Case Studies

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.”


Renal/Cardiac Rehab Case Study

IN CENTER BEDSIDE HEMODIALYSIS

87 year-old male admitted to New Eastwood Rehab Center after a 17 day hospital stay at St. Luke’s Bethlehem. He was admitted with VTACH S/P Cardiac Arrest, VDRF and S/P Cardiac Cath, Ischemic Cardiomyopathy with EF 35%- S/P AICD placed 8/27/19 and Dysphagia and Aspiration Pneumonia with Past Medical History of Chronic Renal Failure.

Nursing Interventions

Monitor Fluid Balance: 1500 ml Fluid Restriction and Daily Weight Monitoring
Monitor Vitals and Labs: including BBG’s-pt on Humalog
Monitor for Signs or Symptoms of Infection: AICD site and Dialysis Access
Aspiration Precautions: Downgraded diet Mechanical Soft and Nectar Liquids

Respiratory Interventions

Maintain Adequate Oxygenation: Patient admitted on 3 lpm of oxygen continuous
Maintain Nocturnal Support: Bipap secondary to Respiratory Failure/VDRF

Therapy Interventions

On Admission, Richard could ambulate 30 feet with roller walker and Min A with increased work of breathing and fatigue. His Bed mobility and transfers also required Min A. Upon Discharge, Richard was ambulating 220ftx2 with a roller walker and supervision for both ambulation as well as bed mobility and is climbing 10 steps. 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.

SLP worked to upgrade diet and strengthen swallow with use of Synchrony to Visualize swallow with use of Virtual Reality Biofeedback. After demonstration of safe and efficient consumption of thin, patient was upgraded to thin liquids.

Patient was weaned off oxygen therapy and returned home on room air, his bipap was discontinued and his diet was upgraded to Renal Mechanical Soft and thin liquids. He returned home with his wife and support from his daughter after a 25 day LOS in STR. He was discharged with Revolutionary Home Health. He plans to drive himself to and from dialysis and has follow up appointments secured by with his PCP, Dr. Stauffer, and his Nephrologist, Dr. Dunn.

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