Heart Failure Case Study
71-year-old female admitted to New Eastwood Rehabilitation and Healthcare Center from St. Luke’s Monroe with admitting diagnosis of Acute Heart Failure, CKD, Lymphedema, cellulitis, and history of Obstructive Sleep Apnea.
Nursing and Respiratory Interventions – (Full Time ONSITE Respiratory Therapy)
Medication Management – Lasix, Aspirin, Keflex, Pravastatin
Monitor Fluid Balance / Increased Weight Monitoring
Monitor Labs – CBC and BMP
Wound Healing – cellulitis LLE
Maintain Nocturnal Support – OSA
Pacing and Endurance with activity
Under the Direction of Cardiologist, Dr. Amit Gupta, Multi-Disciplinary Heart Failure Education was provided throughout her stay at New Eastwood by various members of the care team. Patients follow up appointment was secured with St. Luke’s Cardiologist, Dr. Aminprior to discharge.
Patient returned home after a 14 day stay ambulating 150 feet and climbing 3 steps. She has support from Kindred Home Health. She continues to follow with PCP, Dr. Joseph Casella and Young’s Medical for DME.
Cardiac Heart Failure Case Study
85-year-old male admitted to New Eastwood Rehabilitation and Healthcare Center from St Luke’s Warren with admitting diagnosis of new onset CVA with Acute Renal Failure, history of hypertension, AFIB and Heart Failure.
Nursing Interventions
Zio Patch Heart Monitoring – Assess Need for Loop Recorder
Medication Management – Losartan, Lasix, Coreg, Amiodarone, Atorvastatin
Daily Weight Monitoring and Trending
Monitor Fluid Balance – 2000ml Fluid restriction
Monitor Labs – CBC, BMP, PT/INR
Under the Management of St. Luke’s Cardiology Associates and the Cardiac education the team provided throughout his stay at New Eastwood, the patient returned home with his wife after 16 days in short term rehab.
He will continue to be followed by PCP, Dr. Frank Lombardi and St. Luke’s Cardiologist, Devendra Amin. All Follow up appointments are secured, and he will have continued support from St. Luke’s Home Health Services.
Pulmonary Case Study
54-year-old male admitted to New Eastwood Rehab Center after an 8-day hospital stay at St. Luke’s Warren where he was admitted for Acute on Chronic Respiratory Failure and COPD, Pneumonia, Anxiety and Hypertension. Past medical history of Diabetes, hyponatremia and physical deconditioning.
Nursing and Respiratory Interventions
Monitor Vitals & Educate/Assess difference between anxiety limitations vs physical limitations
Monitor Labs: BBG’s for diabetes, Labs to monitor for S/S of continued infection
Medication Management: Monitor use of anti-anxiety meds-adjust as appropriate for
Improved Quality of life
Maintain Nocturnal Support: Trilogy Daytime Compliance trials with the help of our
full-time respiratory therapist to increase Nocturnal use
Bronchodilitation: Prednisone taper and monitor nebulized medication regimen
Maintain Adequate Oxygenation: Patient on Oxygen at 4lpm via nasal cannula
Dietary Interventions
Maintain Adequate Diet: Educated on good food choices including less carbohydrates; Prosource added for additional Protein source.
Therapy
Upon admission, Patient required moderate assistance for sit to stand, Moderate assist with ADL’s. He was tolerating stand pivot transfers from bed to commode only. Upon discharge, he was independent with all self-care tasks, able to ambulate 225 feet with a roller walker and ascend and descend greater than 15 stairs.
Upon Discharge: Patient states “he has a better understanding of his disease process and he’s feeling better than he’s felt in over a year”. He has had a noted increase in tolerance with use of his Trilogy at hour of sleep.
With the help of our Full Time Respiratory Therapist, He was qualified for Trilogy in community. He returned home with his wife to a home with 18 steps to enter after a 9-day LOS in STR. He will follow with Dr. Nekoranik as well as his St. Luke’s Care Navigator, Ina Nechita. His PCP is Dr. Durrani.
Pulmonary Rehab Case Study
52 Year-Old male admitted to New Eastwood Healthcare and Rehabilitation Center from LTACH Kindred Philadelphia after a hospitalization S/P tracheostomy and Peg tube placement secondary to Acute Hypoxic and Hypercapnic Respiratory Failure and Dysphagia
Nursing and Respiratory Goals and Intervention
Maintain Safety, Medication Management, Advance PO Diet/ Upgrade consistency
Maintain Patent Airway: Wean airway as tolerated; Bronchodilitation and Secretion Management, Pacing and Endurance with activity
Accomplishments
Tracheostomy Tube that was weaned with successful capping trials while simultaneously working with SLP to advance PO trials over a 25 days coarse of time. Patients PEG tube was weaned and patient advanced to full PO diet.
Therapy Interventions
Upon admission, the patient required min assist with bed mobility and moderate assist with transfers and was able to ambulate 5 feet with a roller walker CG assist. He participated in Occupational and Physical therapy 6 times a week for 5 weeks. He was determined to return to his group home with all his friends. He discharged home and was independent in all self-care tasks and able to ambulate 250′ with a RW and climb 13 stairs. His PO advancement allowed him to enjoy taco lunch with the Activities group prior to his discharge and he looks forward to pizza at his favorite restaurant upon return home. He required no supplemental oxygen therapy.
When we asked the patient… David explains he was told at the hospital “that I would never return to my home and I would live in a nursing center the rest of my life.” “I was scared and worried.” “The staff was always very helpful.” “Tricia and the therapy department are wonderful.”
“I came here with a tracheostomy and a peg tube and am leaving without them. Thank you New Eastwood. I would recommend here anytime.”
