Excellence in Pulmonary Care
A 58-year-old male was admitted to Laurel Brook Rehabilitation Center from Virtua Marton Hospital with an initial admission of respiratory failure and acute hypercapnia. He has an extensive history of Chronic hypercapnic Respiratory Failure, COPD, OSA with home BIPAP and oxygen, HTN, A-fib, and diabetes.
On admission, the patient was followed by our internal clinical team led by PCP Dr. Gita Ponnappan, Dr. Salah Mohageb, Pulmonologist Dr. John Bermingham, Physiatrist Dr. Michael Rhee, and Tammy Chan NP, FT In-house RT, FT Dietitian, and Specialty Program Nurse Coordinator.
Nursing Intervention
Medication and Pain Management
Maintaining Adequate Nutrition – Dietary consultation and extensive education.
Monitor Labs & Diagnostic Studies – Frequent labs, In-house Chest X-ray showing bibasilar atelectasis.
Pulmonary Intervention
Respiratory management – The patient was admitted with a new diagnosis of Obesity Hypoventilation Syndrome and required AVAPS. He was using oxygen at home along with a Bipap. The internal team worked with the patient starting him on AVAPS through a trilogy machine which provided him with all the respiratory support requirements. He will no longer need to use his Bipap machine at home. Extensive education was provided on the difference between AVAPS and Bipap and why he would benefit more from using AVAPS. The in-house RT worked with him daily to get him comfortable with the machine and mask before being discharged. Education also included incentive spirometer usage, energy conversation, oxygen toxicity, and smoking cessation.
Therapy Intervention
Before admission to Laurel Brook, the patient was at a supervision level for his self-care tasks and was able to walk household distances. Upon admission, the patient required maximum assistance with self-care tasks and transfers for safety reasons. His ambulation was at a contact guard with staff support. Upon discharge, the patient was able to walk 50 feet with a rolling walker and ascend/decent 5 steps with minimal assistance. He was also independent with his self-care talks. This allowed the patient to meet his goal of returning home.
The patient was discharged home with the support of his family and Bayada Burlington Home Care Services. Respiratory equipment including the Trilogy was ordered through Prompt Care Home Care. All follow-up appointments were made before discharge including his community APN, Kristie McNally, and Pulmonologist Dr. Scott Seifert.
Excellence in Pulmonary Care
A 58-Year-Old Female was admitted to Laurel Brook Rehabilitation Center from Select Specialty Hospital Willingboro with an initial admission of Acute Kidney Injury (AKI), Respiratory Failure, and was intubated. On admission to Laurel Brook Rehabilitation, the patient arrived with a Tracheostomy and Peg tube. She has a history of Chronic Respiratory Failure, HTN, hyperlipidemia, Electrolyte Imbalance, and a history of TBI.
On admission patient was followed by our internal clinical team led by PCP Dr. Andrew Blank, Enide Felin ANP, In-house (FT) RT Linda Hirsch, In-house (FT) RD Alexander Morgan, Specialty Program Coordinator Pimmada Yuliyanov MSN-RN. The patient was followed closely by our Pulmonologist Dr. John Bermingham.
Nursing Intervention:
Medication and Pain Management
Maintain Adequate Nutrition – NPO on admission, receiving enteral nutrition including supplements. Advanced to regular texture with thin liquids upon discharge.
Monitor Labs & Diagnostic Studies – In-house Chest X-ray and frequent labs
Pulmonary Intervention:
Tracheotomy management – 30% trach collar with humidification, consistent monitoring of pulse oximetry to maintain adequate oxygenation and pulmonary toiletry for secretion management.
Tracheotomy weaning – initiated with Passy Muir valve (PMV) placement, progressing to capping trials with supplemental oxygen via NC. Advancing to decannulation with oxygen support via NC. Resulting in successful tolerance to room air supported by stable walking pulse oximetry studies, to ensure room air tolerance for discharge to home.
Therapy Intervention:
Upon admission patient required transfers from sitting to standing and ambulating 5ft with a rolling walker with moderate assistance. She was unable to perform steps on admission. ADL’s including upper and lower body dressing required contact guard assistance. She worked hard with therapy to achieve her goal of returning home with her family prior to the holidays. Upon discharge, she was able to ambulate 250 Ft with a rolling walker and perform 16 steps and her ADLs improved to contact guard.
The patient was followed closely by speech therapy to advance diet along with decannulation of tracheotomy.
After 20 days in our Short-Term Rehab, she returned home to her family and the support of Bayada Home Care Services. All follow-up appointments were made prior to her discharge including her community PCP Dr. Johnathan T. Wiseman and Gastrointestinal Specialist Dr. McCallion.
Korean Community
Neurology Rehab Case Study
Y.M., Female, 74 years old was admitted to Laurel Brook Rehabilitation Center & Healthcare from Cooper University Hospital with admitting diagnosis of failure to thrive due to Advance Parkinson’s disease. She has an extensive history of falls, RA, and hyperlipidemia.
Nursing Intervention
Medication Management Pain Management including therapy modalities
Laboratory and diagnostic testing as ordered
Behavioral Management includes non-pharmacological interventions and medication management.
Dietitian Consult with FT dietitian, including cultural preferences with Korean Diet
The patient was followed by our internal clinical team led by PCP Dr. Peter Curreri. The patient was rounded on weekly by Dr. Michael Gallagher, Cooper Neurologist, Dr. Adam Schindelheim, Physiatrist, and the facility clinical nursing team.
Therapy
The patient’s initial assessment included total dependence with care including bed mobility, transfers, and ADLs.
She worked hard with therapy to increase her strength to achieve her goals to return home with her husband and to require less assistance from him. Upon discharge, she was able to perform bed mobility with minimum assistance, contact guard assistance needed for upper body dressing and hygiene. She was able to stand for approximately 2 minutes with upper extremity support and to self-propel wheelchair at approximately 100-150 feet.
After rehabbing at Laurel Brook Rehabilitation, the patient returned home with the support of her husband with Moorestown Visiting Nurses Association Home Care Services. All follow-up appointments were made prior to discharge including Community PCP Dr. Arthur McDermet.
Excellence in Specialty Care
A 55-Year-Old Female (G.J.) was admitted to Laurel Brook Rehabilitation Center from Virtua Our Lady of Lourdes Hospital. Admitting diagnoses include Acute Stroke, Left Pleural Effusion, Acute Kidney Injury, HTN, and Anemia. The patient has a medical history of A-Fib, Type II diabetes, and chronic lymphedema.
The patient was followed by our internal clinical team led by PCP Dr. Peter Curreri, Kathryn Valenzano APN, Enide Felin APN, In-house (FT) Respiratory Therapist, Dietitian, and Specialty Program Coordinator. The patient was reviewed by our specialty physician including Pulmonologist Dr. John Bermingham, Cardiologist, Dr. Michael Horwitz, Neurologist, Dr. Michael Gallagher, and Nephrologist Dr. Richard Specter.
Nursing Intervention
Medication Management – Medications including heart failure, pulmonary and nephrology system management
Maintain Adequate Nutrition – Carbohydrate Controlled and Heart Healthy Diet
Monitor Labs & Diagnostic Studies – CBC, BMP, In-house EKG, and Chest X-ray
Lymphedema Management – Daily treatments including wraps and patient education
Therapy Intervention
Upon admission, the patient’s initial assessment was obtained. She was unable to transfer without assistance nor ambulate more than 25 feet with a rolling walker. She was able to dress her upper body with independence but had increased difficulty with lower body dressing. The patient’s and family’s commitment to obtaining her goal of going home was achieved through intense therapy. Prior to discharge, she progressed to a set-up level with lower body dressing using an assistive device for lower body clothing.
During her stay, it was identified through comprehensive neurology and cardiac assessment that the patient would require a heart monitoring device (loop recorder) to evaluate recurring of A-Fib episodes. Immediate consultation included the patient, family, Primary Provider, and Cardiologist to discuss the patient’s plan of care.
After Short-Term Rehabilitation at Laurel Brook Rehab, the patient returned home with the support of her husband and daughter. Prior to discharge, all follow-up appointments were made including her community provider Faviola Seche, APN. An appointment was also made with Dr. Rawan, Electrophysiologist of Virtua Health for the cardiac monitoring device.
Heart Failure / Neuro Rehab Case Study
Y.M., Female, 74 years old was admitted to Laurel Brook Rehabilitation Center & Healthcare from Cooper University Hospital with admitting diagnosis of failure to thrive due to Advance Parkinson’s disease. She has an extensive history of falls, RA, and hyperlipidemia.
Nursing Interventions
Medication Management Pain Management including therapy modalities
Laboratory and diagnostic testing as ordered
Behavioral Management includes non-pharmacological interventions and medication management
Dietitian Consult with FT dietitian, including cultural preferences with Korean Diet
Therapy
The patient’s initial assessment included total dependence with care including bed mobility, transfers, and ADLs.
She worked hard with therapy to increase her strength to achieve her goals to return home with her husband and to require less assistance from him. Upon discharge, she was able to perform bed mobility with minimum assistance, contact guard assistance needed for upper body dressing and hygiene. She was able to stand for approximately 2 minutes with upper extremity support and to self-propel wheelchair at approximately 100-150 feet
After rehabbing at Laurel Brook Rehabilitation, the patient returned home with the support of her husband with Moorestown Visiting Nurses Association Home Care Services. All follow-up appointments were made prior to discharge including Community PCP Dr. Arthur McDermet.
Heart Failure / Neuro Rehab Case Study
C.H., male, 67 years old. admitted to Laurel Brook Rehabilitation Center & Healthcare from Virtua Our Lady of Lourdes Hospital with admitting diagnosis of S/P Stroke with right hemiplegia and dysphagia. He has an extensive cardiac history including Heart Failure (EF 20-25%), HTN, cardiomyopathy, and CAD.
Nursing Interventions
Medication Management and Pain Management including therapy modalities
Monitor Fluid Balance – Weight Monitoring, Dietician CCHO, and Heart Healthy diet choices
Laboratory and diagnostic testing including in-house EKG
Surgical Wound Management – Daily wound site assessment
The patient was followed by our internal clinical team led by PCP Dr. Nisha Kumar, Cardiologist Dr. Michael Horwitz, and Neurologist Dr. Michael Gallagher.
Therapy
The patient’s initial assessment included needing excessive assistance with all ADLs post Stroke and managing his life vest which supports his Heart Failure diagnosis.
Upon cardiology assessment, the patient required an IMMEDIATE surgical procedure for an Automatic Implantable Cardioverter Defibrillator (AICD). He was directly admitted to Virtua Our Lady of Lourdes Hospital.
Upon returning to the facility with the AICD, the patient was reassessed. He was reassessed and prepared to work hard with the therapy team to obtain his goal of returning home.
Prior to discharge patient progressed to minimal assistance with transfers and stand pivots and ADLs.
The patient returned home alone with Bayada Home Care Services. All follow-up appointments were made prior to discharge including Community Cardiologist Dr. Peter W. Bulik and Elizabeth Tiffany-Ellis, APN of Virtua Cardiology Group.
Excellence in Specialty Care
Male, M.W. 64 years old admitted to Laurel Brook Rehabilitation Center & Healthcare from Cooper University Medical Center Hospital with admitting diagnosis of Abdominal Pain and Shortness of Breath. The patient has a history of Heart Failure, A-fib, CHF, CAD, DM, HTN, Osteomyelitis, and recent amputation of the Left toe.
The patient was followed by our internal clinical team led by PCP Dr. Andrew Blank. Enide Felin NP, In-house FT RT, In-house (FT) RD, and RN Specialty Program Coordinator. The patient was assessed weekly by our Pulmonologist Dr. John Bermingham, Cardiologist Dr. Michael Horwitz, Physiatrist Dr. Adam Schindelheim, and Wound APN Elizabeth Quince.
Nursing Interventions
Medication and Pain Management
Maintain Adequate Nutrition – Followed closely by Dietitian to monitor fluid restriction and nutritional status
Monitor Labs & Diagnostic Studies – CBC, BMP, BNP, Urinalysis, In-house EKG, Radiology Studies
Wound Management – Daily dressing changes and assessments, weekly wound monitoring by the APN
Other Nursing Interventions – Daily measuring of abdominal girth as per ascites diagnosis
Therapy
On admission, the patient was able to perform bed mobility with minimal assistance, transfer sit/stand with contact guard assistance, and ambulated 10ft using a rolling walker with minimal assistance. He also required moderate assistance with upper and lower body bathing and dressing.
The patient actively participated in every therapy session and was very motivated to return home with his wife and daughter. Upon discharge, he was able to perform bed mobility and transfers at a supervision level. He ambulated up to 150ft with a rolling walker. He was able to complete 8 steps using both handrails with supervision.
The patient returned home with Bayada Home Health Care services and the support of his wife and daughter. All follow-up appointments were scheduled prior to discharge including appointments with Cooper Nephrologist Dr. Arturo R. Canto, Cardiologist Dr. Brett Waldman, and Community Primary Care Physician Rosemary Stag APN.
Heart Failure / Pulmonary Rehab Case Study
A.H., Female, 74 years old, admitted to Laurel Brook Rehabilitation Center & Healthcare from Virtua Voorhees Hospital with admitting diagnosis of S/Pleft knee effusion. The patient has an extensive cardiac and pulmonary history including a watchman procedure, HTN, A-Fib, COPD, Obstructive Sleep Apnea, and anemia.
Nursing Interventions
Medication Management includes diuretic management, DVT prophylaxis
Pain Management including therapy modalities
Monitor Fluid Balance – Weight Monitoring, Dietician CCHO, and Heart Healthy diet choices
Laboratory and diagnostic testing including in-house EKG
The patient was followed by our internal clinical team led by PCP Dr. Andrew Blank and Enide Felin NP, FT In-house Specialty Program Coordinator, FTIn-house RT, and Dietitian. The patient was rounded on weekly by Dr. Michael Horwitz, Cardiologist, and Dr. John Bermingham, Pulmonologist.
Therapy
The patient’s initial assessment included maximum assistance with bed mobility, and transfers, along with upper and lower body dressing and bathing.
She worked hard with therapy to increase his strength and endurance to achieve her goals. Upon discharge, she was able to perform bed mobility with minimum assistance. She progressed to moderate assistance with self-care tasks. The patient was able to ambulate in a rolling walker100 ft with supervision.
After 15 days of Rehabilitation at Laurel Brook Rehab, the patient returned home to Spring Oak Assisted Living Facility with Bayada Home Care Services. All follow-up appointments were made prior to discharge including Community PCP Dr. Lisa Dructor and Cardiologist Dr. Annie Peter, The Heart House.
Heart Failure/ Pulmonary / HD Rehab Case Study
Male, 68 years old, admitted to Laurel Brook Rehabilitation Center & Healthcare from Virtua Our Lady of Lourdes Camden with admitting diagnosis of Shortness of Breath, Pneumonia, and Heart Failure with an EF 25-30%. The patient has an extensive medical history including AKI, HTN, Anemia, Diabetes, CVA, and Hemo-dialysis (HD).
The patient was also followed by Virtua Our Lady of Lourdes Heart Failure Services with Theresa M. Rowe, MSN, CRNP, and the HF team.
Nursing Interventions
Monitor Fluid Balance – Fluid restrictions and Dietitian oversite.
Electrolyte monitoring and evaluated frequently
Medication Management and Pain Management
Reviewed weekly: Cardiology IDT led by Virtua Cardiologist Dr. Michael Horwitz, Nephrologist Dr. Richard Specter, Pulmonologist Dr. John Bermingham, along with Enide Felin, APN,FT Respiratory Therapist, and the clinical nursing team.
Therapy
Upon admission, the patient required moderate assistance for bed mobility, transfers, and self-care tasks. He was only able to walk 20ft with a rolling walker. He worked hard with therapy and the nursing team to increase his strength and endurance to achieve his therapy goals to return home. Upon discharge, he performed all self-care tasks, transfers, and bed mobility with minimal assistance. He was also able to ambulate 250ft with a rolling walker.
The patient returned home to Brookdale Assisted Living with the support of Bayada Home Care Services. All follow-up appointments are scheduled prior to discharge including his Primary Care Physician Dr. Steven Santangelo.
Heart Failure/ Peritoneal Dialysis (PD) Rehab Case Study
Female, 53 years old, admitted to Laurel Brook Rehabilitation Center & Healthcare from Virtua Our Lady of Lourdes Camden with admitting diagnosis of Sepsis. She has an extensive cardiac and nephrology history including congestive heart failure, anemia, HTN, and peritoneal dialysis (PD).
Nursing Interventions
Monitor Fluid Balance – Peritoneal dialysis daily at bedside including PD protocols, fluid restriction, and Dietitianoversite.
Electrolyte monitoring and evaluated frequently
Medication Management and Pain Management
Reviewed weekly: Cardiology IDT led by Virtua Cardiologist Dr. Michael Horwitz, Nephrologist Dr. Richard Specter along with Enide Felin, APN, and the clinical nursing team.
Peritoneal Goals
Goals: Maintain Peritoneal Dialysis Protocols
Peritoneal dialysis is administered daily, with weights, labs, and dietary management.
Therapy
Upon admission, the Patient required assistance for bed mobility, transfers, and self-care tasks. She worked hard with Therapy and the Nursing Team to increase her strength and endurance to achieve her therapy goals. Upon discharge, she was returned to her prior level of independence. She was able to return to work and drive her car!
After 22 days of SNF rehabilitation, the patient returned home with the support of her family. All follow-up appointments are scheduled prior to discharge including her Primary Care Physician Karen Anne Bocchicchio, CRNP, along with Bayada Home Care Services.
Heart Failure / Hemo-Dialysis / Surgery Rehab Case Study
Male, 75 years old, admitted to Laurel Brook Rehabilitation Center & Healthcare from Deborah Heart & Lung Center patient of Dr. Barn Cardiologist with admitting diagnosis of Heart Failure EF 30-35%, ESRD, Vascular Ulcer resulting in Left Below Knee Amputation. The patient has an extensive medical history of CHF, HTN, Diabetes, CAD, and a surgical history of Right Below Knee Amputation.
Nursing Interventions
Monitor Fluid Balance – Fluid Restriction, Weight Monitoring, Dietitian oversight
Electrolyte monitoring and evaluated weekly
Medication Management and pain management
Surgical Wound Management – Followed by Wound Team; daily wound care provided.
Reviewed weekly: Cardiology IDT led by Virtua Cardiologist Dr. Michael Horwitz, along with Enid Feline, APN, and the internal clinical team.
Therapy
Upon admission, the patient required maximum assistance for bed mobility and self-care tasks, he was also unable to stand or walk. He worked hard with the therapy and nursing team to increase his strength and endurance to achieve his therapy goals. During his rehabilitation at Laurel Brook, he received a prosthetic leg which enhance his therapy outcome.
Upon discharge, he was moderate assistance for bed mobility, transfers, and supervision for all self-care tasks. With his prosthetic leg, the patient was able to walk 50 ft with supervision.
The patient returned home with the support of his family. He has a scheduled follow-up appointment with his Primary Care Physician Dr. Thomas Y. Lee and Cardiologist Dr. Barn from Deborah Heart & Lung along with Bayada Home Care Services.
R.P., Male, 54 years old, admitted to Laurel Brook Rehabilitation Center & Healthcare from Cooper University Medical Center Hospital with admitting diagnosis S/P Anterior cervical discectomy and fusion of C6-C7 was performed by Dr. Steven Yocum, Neurosurgeon. The patient has a history of HTN, MS (multiple sclerosis), DM, and Asthma.
Nursing Interventions
Medication Management & Pain Management
Monitor Fluid Balance – Weight Monitoring, Dietician educated on Carb Control choices.
Laboratory and diagnostic testing.
Wound Management – Surgical wound; daily wound care provided.
(R.P.) was followed by our internal clinical team led by PCP Dr. Andrew Blank and Enide Felin NP, In-house FT, Specialty Program Coordinator Pimmada Yuliyanov RN, RD Alexander Morgan. The patient was rounded on weekly by our Neurologist, Dr. Michael Gallagher.
Therapy
The patient was admitted with an Aspen collar in place, on admission patient was maximum assistance with total dependence on staff to perform bed mobility and transfers with a sit-to-stand device.
He worked hard with therapy to increase his strength and endurance to achieve his goals. Upon discharge, he was able to perform bed mobility at minimum assistance with the Aspen collar in place and transfers supervision. Pt was able to propel in w/c 150 ft with supervision. Pt progressed to ambulation with the use of ar/w 60 ft with assistance and ascend/descend 8 steps with both handrails and minimum assistance.
After rehabilitation at Laurel Brook Rehab, the patient returned home with family and with the support of his father. He has Bayada Home Care Services and will follow up with his PCP in the community, Edmund J. Decker, DO along with Dr. Steven Yocum of Cooper Care Alliance Neurosurgeon.
Orthopedic Rehab Case Study
Male, T.B. 88 years old. admitted to Laurel Brook Rehabilitation Center & Healthcare from Virtua Memorial Hospital with admitting diagnosis S/P ORIF of the right hip procedure performed by Orthopedic Surgeon Dr. Mark G. Schwartz. Patient has a history of Falls, Chronic Pain, BPH, DVT and Gerd.
Nursing Interventions
Medication and Pain Management.
Monitor Fluid Balance – Weight Monitoring, Dietician educated on food choices.
Electrolyte monitoring and evaluated weekly.
Wound Management – Surgical wound; daily wound care provided.
Therapy
Upon admission, patient was full weight bearing status per surgeon. T.B. required extensive assistance to perform bed mobility and transfer task. He was unable to ambulate due to pain.
T.B. actively participated in therapy with the team OT and PT permitting him to make great gain in his recovery. Attended therapy 5-6 times a week and his wife/family were trained on proper techniques to assist him at home such as ambulation with a rolling walker, transfers, stair training and car transfers. T.B. progress so well that he was able to use the nu-step bike/equipment with resistance for 7-8 minute while not exceeding 90-degree hip flexion and 0 complain of pain. Training also included safety and proper techniques for upper body and lower body dressing and bathing,
Upon discharge T.B. was able to ambulate with a rolling walker 150 feet, even progressing to the use of a 4 wheeled walker. He was able to ascend/descent 4 steps with handrail and minimal assistance.
T.B. returned home with the support of his family and loving wife. He has a scheduled follow-up appointment with his PCP Dr. Stefan Mathews in the community. Bayada Home Care will support his homecare needs.
Excellence in Specialty Care
Male, D.B. 74 years old admitted to Laurel Brook Rehabilitation Center & Healthcare from Penn Presbyterian Medical Center with admitting diagnosis S/P CABG X3 Heart Failure (EF 37%). He has significant Cardiac history including HTN, A-Fib w/RVR, AKI, Seizures, DM failed extubating. Admitted to SNF w/tracheostomy & Peg Tube.
(D.B.) was followed by our internal clinical team lead by PCP Dr. Andrew Blank. Enide Felin NP, In-house (FT) RT Barbara Vennell, In-house (FT) RD Alexander Morgan, Specialty Program Coordinator Celeste Houston BSN-RN. Patient was assessed weekly by our Pulmonologist Dr. John Bermingham, Cardiologist, Dr. Michael Horwitz, Neurologist, Dr. Michael Gallagher and Jessica Sweeney PA, and Nephrologist Dr. Richard Specter / DaVita Dialysis Team.
Nursing Interventions
Medication Management- IV Antibiotic Therapy, Diuretic, Calcium Channel Blocker, Anti-diabetic( PO & SQ), Anticoagulants, Urinary Retention, Proton Pump Inhibitor, Supplements
Maintain Adequate Nutrition- NPO on admission, receiving enteral nutrition. Followed closely by Dietitian and Speech therapy. Diet advanced to regular texture thin liquids. Upon discharge he was able to feed himself.
Monitor Labs & Diagnostic Studies- CBC, BMP, BNP, Urinalysis, In-house EKG, Radiology Studies
Reviewed weekly: Cardiology IDT lead by Virtua Cardiologist Dr. Michael Horwitz, along with Enid Felin, AGPC-APN-C and Celeste Houston RN, BSN. PCP Dr. Andrew Blank
Pulmonary Interventions
Tracheotomy management – 28% trach collar with humidification, consistent monitoring of pulse oximetry to maintain adequate oxygenation, and pulmonary toiletry for secretion management.
Tracheotomy weaning – initiated with Passy Muir valve (PMV) placement, progressing to capping trials with supplemental oxygen via NC. Advancing to successfully tolerating (PMV) with supplemental oxygen on discharge. RT provided 1:1 education with patient and family prior to discharge to help support needs.
Post Discharge – Continued communication with family, patient has successfully weaned to room air advanced to capping trials and eventually decannulation at home with the continued support and follow-up with our Pulmonologist and respiratory care team.
Therapy
Upon admission D.B. was total dependent for all transitional movements including bed mobility, transfers, and unable to walk. He required max assistance of 2 therapists to sit on edge of bed. With persistence and determination, he consistently worked hard with therapy to achieve his goals including tolerating sitting in a chair for 2-3 hours at a time & sit unsupported with assist of 1 person vs 2. The patient returned home with Holy Redeemer Homecare Services and the support of his family. All follow-up appointments were scheduled prior to discharge including appointments with PCP Dr. Jeffrey Pinto, Cardiologist-Dr. Sorensen, Penn Cardiac Surgeon-Dr. Hargrove, and Penn Dermatology-Dr. Kist.
Cardiac / Ortho Rehab Case Study
Male, T.K. 85 years old admitted to Laurel Brook Rehabilitation Center & Healthcare a patient of Dr. Rakesh Mashru Orthopedic from Cooper University Hospital with admitting diagnosis S/P fall right femoral fracture s/p ORIF. Patient has a significant cardiac history involving HTN, CAD and A-Fib.
Nursing Interventions
Monitor Fluid Balance – Weight Monitoring, Dietician educated on food choices.
Electrolyte monitoring and evaluated weekly
Diagnostic testing & labs – weekly labs, Inhouse EKG, bilateral venous dopplers
Medication Management – Diuretics, Blood Thinner, Statin, Nitrate, Beta Blocker, Supplements
Wound Management – Surgical wound; daily wound care
Reviewed weekly: Cardiology IDT lead by Virtua Cardiologist Dr. Michael Horwitz, along with Enid Felin, AGPC-APN-C and Celeste Houston RN, BSN. PCP Dr. Andrew Blank
Therapy
Upon admission, patient was evaluated by physical, occupational and speech therapy. He required moderate assistance for self-care tasks, minimal assistance for transfers, and was unable to ambulate. He was committed to working hard in PT and OT to increase his strength and endurance to achieve his therapy goals. Upon discharge, he was able to ambulate 60 feet with a rolling walker with close supervision and complete all his self-care tasks with close supervision as well.
The patient returned home with Bayada homecare services and the support of his wife and family. All follow-up appointments were scheduled prior to discharge including an appointment with Cooper Cardiologist Dr. Sabir.
Cardiac/Renal Rehab Case Study
66-year-old male admitted from Virtua Lourdes Camden to Laurel Brook Rehab Center after several hospitalizations over the past few months. Most recent hospitalization diagnosis was s/p CABG with a sternal wound, wound vac for healing. EF of 50-55%. Chronically, Patient with acute and chronic combined systolic (Congestive) and Diastolic (Congestive) Heart Failure, HTN, Pacemaker insertion, ESRD (was PD patient at home/ On HD while in our center), Diabetic, PVD and bilateral amputations.
Weekly Specialist Led IDT
Care team walking rounds & chart review led by Dr. Michael Horwitz, Cardiologist
Care team weekly rounds & discussion led by Dr. Richard Spector, Nephrologist & Davita Dialysis Team
Nursing Interventions
Medication Management: CHF Protocols including IV/PO Lasix, weights, EKG and other diagnostic testing
Monitor Fluid Balance: HD 3 times a week, Weight Monitoring and Dietician educated on Renal and Low Sodium Food choices.
Monitor Oxygen Therapy: Followed by RT to wean/monitor oxygen therapy 3-4 Lit via NC. Oxygen therapy education along with respiratory exercise including incentive spirometer
Monitor Vitals and Labs: Patient vitals monitored Q-Shift along with weekly lab Monitoring (CBC, BMP, BNP)
Wound Healing/Wound Vac: Daily wound care along with weekly NP/wound team rounds. Management, assessment, and treatment including wound vac function orders. (James discharged w/out wound vac – wound headed)
Therapy
Upon admission, Joseph was completely Dependent with all mobility and ADL’s. He was receiving occupational, physical and speech therapy 5 days a week during his stay. Upon discharge from Skilled Stay, Joseph is at supervision level with self-care tasks, independent with his prosthetic, able to ambulate 40-75 feet with a rolling walker.
After 69 days in STR, Joseph returned home to his apartment with skin intact and new start oxygen therapy. He will have the support of his friend along with Virtua Home Care Services. He will return to his home HD Center. All follow up appointment with his PCP in the community are secured.
Cardiac/Renal Rehab Case Study
ON SITE HEMODIALYSIS UNIT
81-year-old patient of Dr. Blank admitted to Laurel Brook Rehab Center after a 6 day stay at Virtua Lordes Camden. He was admitted S/P falls with Radial fracture S/P Surgery, Hypertension and Parkinson’s. Chronically, the Patient is on hemodialysis for ESRD. His increased dizziness and overall weakness made therapy somewhat challenging.
Weekly Cardiac IDT
Care team walking rounds and round table discussion with Dr. Horowitz, Cardiologist
Nursing Interventions
Monitor Fluid Balance: 1200ml Fluid Restriction.
Wound Healing: Left heal- Followed by Dr. Jacobs, Podiatry
Monitor Vitals and Labs: Patient had Vitals monitored Q Shift and
weekly CBC and BMP monitoring,
Medication Management: Cardiac patient requiring frequent monitoring and medication adjustment to ensure stability
Therapy
On Admission, Patient could ambulate 50ft with hemi-walker and Min A due to increased dizziness and overall weakness. His Bed mobility and transfers also required Min A. Ronald was determined to return home and worked hard to get there.
Upon Discharge, Patient was ambulating 350 ft with a SPC and distant supervision for both ambulation as well as bed mobility and climbing 4 steps. Our Onsite HemoDialysis Unit allowed for less travel outside the center and a less fatigued patient. This resulted in a quicker recovery, a stronger patient and ultimately, a faster return to home.
Patient returned home with a wife and daughter after a 45 day LOS in STR. He was discharged with Bayada Home Care and returned to Outpatient HD in Delran.
Cardiac Rehab Case Study
81-year-old male admitted to Laurel Brook Rehab Center after a seven-day hospital stay at Lourdes. He was admitted with paroxysmal atrial fibrillation with EF of 10-15%. He was too high risk for CABG therefore was medically managed and prescribed to wear a LifeVest. Chronically, Patient had a history of seizures and was talking Primidone. Primidone used with Lasix made regulating blood pressure a bit challenging.
Weekly Cardiac IDT
Care team walking rounds and discussion lead by Dr. Horowitz, Cardiologist
Nursing Interventions
Monitor Fluid Balance: 1800 ml Fluid Restriction,
Daily Weight Monitoring and Dietician educated on
Low Sodium Food choices.
Monitor Vitals and Labs: Patient had Vitals monitored Q Shift and
weekly CBC and BMP monitoring
Life Vest Monitoring: verify function and placement Q shift;
Change battery Q Day
Therapy
On Admission, Harry could ambulate 15’ with roller walker and Min A with increased work of breathing and fatigue. His Bed mobility and transfers also required Min A.
Upon Discharge, Harry was ambulating 120’ with a roller walker and distant supervision for both ambulation as well as bed mobility.
Patient returned home with a friend/caregiver after a 21 day LOS in STR. He was discharged with Holy Redeemer Home Care and had a follow-up appointment secured by with his PCP in the community.
