Multi-System Rehab Case Study
A male, 82-year-old patient was admitted to West Gables Health Care Center from West Gables Rehabilitation Hospital with an admitting diagnosis of S/P fall sustaining a TBI/subdural hematoma, and hypoxic respiratory failure secondary to pneumonia. He has an extensive history of COPD, HTN, DM, and dementia.
The patient is reviewed weekly by our in-house PCP Dr. Yoandy Rodriguez, Cardiologist Dr. Javier Reyna, Neurologist Dr. Carlos Ramirez-Calderon, Pulmonologist Dr. Alvaro Skupin, and FT Respiratory Therapist, Specialty Program Nurse Coordinator along with the daily clinical care of the nursing team!
Nursing Interventions:
Medication Management – Calcium channel blocker, statin, steroids, antihistamine, and antacids, urinary retention, and supplements.
Pain Management – mediation including therapy modalities.
Laboratory and Diagnostic Testing – Labs, Inhouse EKG, and X-ray capabilities.
Monitor Fluid Balance and Electrolytes – Weight management, Dietary consult, and nutritional education.
Pulmonary / Respiratory Interventions:
Goals: Maintain Adequate Oxygenation, Bronchodilation, and DB&C Exercises Initial assessment revealed that the patient was on oxygen at 2 lpm via N/C. The patient’s goal was to return to his prior level of not having to use supplemental oxygen. GOAL MET! The plan of care consisted of incentive spirometry, cough & deep breathing exercises, and optimized oxygen conservation interventions.
Therapy:
Upon admission, the patient was dependent with self-care tasks, bed mobility, transfers, and unable to ambulate due to deconditioning. The patient made significant gains while participating with the therapy team, including strength and mobility. Upon discharge, the patient was contact-guard with all self-care tasks, bed mobility, and transfers. He was able to ambulate 175 feet with a rolling walker safely.
The patient was discharged with the support of his daughter to Riverside Care Center for long-term services. All his follow-up appointments will be made once he transitions to his new center.
Heart Failure / Pulmonary Rehab Case Study
Female, C.M. 76 years old patient was admitted to West Gables Health Care Center from Doctors Hospital with an admitting diagnosis of Metabolic Encephalopathy, Respiratory Failure with Hypoxia, CHF, and Pulmonary Infiltrate. The patient has a life vest currently in place. The patient has an extensive history of Acute Pulmonary Edema, Heart Failure, and Dysphagia.
Nursing Interventions
Medication management – Diuretic Management, Bronchodilators
Laboratory and Diagnostic Testing – Inhouse EKG and Chest X-ray
Monitor Fluid Balance and Electrolyte – Daily Weight Monitoring, FT Dietician educated on good food choices.
The patient is reviewed weekly by our in-house Cardiologist Dr. Ginzo, Alberto; Pulmonologist, Dr. Skupin, Alvaro and FT Respiratory Therapist Eddie Acosta.
Respiratory Interventions
Goals: Maintain Adequate Oxygenation, Bronchodilation, and DB&C Exercises
Initial Screening – Continuous Oxygen @ 4 Liters via n/c. The patient had an extensive respiratory history. Respiratory treatment included a nebulizer DuoNeb, Pulmicort, and steroid therapy. Incentive Spirometry for Deep Breathing exercises is used independently. On discharge, the patient regained her independence, able to ambulate without supplemental oxygen.
Therapy
Upon admission, the patient required moderate assistance with all self-care tasks, bed mobility, and transfers. She participated aggressively in physical therapy and occupational therapy with the anticipation of returning home. Upon discharge, the patient was independent with all self-care tasks and able to ambulate 400 feet with a rolling walker.
The patient returned home with her supportive family. She has RB Home Health Services to support her. All follow-up appointments were made before discharge, including her Primary Care Physician and specialist.
Excellence in Specialty Programs
Female, M.M. 69 years old patient was admitted to West Gables Health Care Center from West Gables Rehabilitation Hospital referred by Dr. Yoandy Rodriguez with admitting diagnosis of Acute Respiratory Failure, COVID-19, NSTEMI, Pressure Ulcers, and a GI Bleed. The patient has a history of HTN, Type II DM, and Parkinson’s Disease.
Nursing Interventions
Wound Care Management – Daily wound care including Wound Vac Changes.
Laboratory and Diagnostic Testing – Frequent labs monitoring patients’ hemodynamic status. In-house EKG and Chest X-ray.
Medication Management
Pain Management – Including medication and therapy modalities
The patient was reviewed weekly by our In-House Neurologist Dr. Ramirez-Calderon, Carlos; Wound Team Dr. Trabanco, Carlos, Pain Management Dr. Polanco, Robert and Attending physician Dr. Rodriguez, Yoandy, and daily clinical nursing care by the internal team.
Therapy
Upon admission, the Patient required maximum assistance with all self-care tasks, bed mobility, and transfers. She participated aggressively with the therapy department to achieve her goal of going home. Upon discharge, she achieved modified independence for bed mobility and transfers. She left the facility being able to ambulate up to 500 feet with a rolling walker.
The patient returned home to S&S Senior Care ALF with the support of Caritas Home Health. All follow-up appointments made prior to the patient’s discharge including Primary Care Physician Dr. Lidia Bermudez.
