Case Studies

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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