90-year-old female DIRECTLY admitted to Springfield Rehabilitation and Healthcare Center from her assisted living community for nursing and rehabilitation services. Patient with extensive past medical history including CVA affecting right dominant side, ambulatory dysfunction complicated by recurrent falls, recent RLE hematoma, spinal fractures, CHF, HTN, HLD, Afib and recent PNA/bronchiolitis.
Medication Management – Lasix, Amiodarone, Eliquis, Cozaar, Metoprolol, Crestor
Maintain Safety – s/p recurrent falls at home; promote safety
Monitor Recent RLE Hematoma – on Eliquis; monitor clinically
Monitor Weight – Dietitian following, encourage PO intake including ENSURE BID and fortified pudding BID
Goals: To regain strength, endurance, and independence to be able to return home to her assisted living facility.
Interventions: Patient worked closely with therapy to adjust her adaptive equipment to promote independence with eating. Therapy provided right sided arm rest cushion to decrease right lateral lean while seated out of bed in wheelchair. After participating with PT and OT, she was able to advance from being mostly wheelchair bound at baseline to moderate assistance for bed mobility, transfers, and ambulation at discharge.
The patient returned home to Sunrise Assisted Living in Newton Square after a successful stay in STR. She will continue to follow with Bayada in the community and with her PCP, Dr. Sevag from Main Line Health.
Pulmonary Recovery Case Study
88-year-old female (P.C.) admitted to Springfield Healthcare and Rehabilitation Center after a stay at Kindred Hospital s/p right buttocks mass removal and increased respiratory distress post-op resulting in intubation. She received S/P Trach placement and Peg tube removal.
Monitor Vitals- Monitoring of Hemodynamics & Encouraged Hydration
Maintain Adequate Nutrition- Ensure and Super food
DVT Prophylaxis- Lovenox
Treat Infection- Antibiotic Therapy with Augmentin
Respiratory Therapy Interventions:
Maintain Patent Airway- wean as able- GOAL MET
Maintain Adequate Oxygenation- NEW to Oxygen Therapy; 2 liters on Admission, wean as tolerated
Bronchodilitation- ProAir MDI
Deep Breathing and Cough- Incentive Spirometry to prevent atelectasis
Springfield was the perfect continuum for this patient to continue care with our onsite Pulmonologist, Dr. Gerald Meis associates while at Kindred. His collaboration with our Full Time Respiratory Therapist was key to achieving trach weaning and decreased levels of oxygen therapy.
Patient followed with her ENT, Dr. Raymond Lesser in the office and tracheostomy tube was no longer required. Patient continues to wean from chronic oxygen therapy as well as to work to gain strength with the therapy team at Springfield. Her physician in the community is PCP Dr. Alan Mezey.
The campus of choice for Post-Acute Pulmonary Care Continuum of Springfield, Pa.
COVID-19 Case Study
80-year-old female admitted to Springfield Healthcare and Rehabilitation Center after a 9 day stay at Lankenau Hospital with admitting diagnosis of Covid 19 Pneumonia with Respiratory Failure and Hypertension and a history of COPD and Diabetes.
Monitor Labs& Vitals: Monitor Hemodynamics & Encourage Hydration for
Medication Management: Lipitor, Lovenox, Insulin and Albuterol
Monitor Cardiac Status: Diagnostic Testing Onsite- EKG obtained
Maintain Adequate Oxygenation: Oxygen at 2 lpm; Weaned by day 7 of admission and patient returned home without Oxygen Therapy
Deep Breathing Exercises: to ensure Optimal Hyperinflation
Upon admission, Patient required minimal assistance with all self-care tasks and was able to ambulate 15 feet with min assist. She was receiving occupational and physical therapy 5 times a day throughout her stay. Upon discharge, she was independent with all self-care tasks, able to ambulate 50 feet with a rolling walker and stand by assist and weaned from oxygen therapy.
Patient recovered safely and returned back to 55+ Community with Mainline Home Health Services. Patient will follow in the Community with PCP, Dr. Jean Hobbs.