Case Studies

Pulmonary Rehab Case Study

56 Year Old Female (V.W) admitted to Provi dence Healthcare and Rehabilitation Center after a 50+ day stay at Mercy Fitzgerald Hospital with Admitting Diagnosis of Ischemic Bowel with History of Hepatitis C and Liver Cirrhosis. Patient Admits to Providence S/P Tracheostomy and Peg tube Placement wi th Abdominal Wound Requiring Wound Vac.

Nursing Interventions

Wound Healing: Abdominal Wound 18x3x2 on Admission requiring Wound Vac
Medication Management: Lasix 40 mg daily, Lisinopril
Maintain Adequate Nutrition: Enteral Feeds on Admission
Monitor Labs: CBC, BMP, BBG’s

Respiratory Interventions

Maintain Patent Airway: Airvo Warm Humidity to assist with managing secretions
Maintain Adequate Oxygenation: Wean as tolerated

Reviewed weekly at Pulmonary Interdisciplinary Team Meeting lead by our in-house Pulmonologist, Dr. Korman. Patient progressed quickly:
Day 6: Trach Weaned
Day 18: Peg Removed-Diet advanced to Regular and Thin Liquid
Day 18: Wound Vac Discontinued
Day 20: Oxygen Discontinued
Upon Discharge: Family Educated on Wound Care to Abdomen

Therapy

Upon Admission, Patient was unable to ambulate and required maximum assist with all self-care. She received Physical and Occupational Therapy 5 times a week for 4 weeks. Upon Discharge, she was independent with all self-care tasks and able to ambulate 40 feet with a roller walker and contact guard.

After 30 days in Short Term Rehab, Patient returned home with husband and supportive daughter. She was followed by Mercy Home Health and will follow with her PCP, Dr. Cynthia Cheng in the community.


Cardiac/Renal Rehab Case Study

IN CENTER BEDSIDE HEMODIALYSIS AND IV MILRINONE

66 year-old male admitted to Providence Rehabilitation Center after an 11 day hospital stay at Mercy Fitzgerald Hospital. He was admitted with Sepsis secondary to Scrotal Abscess. He has a PMH of End Stage Renal Disease, Chronic Systolic Heart Failure and Cardiomyopathy and is not a Candidate for LVAD or Transplantation Surgery.

Nursing Interventions

Monitor Fluid Balance: 1500 ml Fluid Restriction and Daily Weight Monitoring
Wound/Infection Management: Vanco MWF and Care to Scrotal Abscess
Monitor Vitals and Labs: Weights: 184 on admit to 176 on DC and BP managed well.
Medication Management: IV Milrinone at 3ml/hour and Torsemide 40mg BID

Respiratory Interventions

Maintain Adequate Oxygenation: Patient admitted on 2 lpm of oxygen continuous

Therapy

On Admission, the patient could ambulate 30 feet with roller walker and Min A. His Bed mobility were max assist and transfers required Min A.

Upon Discharge, he was ambulating 225 ft with supervision and is climbing 12 steps supervision level.

Bedside dialysis and less travel outside the center, to and from Dialysis, allowed for a less fatigued patient. This resulted in a quicker recovery, a stronger patient and ultimately, a faster return to home.

Patient was weaned off oxygen therapy and returned home on room air. He returned home with his Significant Other after a 17-day LOS in STR. He was discharged with Penn Home Health Services and Discharged back to Davita Waverly in his MWF 1030am time slot. He has follow up appointments secured with his PCP, Dr.Cosa, and is followed by Dr. Ross Zimmer, Cardiology and Dr. Jen Patel, Nephrology.


Pulmonary Rehab Case Study

58 Year-Old male admitted to Providence Healthcare and Rehabilitation Center after a 20 Day stay at Mercy Hospital Philadelphia. Patient was admitted S/P tracheostomy and Peg tube placement secondary to Sepsis Pneumonia with a history of COPD and Hypertension.

Nursing and Respiratory Goals and Intervention

Maintain Safety, Medication Management, Advance PO Diet/ Upgrade consistency

Maintain Patent Airway- Wean airway as tolerated; Bronchodilatation and Secretion Management, Pacing and Endurance with activity and Evaluate Patient for OSA.

Weekly Pulmonary IDT

Care team discussion including Our In-House Pulmonologist as well as our full time Respiratory Therapist.

Accomplishments: Tracheostomy Tube was weaned after successful capping trials while simultaneously working with SLP to advance PO trials over a 12-day coarse of time. Patients
PEG tube was weaned and patient was advanced to a full PO diet consisting of Regular texture and thin liquids. In addition, after successful trach tube weaning, A Sleep Study was conducted at the center to rule out Obstructive Sleep Apnea. Sleep Apnea was ruled out and no nocturnal support treatment was recommended.

Therapy

Upon admission, the patient required moderate assist with bed mobility and transfers. He was not able to ambulate. He participated in Occupational and Physical therapy 6 times a week for three weeks. He discharged to home with his significant other to their apartment with 8 steps to enter. He was independent in all self-care tasks and able to ambulate 100′ with a Single Point Cane with Supervision and is ambulating 15 stairs.

He returned home after a 24 day stay in STR with VNA services from Mercy Home Health. He was followed by our in-house Pulmonologist, Dr. Korman, throughout his stay in Short term rehab. Upon Discharge, he will follow up with his PCP Dr. Gathers and Dr. Michael Sherman, Pulmonologist at Drexel Med.


Cardiopulmonary Rehab Case Study

76 year-old female admitted to Providence Rehabilitation Center after a 20 day hospital stay at Penn Medicine. She was admitted with Chronic Diastolic CHF, Pulmonary Hypertension and COPD. In the hospital, she originally required Optiflow High Flow O2. She was successfully weaned to 8-10 liter via nasal cannula- making Next Level Short Term Rehab Placement a bit challenging. Our Specialty Level Physicians as well as Complex Care Team made Providence the right place for her!

Nursing Interventions

Monitor Fluid Balance: 1500ml Fluid Restriction
Daily Weight Monitoring, Lasix 80mg BID with Potassium supplementation;
Dietician educated on Heart Healthy Food choices.
Monitor Vitals and Labs: Vitals monitored Q Shift and weekly CBC and BMP
Medication Management: Continue Tadalafil for Pulmonary Hypertension

Respiratory Therapy Interventions

Maintain Adequate Oxygenation: Admitted on 8-10 lpm via Nasal Cannula;
Converted to conserving device to allow optimal oxygenation and improvement
Bronchodiliation, Pacing and Endurance Training with Activity

Weekly Cardiac IDT

Care team discussion including Our In-House Nurse Practitioner as well as our In-House Pulmonologist and Respiratory Therapist.

Therapy

On Admission, Maggie could ambulate 20 ft with roller walker and Min A with increased work of breathing and fatigue. Her Bed mobility and transfers also required Min A. She climbed 2 steps with CGA. Upon Discharge, Maggie was ambulating 125 ft with a roller walker and distant supervision for both ambulation as well as bed mobility; She was climbing 15 steps with supervision.

Patient returned home with her daughter and granddaughter after a 13 day LOS in STR. She was seen by Cardiologist in the community and was seen by our in house Pulmonologist, Dr. Korman, IN THE CENTER PRIOR TO DISCHARGE.

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