): importance of monitoring urine output, daily weights per provider orders, fluid restriction if prescribed, and signs to report, including decreased urine output, swelling, sudden weight gain, and shortness of breath.
• Coronary artery disease (CAD): recognition of chest pain or pressure, shortness of breath, palpitations, and unusual fatigue, with instructions to call 911 for new, severe, or unrelieved chest pain or shortness of breath.
• Anemia: signs such as increased weakness, fatigue, dizziness, shortness of breath with usual activity, and pale skin, and when to report these to the provider.
• Peripheral vascular disease (PVD): symptoms including leg pain with walking, cold or pale extremities, wounds on legs or feet that do not heal, and need to report new or worsening pain, color changes, or non healing sores.
• Obstructive sleep apnea (OSA): importance of consistent use of prescribed CPAP or other device, monitoring for loud snoring, witnessed apneas, morning headaches, and daytime sleepiness, and reporting intolerance of equipment or worsening symptoms to provider.

SN emphasized identification of warning signs requiring immediate medical attention, including chest pain, shortness of breath at rest or worsening, sudden weight gain, decreased urine output, black or bloody stools, severe or increased weakness, confusion, or other changes in mental status. Patient and caregiver instructed to follow provider specific parameters for when to call the office and when to seek emergency services.

Patient and caregiver were asked to:

• Name at least two key symptoms to report for CKD, CAD, anemia, PVD, and OSA.
• Describe at least three warning signs that require immediate medical attention.
• State when they would call the provider versus call 911.

Patient and caregiver were able to correctly identify decreased urine output and sudden weight gain for CKD, chest pain and shortness of breath for CAD, increased weakness and fatigue for anemia, leg pain with walking and non healing sores for PVD, and loud snoring and stopped breathing during sleep for OSA. They verbalized that chest pain, severe shortness of breath, black or bloody stools, sudden confusion, and severe new weakness would require immediate medical evaluation. Minimal cueing required.

Skilled nursing remains medically necessary to provide comprehensive multi system disease education, assess understanding using teach back, monitor for changes in symptoms, reinforce plan of care, and coordinate findings with the healthcare provider to prevent complications and hospitalization.