Short Term Rehab Case Study
98-year-old male admitted to Springfield Rehabilitation and Healthcare Center from Crozer Chester Medical Center after presenting to the emergency department s/p fall. While at Crozer, he was subsequently found to be COVID positive along with acute hyponatremia. Patient with extensive past medical history of CVA, ambulatory dysfunction c/b falls, likely chronic wedge compression of T12, dementia, HTN, PAF, BPH, anxiety and depression.
Nursing Interventions:
Medication Management – Amlodipine, Lasix, Lorazepam, Metoprolol, Mirtazapine, Flomax
Maintain Safety – s/p fall at home; promote safety
Monitor Vitals, Weight, and Labs – weekly weights, vitals every shift, frequent lab monitoring for hypokalemia and hyponatremia
COVID Positive – symptom management and continue supportive therapy, on room air
Therapy Interventions:
Goals – To regain strength, endurance, and independence with ADLs to be able to return to his independent living facility.
Interventions – Upon admission, he was Min A for bed mobility, Mod A for sit-stand and able to ambulate 12’ Min A with a rolling walker. After actively participating with physical and occupational 5 days a week, he was able to return home to his independent living facility ambulating 200’ CGA with a rolling walker.
Patient returned home to Plush Mills Independent Living Facility after 20 days LOS in STR. Referral was made to Continuous Home Care in the community and he will continue to follow with his PCP, Dr. Feinberg.
Wound Care Case Study
66-year-old female admitted to Springfield Rehabilitation and Healthcare Center from Lankenau Medical Center after being admitted from the emergency department with sepsis secondary to UTI and COVID infection c/b altered mental status. Patient also with alcohol abuse disorder and failure to thrive found to have extensive buttock wounds due to debility and immobilization. While at Lankenau, patient was deemed not to have a safe living environment in the community. Patient was admitted to Springfield Rehabilitation & Healthcare Center for ongoing wound care needs while identifying a safe long-term living environment.
Nursing Interventions:
Wound Management – vitamin/mineral supplements to promote wound healing, offloading bony prominences, local daily wound care, low air loss mattress, bilateral buttock stage 3 resolved at the time of discharge
Maintain Safety
Maintain Adequate Nutrition – Followed closely by Dietitian. Promote oral intake, patient tolerating mechanical soft regular diet/thin liquids with ProSource BID, magic cup BID and Ensure Plus TID
COVID Positive – symptom management and continue supportive therapy, on room air
Therapy Interventions:
Upon admission, patient was Max A for bed mobility and dependent for transfers. During her stay at Springfield Rehab, she was able to advance to Min A for rolling in bed and Mod A for supine to sit.
During her stay at Springfield Rehab, she was followed closely by Dr. Haas from Advanced Wound Care Specialists. At the time of discharge, the patient’s wounds were healed, and she discharged to Broomall Manor for long-term care.
Case Study
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.
Nursing Interventions:
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
Monitor Vitals
Therapy Interventions:
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.
Nursing Interventions:
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
Therapy
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
Hypotension
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
Therapy
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.
