Cardiac Rehab Case Study
A male, 87-year-old patient was admitted to Oakland Rehabilitation & Healthcare Center from Valley Hospital with an admitting diagnosis of COVID-19, weakness, dizziness, and lightheaded. The patient has an extensive history of Anemia, Falls, A-Fib, CAD, HTN, hyperlipidemia, and neurogenic bladder.
Reviewed by IDT led by PCP Dr. Arun Sehgal, Cardiologist Dr. Budhwani, Physiatrist, Dr. Cristin McKenna, In-house Specialty Program Nurse Coordinator along with the daily clinical care of the nursing team!
Nursing Interventions:
Medication management – vasodilator, blood thinner, antihypertensive, and diuretic.
Neurogenic bladder management – urinary retention medication, Foley catheter management education and care.
Dietary Consult – including weight, Heart Failure low sodium diet, and supplements.
Diagnostic and laboratory studies – Frequent labs including PT/INR to manage Coumadin levels and in-house EKG and X-ray capabilities.
Pain Management – Medication management, therapy modalities, and safety awareness education.
Therapy Interventions:
Upon admission, he was moderate assistance with mobility, transfers, and self-care tasks including toileting and dressing. The patient worked with the nursing team to gain strength with mobility. Upon discharge, he was at an independent level for all self-care tasks. He was also able to ambulate 300 feet with a rolling walker and ascend/descend 12 steps safely.
After a successful SNF Rehab, he was able to return home with the support of his family. Before discharge, all follow-up appointments were made including his Community Primary Care Physician Dr. Harmeet Singh, and Cardiologist Dr. Robin Feigelis of Valley Health Westwood.
Cardiac/CKD Case Study
64-year-old male admitted to Oakland Rehabilitation and Healthcare Center from Chilton Hospital S/P Syncope with fall, Chronic AFIB Acute Kidney Failure and LLE DVT.
Nursing Interventions
Medication Management – Lasix, Macrobid, Eliquis
Maintain Safety
Monitor Fluid Balance – increased weight monitoring
Monitor Labs, Diagnostics and Vitals – CBC, CMP, BMP
Renal Diet Education – Registered Dietician
Pacing and Endurance Training with Exertion
Under the Direction of our In-House Cardiologist, Dr. Navin Budhwani as well as the Daily Guidance provided by Our In-House Nurse Practitioner, patient was monitored closely for Fluid Balance and Lab Values. Patient worked hard to gain the strength required to return home. The clinical team guided him without any unplanned hospital discharges.
Patient returned home independently with support from Valley Home Care for the in-home skilled services. He will continue to be followed by PCP, Dr. Lydia Barbara. Oakland has always been and continues to be the Cardiac Center of Choice in Bergen County.
Covid-19/Pulmonary Rehab Case Study
56-year-old male admitted to Oakland Rehabilitation and Healthcare Center from Englewood Hospital with Acute Respiratory Failure and Hypoxia. He was Covid (+) and CDIFF (+). Prior to coming for Short Term Rehab, Patient had a 31-day Hospitalization requiring 2 weeks of ventilation management, IV antibiotics, TPN and HFNC.
Because of our Onsite Full Time Respiratory Therapist and Abilities to Accommodate High Oxygen Flows, Oakland Rehabilitation was identified as the only short-term rehab with capabilities to manage the patient’s oxygen requirements and severe decompensation with exertion.
Nursing Interventions
Medication Management – Antibiotic therapy
DVT Prophylaxis – IV Lovenox to PO Eliquis transition
Monitor Labs & Vitals – Few episodes of Bradycardia otherwise stable
He had a Venous Doppler conducted to his B/L LE while in house to rule out DVT which was negative.
Respiratory Interventions
Maintain Adequate Oxygenation– patient weaned from HFNC to 6lpm via Oxymizer to requiring 2 lpm via nasal cannula with exertion only.
Deep Breathing & Cough– Patient consistently achieving 1200ml on Incentive Spirometry
Pacing and Endurance with Activity– Respiratory Therapist worked alongside Therapy Department to improve endurance while educating on pacing with necessary breaks.
Pulmonologist oversight with Dr. Sharma continued throughout pandemic.
Therapy
Upon admission, Patient is mod assist with all transfers and requiring 6 lpm and frequent rest breaks. He was receiving occupational and physical therapy 5 times a week for 3 weeks. Upon discharge, he is ambulating 250 feet w/0 AD and has been weaned to 2lpm via nasal cannula through Apria DME. He will follow up with PCP, Dr. Christopher in his hometown of NY.
Cardiopulmonary Case Study
57-year-old male admitted to Oakland after a 38-day hospitalization at St. Joe’s Hospital and a 16 day stay at Kessler Rehab. Patient with diagnosis of Cerebral Infarction requiring Decompressive Hemicraniectomy with Severe Encephalopathy. Patient has a history of Chronic Systolic CHF and Cardiomyopathy with an Ejection Fraction of 20-25%.
Nursing Interventions
Medication Management– Heparin, Carvedilol and Amiodarone
Maintain Proper Nutrition– Enteral Nutrition Dependent
Aspiration Precautions– upgrade diet as tolerated
Wound Healing– sacral wound treatment
Monitor Vitals– AFIB with Rapid Ventricular Rate
Treat Infection– Acinetobacter Pneumonia
Maintain Safety– Risk for Falls
Respiratory Interventions
Maintain Patent Airway– Wean trach as tolerated
Secretion Clearance– Suction as needed
Maintain Adequate Oxygenation– Wean oxygen as tolerated
Oakland’s On-Site Respiratory Therapist worked alongside the Speech Language Pathologist as well as the other members of the Clinical Care team and are excited to share he has been successfully trach weaned.
Due to the patient’s overall complexity and continued care needs, Patient’s wife feels plan of care for her husband should continue with Long Term Care at Oakland.
Patient is followed on Oakland’s Campus by Pulmonologist, Dr. Singh and Cardiologist, Dr. Budhwani. This allows for less transportation time and increased time to enjoy the activities provided at Oakland.
The Caring Clinical Team and Engaged Activity Department makes the Environment at Oakland #NextToHome.
Pulmonary Rehab Case Study
76-year-old female admitted from Bayonne Medical Hospital with Diagnosis of Pneumonia, COPD, Acute Respiratory Failure, Hypertension and Obesity.
Nursing Interventions
Treat Infection: On Antibiotic for Pneumonia
Monitor Labs: Frequent BBG monitoring, sliding scale insulin
Medication Management for Pain: Fractured Vertebra L2
Maintain Safety
Respiratory Interventions
Our Full Time Respiratory Therapist Assisted in following Goals: Wean Oxygen as tolerated– Admitted on 4 lpm Oxygen Therapy-; weaned to 2lpm.
Bronchodilitation and Secretion Clearance: nebulizer therapy QID.
Qualify for Trilogy: Due to the inability to tolerate Bipap ST and her being high risk for RTH, Our RT considered patient for Trilogy. With the help of Dr. Sehgal, Patient was Qualified for Trilogy Nocturnal Support for home use.
Patient was reviewed weekly in the center by Dr. Sehgal, Pulmonologist, and Interdisciplinary Care Team during our Pulmonary IDT Meeting.
Therapy
Upon admission, Patient required moderate assistance with all self-care tasks and was able to ambulate 25 feet with minimal assistance. She was receiving occupational and physical therapy for 5-6 times a week. Upon discharge, she was independent with ambulation and able to ambulate 125 feet with a rolling walker and supervision.
Patient returned home with 24-hour caregiver after a 45-day length of stay on Oxygen at 2LPM and Trilogy at hour of sleep for Chronic Respiratory Failure. Patient and Daughter were educated on Benefits of Consistent Trilogy use to reduce Risk for Return to Hospital. She will follow up with her pulmonologist in the community.
