Pulmonary Case Study
81-year-old female patient admitted to Collingswood Rehabilitation and Healthcare Center after a prolonged hospitalization at Suburban Hospital with admitting diagnosis S/P TAVR w perforation and pericardial effusion and recurrent pleural effusions. The patient had a history of CKD Stage 3, Aortic Stenosis, and Pulmonary Hypertension. She required Tracheostomy and PEG tube upon admission.
Nursing and Respiratory Interventions
- Maintain Patent Airway- Wean patient airway as tolerated
- Maintain Nutrition- Upgrade to PO diet and wean from PEG tube as tolerated
- Monitor Fluid Balance- Lasix titration in center, compression stocking to LLE
- Weight Monitoring- Weights trending down throughout stay
- Monitor Labs- BMP, CBC weekly
- Aspiration Precautions- Nectar thick liquids on admission
- Maintain Adequate Oxygenation – 6 LPM on admission; wean oxygen as tolerated
The interdisciplinary team under the leadership of Collingswood’s onsite Pulmonologists, Dr. Kuruvilla and Dr. John as well as a full-time respiratory therapy service, led by Linda Lennon, RT assisted this patient to make great progress in her recovery.
Accomplishments
Tracheostomy Removed • Oxygen Discontinued • Upgraded diet to Regular Texture and Thin Liquids • Peg Tube Removed • Currently Ambulating 10 feet with Assistive Device
Cardiac Case Study
71-year-old male admitted to Collingswood after a 10-day hospitalization at Bridge Point Capitol Hill following a stay at George Washington University Hospital S/P Stroke, AAA Repair, Sepsis and Dysphagia with a history of DVT and Hypertension.
Nursing Interventions
Cardiac Monitoring- Zio Patch monitoring x 2 Weeks-Showing SVT-Beta Blocker started
Medication Management-Asprin, Aldactone 25 daily, Metoprolol 25 daily, Insulin
Maintain Adequate Nutrition- Liquid Hope Enteral Formal
Wound Healing- Left Upper Back, Midline Chest and Sacrum
Monitor Labs and Diagnostics- BBG’s, UA C&S, CXR
Educate Family on Nutritional Replacement via PEG tube
Reviewed weekly in Cardiac IDT and seen weekly by patient’s community Cardiologist, Dr. Chen
Respiratory Interventions
Chest Physiotherapy Vest Therapy- Treat Newly Diagnosed Infiltrate
Aspiration Precautions- Downgraded Puree and Nectar Thick Liquids; FEE’s
Conducted In- House
Followed by Full-Time In-House Respiratory Therapist
Therapy
Patient received occupational and physical therapy 5 times a week throughout his extended stay. Upon discharge, he was able to sit independently on edge of bed. Unfortunately, Patient swallow continues to be weak, Nutrition via peg tube continues.
Patient returned home with his wife and daughter after a Short-Term Rehab Stay. He is followed by PCP Dr. Dea Sloan as well as Human Touch Home Care. Dr. Aziz conducted Cardiac Surgery at Hospital Level of Care.
Pulmonary Rehab Case Study
This is a 44-year old male patient admitted to Collingswood Rehabilitation & Healthcare Center with acute respiratory failure with hypoxemia s/p trach, PEG and on hemodialysis from Shady Grove Adventist Hospital following a left basal ganglion hemorrhage.
Nursing Interventions
Maintain patient safety
Blood sugar monitoring- Insulin
ESRD on Hemodialysis
Electrolyte monitoring- evaluated by Physicians frequently
Respiratory Interventions
Maintain Adequate Oxygenation- weaned from 35% ATC on admission to room air on DC
Bronchodilation/ Secretion Clearance- Received Routine Nebulizer therapy
Trach Wean- Tolerated capping trials and was trach weaned within 7 weeks of his stay
Reviewed weekly at Pulmonary IDT lead Pulmonologist, Dr. John
Therapy
Upon admission, the patient was bedbound requiring assistance with bed mobility, transfers, personal hygiene, toileting, and ambulation. Upon discharge, patient was able to ambulate with supervision, eat independently, and ambulate with very minimal assistance.
The convenience of onsite Dialysis allowed for the increased time for trach tube weaning and physical therapy due to less time spent on transportation. This therefore allowed for less fatigue and a quicker overall recovery.
Patient expressed his gratitude for the staff and could not wait to return home to his family. “I can’t believe I am able to walk and speak now”. Patients length of stay was 43 days. He was successfully trach weaned, discontinuing PEG feedings, and discharged safely to home with Outpatient Dialysis.
Pulmonary Rehab Case Study
This is a 69-year old female patient admitted to Collingswood Rehabilitation & Healthcare Center with acute respiratory failure with hypoxemia s/p trach and PEG from Washington Hospital Center following a subarachnoid hemorrhage resulting in encephalopathy.
Nursing Interventions
Maintain patient safety
Blood sugar monitoring- lantus
Electrolyte monitoring- evaluated by Physicians frequently
Reviewed weekly at: Pulmonary IDT lead Pulmonologist, Dr. John
Dietary Interventions
Maintain Adequate Oxygenation- weaned from 28% on admission to room air on DC
Bronchodilation/ Secretion Clearance- Received Routine Nebulizer therapy
Trach Wean- Tolerated capping trials and was trach weaned within 3 weeks of her stay
Therapy
Upon admission, the patient was bedbound requiring assistance with bed mobility, transfers, personal hygiene, toileting, and ambulation. Patient participated in in Occupational, Physical and Speech therapy 5 times a week to achieve her goals. Upon discharge, patient was able to ambulate with supervision, eat independently, and ambulate at least with assistance.
Patient expressed her gratitude for the staff and could not wait to return home to her family. “Thank you for all you’ve done for me”. Patient’s length of stay was 50 days. She was successfully trach weaned, PEG removed and discharged to Shady Grove Acute Rehab for further therapy.
