Case Studies

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.

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