Orthopedic Case Study
76-year-old male admitted to Springfield Rehabilitation and Healthcare Center from Crozer Chester Medical Center, where he initially presented after mechanical fall. Patient found to have left distal femoral shaft fracture with intact prosthesis. Patient s/p left distal femur ORIF for periprosthetic fracture with Dr. Bruce Lutz. Patient NWB on left lower extremity in knee immobilizer. Post-op course complicated by hypotension and HGB of 7.9 s/p transfusion of 1 unit PRBCs. Hospital course further complicated by urinary retention with foley in place. Past medical history significant for HTN, hyperlipidemia, COPD and PTSD. Patient transferred to Springfield Rehab for continued medical optimization and therapy services.
Nursing Interventions:
Medication Management – HCTZ, Atorvastatin, Aspirin, Flomax, Propranolol, Klonopin
Close Monitoring of Vital Signs including pulse ox
Monitor Surgical Incision for signs and symptoms of infection, incision OTA
Foley Catheter Management – patient s/p foley removal with successful void trial
Pulmonology Interventions:
Followed closely by our Pulmonologist, Dr. Gerald Meis and our full-time in-house Respiratory Therapist. He was weaned off supplemental oxygen and remained stable on room air.
Therapy Interventions:
Upon admission, he required Mod A for bed mobility and Mod A x2 for transfers. He also required assistance with ADLs including Mod A for bathing and Max A for toileting and lower body dressing. An individualized therapy plan was developed consisting of physical therapy and occupational therapy. While in-house, his weight bearing status was liberated to WBAT. At the time of discharge, he was independent for bed mobility and Mod I for transfers and to ambulate 500 feet with RW. He also regained his independence with self-care including supervision for bathing, toileting and lower body dressing.
After a successful stay in short-term rehab at Springfield Rehab, the patient was discharged home with support from family and Bayada Home Health Care. He will continue to follow with his PCP, Dr. Joseph Renzi in the community.
Wound Care Case Study
78-year-old female admitted to Springfield Rehabilitation and Healthcare Center from Bryn Mawr Hospital with diagnosis of hyperglycemia. Patient reports non-compliance with dialysis and taking her insulin for the past 3-4 days prior to admission d/t recent MVA. Patient with hx of skin cancer on both her lower extremities with new diagnosis of skin cancer on her right upper arm. The patient also with multiple hematomas r/t her skin cancer. Pt s/p multiple excisions to RLE, RUE and LLE with wound vac placement for hematoma abscess. Patient with hx of ESRD on iHD. Patient was admitted to Springfield Rehabilitation & Healthcare Center for ongoing wound care, medical optimization, and PT/OT.
Nursing Interventions:
Wound Management – followed closely by Advanced Vascular & Wound Associates. Initially, patient with wound vac to LLE w/ dressing change 3x/wk. Patient with eventual vac takedown→ transitioned to daily xeroform ca alginate dressing changes.
Maintain Adequate Nutrition – Followed closely by Dietitian. Promote oral intake, tolerating Heart Healthy, carb controlled, renal diet with supplemental Nepro BID.
Therapy Interventions
Upon admission, patient was CGA for transfers and able to ambulate 25ft with a 2-wheeled walker with Min A. After actively participating with PT/OT, patient was able to advance to requiring set-up assistance for transfers and ambulating 250ft at a supervision level with a 2-wheeled walker.
After a successful stay at Springfield Rehab, the patient was discharged home with support from Main Line Health Home Care. The patient will continue to follow with her PCP, Sean Flynn, in the community. Prior to discharge, community transit application was completed to ensure she is getting to Davita Upper Darby Dialysis center 3x/wk.
Pulmonary Case Study
65-year-old female admitted to Springfield Rehabilitation and Healthcare Center from Crozer Chester Medical Center where she initially presented with cough, and shortness of breath. Patient admitted with COPD exacerbation and acute respiratory failure with hypoxia. She started on steroids, DuoNeb, Dulera and oxygen increased to 4L ATC. Patient also with c/o weakness and ambulatory dysfunction. Past medical history includes COPD on 2L oxygen nocturnally, pulmonary nodules, dyslipidemia,
cervical spondylitis, and peripheral neuropathy. Patient transferred to Springfield Rehab for continued medical optimization, oxygen titration and therapy services.
Nursing Interventions:
Medication Management – Albuterol, Advair, Hydroxyzine, Tramadol, Cymbalta
Edema Management – s/p Lasix x3 days, encourage elevation and monitoring of LE
Respiratory Therapy Interventions
With the support of our Pulmonologist, Dr. Gerald Meis and our full time Respiratory therapist, the patient was able to actively wean from 4L oxygen via nasal cannula to 2L oxygen via nasal cannula. While in-house she continued to use her Smart Vest for airway clearance. At the time of discharge, the patient was also set up with a mini portable oxygen concentrator to increase her independence.
Therapy Interventions
Upon admission, the patient required Min A for bed mobility and was able to ambulate 10ft with RW and contact guard assistance. She actively participated in therapy. At the time of discharge, she was independent with bed mobility and transfers and was able to ambulate 300ft with RW at a Mod I level.
After a successful stay in short term rehab, the patient was safely discharged home with support from family and Main Line Health Home Care. The patient will continue to follow with her pulmonologist, Dr. Lander and PCP, Dr. Carol Tanzio in the community.
Urgent SNF Case Study
86-year-old female DIRECTLY admitted to Springfield Rehabilitation and Healthcare Center from Crozer Chester Medical Center Emergency Department. She initially presented to Crozer with c/o lower leg swelling, SOB when lying down along with worsening chronic exertional dyspnea. Patient subsequently found to new onset of CHF with bilateral pleural effusions, thought to be secondary to uncontrolled hypertension and elevated troponin, likely demand ischemia in s/o AKI and CHF. PMH includes hypertension, T2DM, CKD stage III, iron deficiency anemia, and hypothyroidism.
Nursing Interventions:
Medication Management – Lasix, Norvasc
Diet – education on importance of Heart Healthy Diet with fluid restriction
Monitor Lab results – CBC, BMP, TSH, Accu-checks
Therapy Interventions:
Goals: Patient was extremely motivated to return to prior level of living with increased functional activity tolerance. Prior to admission, she lived alone in an independent living facility in a 2nd floor apartment with elevator access. She was independent with ADLs and household distances; in the community she used a rollator.
Interventions: Upon admission, pt required Mod A for bed mobility and sup- sit. She ambulated with a tandem gait 100ft CGA with a RW. Patient actively participated with therapy 5 days a week, with interventions to address gait training focused on stride length and directional changes. Upon discharge, she was able to transfer and ambulate 200ft with a RW at a supervision level.
After a 20-day LOS in short term rehab, the patient returned home to Luthern Knolls with support from Crozer Home Health for PT/OT/Skilled nurse. Patient will continue to follow with her PCP, Chrystine Palomba in the community.
Urgent SNF Case Study
78-year-old female DIRECTLY admitted to Springfield Rehabilitation and Healthcare Center from home. Patient recently presented to Crozer Chester Medical Center, with c/o worsening cough, SOB and generalized weakness. Patient subsequently found to be COVID positive started on Decadron, bronchodilators, supplemental oxygen, mucolytics and antitussives. Patient was recommended for rehab placement after hospitalization at CCMC, however, she refused and was discharged home. After being home for 1-day, she realized she was unable to care for herself at home and reached out to the social worker at CCMC, who then reached out directly to the center for an Urgent SNF Admission. The patient was directly admitted to Springfield Rehab the same day.
Nursing Interventions:
COVID Pneumonia Management – Decadron, Mucinex, Levaquin, PRN albuterol
Medication Management – Losartan, Nifedipine, Labetalol, Bumex
Close Monitoring of Vital Signs – Orthostatic vitals and pulse ox
Therapy Interventions:
Goals: Patient presented with decreased endurance secondary to COVID pneumonia which was limiting her functional capability and ability to care for herself independently at home. Patient’s goals were to regain endurance and independence to return home safely.
Interventions: Upon admission, patient was ambulating 20ft standby assist with a rolling walker. She actively participated with therapy. Upon discharge, patient was able to ambulate 200ft standby assist with no assistive device, ascend/descend 8 steps with standby assist and was able to independently perform her activities of daily living.
After a 9-day LOS in short term rehab, the patient returned home with support from Bayada Home Health. Patient will continue to follow with her PCP, Vera Howland.
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.
