Cardiac Rehab Case Study
90-year-old male patient of hospitalist admitted to Meadow Park Healthcare and Rehabilitation Center from St. Agnes Hospital. Patient Admitted with Generalized Weakness, S/P Fall and Interrogation of newly placed AICD (4 days earlier) reveals Device Fired due to Rapid Atrial Rate.
Nursing Interventions
Monitor Labs and Medication Adjustment– elevated BUN and Creatinine- IV Fluids started.
Monitor Vitals and Labs
Medication Management– Eliquis 2.5mg BID, Amlodipine 5mg Daily
Aspiration Precautions– Mechanical Soft/ Nectar Diet on Admission- Upgraded on DC
Maintain Safety
Reviewed weekly with our in-house care team during Cardiac IDT led by Cardiologist Dr. Chopra; Dr. Chopra adjusted and Ultimately Discontinued Diuretic Therapy based on lab results Patient also followed by in house Physiatrist, Dr. Lepre while at Meadow Park.
Therapy
Upon admission, Patient required maximum assistance with all self-care tasks and was able to ambulate 10 feet with roller walker and maximum assist. He was receiving occupational and physical therapy 5 times a day for three weeks. Upon discharge, he was able to ambulate 10 feet with a rolling walker and has a standing tolerance of 60 seconds with minimal assist. Upon Discharge, He continued on a downgraded diet due to reaching max potential secondary to dementia.
Patient returned home with his wife and his daughter after 23 days LOS in STR. In-house PCP, Dr. Ahmed made suggestion for Seasons Hospice at home. Patient set up upon discharge to home. Patients PCP is Dr. Gregory Levickas in the community.
Cardiac/Neuro Outcome Case Study
61-year-old female (T.B.) admitted to Meadow Park Healthcare and Rehabilitation Center from Good Samaritan Hospital with admitting diagnosis of Acute Kidney Injury, LLL Pneumonia and Atelectasis. Patient has a history of Epilepsy, Dysphagia, Hypertension & Right sided Hemiplegia from prior CVA.
Nursing Interventions:
Aspiration Precautions– Patient on downgraded diet
Maintain Pain Free-
Medication Management– Coreg, Atorvastatin, Vimpat, Lamictal, Depakote;
Followed by our cardiologist Dr. Chopra in center on Cardiac rounds
Maintain Safety while improving overall functional mobility
Therapy:
Patient was followed by our in-house physiatrist, Dr. Scott Lepre which optimized pain management allowing patient to physically advance and return home. Upon admission, Patient required 2-person assist due to right hand contractures and lower extremity contractures and was on a Pureed and Nectar Diet. Upon discharge, she was ambulating up to 200 feet with a quad cane and contact guard, requiring frequent rest breaks. Patient progressed and diet was advanced to Mechanical Soft and thin liquids. Patient returned home with her daughter after a 28 days LOS in STR. She has 36 hours of Waiver Services in the community and will follow up with Dr. Wennifer Wiggins, PCP in the community.
