Case Studies

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.”


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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