hep c questions

First I willl give a quick history and then start with the questions. She has had hep c for 35 years and let it go untreated and ignored until 2004 when she went on interferon. She had to quit the medicine before the disease was irradicated because they were worried about cardiac arrest. She has not had any issues until about 3 weeks ago when i found her near unconcious on her bedroom floor. She was taken to the emergency room and sent up to icu. She spent about 10 days on a resperator, had an ammonia level of 101, lactate of 10.3, and a prealbumin below 3. They thinnk she aspirated gastric acid which led to pnemonia and a staph infection in her lungs.While in the icu she had ascites and they pulled of 3500cc of fluid. She was given lactulose among other things and came out of the whole ordeal quite well. She was sent to the floor for a few days then to acute care for a week and is now in a nursing home. She was sent there for physical therapy because she doesnt have the strength to walk. On thursday she was starting to take steps on her own and it looked like she would be home soon. Today she extemely dioriented and confused. I am assuming from elevated ammonis levels. They said that some more lactulose would clear that up in a few days and do not seem too concerned. She also has cirrhosis.

Will she always need to be on the lactulose? Will the confusion return if she is not on it?  What should I be most concerned about? What liver function tests are the most important? Is the malnutrition caused by the hepc and or cirrhosis?

She is just shaking so bad and is so cold and cant hold a glass of water and is so confused and I just dont know what to do. 

April, the only thing I can think of offhand is a Skilled Nursing Unit (SNU.)  However, people generally come from hospital care to that.  Also, if your mom is being discharged soon, she would probably not qualify medically.  As far as insurance goes, unless she has long term care insurance, the only thing she would probably be eligible for is a nursing home.  The only other option would be to see if she can get visiting nurse care, based on the fact that she is living alone.  A nurse would come in every day, or several times a week, and make sure she is taking her medication/lactulose properly and that she has enough; check her lungs and BP, etc.  If the nursing home could recommend this as part of their discharge plan, insurance would be more likely to approve it. 

I suggest you talk to her caseworker at the NH and the case manager with her insurance provider.

Hugs,

Connie