Cardiopulmonary Case Study
This is a 52-year-old male admitted to Westgate Hills Rehabilitation & Healthcare Center from Greater Baltimore Medical Center with a PMH of down syndrome who presented to the hospital for sepsis secondary to pneumonia. After a prolonged hospitalization complicated by respiratory failure S/P seizures, patient required Trach & PEG.
Nursing Interventions
Maintain Safety
Monitor Labs and Vitals – Weekly BMP, CBC, and CMP
IV Antibiotics – Treat Infection
Wound Care – Sacrum Pressure stage 2
Reviewed weekly at: Cardiopulmonary IDT lead by Cardiologist Dr. Athol Morgan, and Pulmonologist Dr Mark Gosnell.
Respiratory Interventions
Maintain Adequate Oxygenation – Weaned from oxygen to RA
Maintain Good Aeration – Bronchodilation and DB&C Exercises
Trach Wean – Maintain Patent Airway and Trach Wean trials leading to Decannulation
Therapy
Upon admission, Patient required maximum assistance with all self-care tasks and was unable to ambulate. He was receiving occupational and physical therapy 5 times a week throughout his stay. Upon discharge, he was independent with all self-care tasks, able to ambulate independently with no assistive device throughout the center.
Patient was discharged to Gallagher Group Home, with the support of Home Health Services, and will follow up with Dr. Mohommad Rahnama in the community.
Pulmonary TRACH Rehab Case Study
A 68-year-old female was admitted to Westgate Hills Rehabilitation and Healthcare Center after a 21 day stay at Mercy Medical Center s/p Acute Respiratory Failure with hypoxia, severe dysphagia, and seizure disorder. She received S/P Trach placement and G-Tube placement.
Nursing Interventions:
- Monitor Vitals – Monitoring of Hemodynamics & Encouraged Hydration
- Pain Management – Medication Management; Along with Therapy Modalities
- Maintain Adequate Nutrition – Admitted NPO Received Enteral Feeding through G-Tube. Discharged with a Full Liquid Diet.
Respiratory Therapy Interventions:
- Maintain Patient Airway / Wean as Tolerated – Passy Muir Speaking Valve Progressed to DECANNULATION- Goal Met Prior to Discharge!
- Maintain Adequate Oxygenation – Supplemental Oxygen with Trach. Discharged Home on Room Air.
- Medication Management – Including Bronchodilator’s
- Deep Breathing and Cough – Incentive Spirometry to Prevent Atelectasis
Therapy Service Interventions:
Upon admission, patient required assistance with mobility, transfers, and self-care tasks. She was motivated to work with the therapist team to improve balance, coordination, mobility, and strength. Upon discharge ambulating with a rolling water 100 feet with distance supervision. She was independent with all her ADL’s.
Westgate Hills was the perfect continuum for this patient to continue care with our on-site Pulmonologist, Dr. Mark Gosnell. The collaboration with our Full-Time Respiratory Therapist, Ron Lior, was key in achieving TRACH DECANNULATION and oxygen weaning prior to patient discharging home.
Accomplishments:
Patient discharged home with strong family support and home care services provided by Home Care of Maryland. She will continue to follow up with her Pulmonologist and PCP, Dr. Jonathan Rich, in the community.
Pulmonary Rehab Case Study
62-year-old male admitted to Westgate Hills Healthcare and Rehabilitation Center after a 30 day stay at University of Maryland Medical Center, Baltimore with Admitting Diagnosis of Respiratory Failure S/P hypoglycemia and seizure. Patient has a history of HIV+ and Polysubstance Abuse. Patient is S/P Tracheostomy & Peg Tube Placement.
Nursing Interventions
Maintain Infection Free– Patient with Trach, Peg and Foley in place
Maintain Adequate Nutrition– Enteral Tube Feedings to PO Diet- GOAL MET
Progress to Normal Bladder Function– Free from Foley Catheter and Initiate Bladder Retraining Program- GOAL MET
Medication and Pain Management
Wound Care– Sacrum- PROGRESSING
Respiratory Interventions
Maintain Patent Airway– Wean as tolerated- GOAL MET
Maintain Adequate Oxygenation– Wean as tolerated- GOAL MET
Team Reviewing progress weekly in our in-house Pulmonary IDT meetings lead by Pulmonologist, Dr. Mark Gosnell
What a Difference 30 days makes!! Trach Tube, Peg Tube and Oxygen Therapy Discontinued, Diet Upgraded to Regular and Thin Liquids and Foley Catheter Discontinued.
Patient returns home ambulating independently with no assistive device. He will return home with home health and his supportive wife, who is also a nurse.
Pulmonary Rehab Case Study
24-year-old unfortunate female (J.B.) admitted to Westgate Hills Healthcare and Rehabilitation Center from Johns Hopkins Hospital with Admitting Diagnosis of ARDS, Traumatic Brain Injury and Covid-19. Patient is S/P Tracheostomy & Peg Tube Placement.
Nursing Interventions
Maintain Infection Free: Patient with Trach, Peg and Foley in place
Maintain Adequate Nutrition: Transition Enteral Tube Feedings to PO Diet
Progress to Normal Bladder Function: Free from Foley Catheter and Initiate Bladder Retraining Program
Medication and Pain Management
Respiratory Interventions
Maintain Patent Airway: Wean as tolerated
Maintain Adequate Oxygenation: Wean as tolerated
Smoking Cessation Education: Respiratory Therapy Bedside Education
Team Reviewing progress weekly in our in-house Cardiac and Pulmonary IDT meetings lead by Cardiologist, Dr. Athol Morgan and Pulmonologist, Dr. Mark Gosnell
What a Difference 30 days makes!! Trach Tube, Peg Tube and Oxygen Therapy Discontinued, Diet Upgraded to Regular and Thin Liquids and Foley Catheter Discontinued.
Therapy
Upon admission, Patient required maximum assistance. She is currently receiving occupational and physical therapy five times a week and is making slow and steady gains. Currently in her rehab stay, she is ambulating 15 feet with a rolling walker and is working hard to make continued gains.
More to follow with patients continued progression!!
Cardiac Rehab Case Study
61-year-old, female (D.C.) admitted to Westgate Hills Healthcare and Rehabilitation Center after a 6 day stay at John Hopkins Hospital with admitting diagnosis of Acute Decompensated Heart Failure and Pneumonia. She has a History of CAD, Bipolar Disorder and COPD.
Nursing Interventions
Monitor Fluid Balance: 1800ml fluid Restriction with increased weight monitoring; Dietician educated on good food choices- Heart Healthy Diet Maintained
Monitor Labs and Diagnostics: CXR obtained for follow up to Pneumonia
Smoking Cessation Education
Medication Management: Lasix 40mg daily, Lisinopril 20 daily, Plavix and Zyprexa
Reviewed weekly in the center at our Cardiopulmonary Interdisciplinary Team Meeting lead by Cardiologist, Dr. Morgan.
Therapy
Upon admission, Patient required minimal assistance with all self-care tasks and was able to ambulate 40 feet with minimal assistance. She was receiving occupational and physical therapy for 5 times a week for 3 weeks. Upon discharge, she was independent with all self-care tasks, able to ambulate 400 feet with a rolling walker and ascend/descend 15 stairs independently.
Patient returned home with HHS after a 21-day LOS in STR. She was Followed by UMD Heart Failure Clinic and her community PCP is Dr. Ahmed
