Cardiac Rehab Case Study
78-year-old female, a beneficiary of the Valley Health System / ColigoCare ACO was admitted to Allendale Healthcare & Rehabilitation Center after a stay at Valley Hospital with an admitting diagnosis of neurological impairment (expressive aphagia). The patient also has a history of A-fib, HTN, TIA, CAD, diabetes, and dementia. The patient is followed by our internal clinical team led by PCP Dr. Jatinder Sawhney, Cardiologist Dr. Hamid Nia, Physiatrist Dr. Bacher, and PA Sharon Shadani, in-house specialty nurse along with the daily clinical care of the nursing team!
Nursing Intervention:
Cardiac medication management – blood thinner, antibiotic therapy, seizure, type 2 diabetic medication, insulin, hormone, supplements, and vitamins. Frequent Labs and diagnostic testing including CBC, CMP, and BMP, as Inhouse EKG and X-ray capabilities.
Pain Management – including therapy modalities.
Dietary Consult – Fluid restriction, Heart Healthy 2gm Sodium diet, and weight management.
Therapy:
Upon admission, the patient demonstrated a decreased ability for word finding. She required assistance for self-care tasks including transfer, mobility, and decreased safety awareness. She worked with the therapy team including speech to support the cognitive deficits identified on admission. Upon discharge, she was able to advance in all areas. Her word-finding improved along with her self-care tasks at a supervision level. She was able to ambulate 350 feet with a rolling walker.
With the support of her family, she was able to discharge back to The Chelsea Assisted Living. All follow-up appointments were made before the patient’s discharge, including Nephrologist Dr. Syed Raza.
Pulmonary Recovered Case Study
65-Year-Old Female (M.H.) admitted to Allendale Healthcare and Rehabilitation Center after a stay at Valley Hospital with Admitting Diagnosis of Acute Respiratory Failure and pneumonitis. Patient has a history of Parkinson’s Disease and Breast Cancer. She arrived with trach tube and s/p peg tube placement.
Nursing Interventions
Monitor Labs – BUN/ Creatinine, BBG’s, CBC and BMP
Advance PO diet as tolerated and wean Peg tube as able – GOAL MET
DVT prophylaxis – Lovenox
Aspiration Precautions
Prevent Infection – Provide Oral Care
Respiratory Interventions
Maintain Patent Airway – Airway education to Husband – GOAL MET
Maintain Adequate Oxygenation – Wean as tolerated – GOAL MET
Deep Breathing and Cough – Maintain Pulmonary Hygiene
Pacing and Endurance Training
Trach Care and Airway Management Education
Patient is seen weekly by our in-house Pulmonologist, Dr. Jason Shatkin. With the support of our Full-Time Respiratory Therapist and the Allendale Clinical Team, patient gained the strength needed to return home with her husband and private duty aide.
Patient progressed in rehab, tolerating her advanced diet to Mechanical Soft and Thin liquids without any unplanned hospital transfers. Patient will continue to be followed by PCP, Dr. Ehab Ibrahim and Pulmonologist, Dr. David Orr.
Pulmonary Recovered Case Study
77-Year-Old Female admitted to Allendale Healthcare and Rehabilitation Center after a stay at Valley Hospital S/P Fall-fractured left wrist; Patient admitting Diagnosis of Metabolic Encephalopathy, Sepsis, UTI with a history of COPD.
Nursing Interventions
Monitor Labs/Diagnostics – CBC, BMP,TSH, Mag
Medication Management – Ceftin, Losartan, DuoNeb
Maintain Safety
Promote Healing – Left upper Extremity Splint
Respiratory Interventions
Maintain Adequate Oxygenation – Wean as tolerated – GOAL MET
Deep Breathing and Cough – Lung Recruitment
Pacing and Endurance Training
Therapy
Pulmonary Management provided by patient’s community pulmonologist, Dr.Jason Shatkin. Team Focused Rounds inclusive of our onsite Nurse Practitioner and Full-Time Respiratory Therapist guided this patient to a successful return home without any unplanned hospitalizations.
Patient returned home alone ambulating 150 feet w contact guard. She will have support from her niece and Valley Home Care. She will continue to follow with PCP, Dr. Mary Bello and Pulmonologist, Dr. Jason Shatkin in the community.
