Orthopedic Case Study
45-year-old Russian speaking male admitted to Roosevelt Rehabilitation and Healthcare Center from Pennsylvania Hospital, where he initially presented for elective surgery for contracture of his right foot. Patient s/p right triple arthrodesis and achilles tendon lengthening with Dr. Keith Baldwin. Post-op he is NWB in RLE splint. Past medical history significant for scoliosis of spine, arthritis, tetraparesis, bilateral hip dislocation and foot deformity. Patient transferred to Roosevelt Rehab for our dedicated Russian Program, continued medical optimization, and ongoing therapy services.
Followed by our Russian Program Medical Director, Dr. Alex Mepari.
Nursing Interventions:
Medication Management – Celebrex, Aspirin, Lipitor, Creon, Entecavir, Oxycodone PRN
Right Lower Extremity Surgical Site – soft cast to right lower extremity. Initially, he was NWB on RLE. During his stay, his weight-bearing status was liberated to WBAT.
Therapy Interventions:
Upon admission, he required assistance with mobility including Min A for bed mobility and total dependence for transfers. He also required assistance with self-care including Min A with hygiene and upper body dressing and Max A for bathing and lower body dressing along with total dependence for toileting. He actively participated with physical and occupational therapy to regain his independence. At discharge, he was Mod I for bed mobility and transfers, standby assistance to ambulate 150 feet with RW and safely ascend/descend > 15 steps with supervision. He also regained his independence with self-care including set-up assistance for toileting and dressing and Min A for bathing.
After a successful stay at Roosevelt Rehab, the patient was able to return home safely with support from family. He will continue to be followed by his PCP, Dr. Leonid Magidenko in the community.
Cardiac Case Study
83-year-old male admitted to Roosevelt Rehabilitation and Healthcare Center from Abington Hospital, where he initially presented from outside hospital with NSTEMI. Patient s/p cardiac catheterization with atherectomy stent placement to RCA. Hospital course complicated by patient being found unresponsive and without pulse. CPR initiated and ROSC achieved after 30 seconds. Etiology likely syncopal episode secondary to hypotension. Patient on DAPT with Plavix and Aspirin. Hospital course
further complicated additional hypotensive episode and acute GI bleed. Aspirin and Plavix initially held. At discharge, patient maintained on Plavix. Past medical history is significant for HTN, HLD, CVA, dementia, macular degeneration, glaucoma and prostate cancer s/p radiation. Patient transferred to Roosevelt Rehab for medical optimization and continued therapy services.
Nursing Interventions
Medication Management – Lopressor, Seroquel, Plavix, Cozaar, Atenolol, and Flomax
Close Monitoring of Vital Signs
Monitoring of Labs
Cardiology Interventions
Patient followed by our Cardiologist, Dr. Scott Pfeffer. Patient maintained on Plavix. Plan with restart Aspirin in 2 weeks if hemoglobin remains stable. Patient remained stable from a cardiac perspective.
Therapy Interventions
Upon admission, he required assistance Max A for bed mobility, and Mod A for transfers and ambulation 40 feet with RW. He also required assistance for self-care including Min A for toileting and dressing and Mod A for bathing. An individualized therapy plan was developed consisting of physical, occupational and speech therapy. He actively participated with therapy to regain his independence. At discharge, he was required standby assistance for bed mobility, transfers and ambulate 200 feet with RW. He required Min A for self-care including bathing, toileting, and dressing.
After 7-days at Roosevelt Rehab, the patient was discharged home alone with support from family and Bayada Home Care. He will also be supported by his PCP, Dr. Roberto Panis in the community.
New Start Dialysis Case Study
63-year-old female admitted to Roosevelt Rehabilitation and Healthcare Center from Temple University Hospital, where she initially presented to the emergency department to establish access and initiate dialysis due to oliguria. Patient s/p right tunneled dialysis catheter placement and dialysis initiated. Course c/b reports of neck pain at baseline. Neurosurgery consulted; patient found to have chronic atlantoaxial subluxation likely related to arthritis. Plan for possible cervical fusion as an outpatient pending medical optimization. Patient with extensive past medical history including CKD with anemia d/t HTN, Afib c/b CVA on AC with chronic right sided weakness, seizures, COPD, and glaucoma with severe visual impairment. Patient transferred to Roosevelt Rehab for on-site dialysis, medical optimization, and continued therapy services.
Nursing Interventions
Medication Management – Keppra, Eliquis, Coreg, Symbicort, Amlodipine
Maintain Safety – patient with severe visual impairment and hx of seizures
New Start Dialysis – nephrology following, continue Retacrit weekly
Bowel Management Regimen – course c/b constipation, no bowel obstruction on x-ray, continue bowel program with Colace BID, Miralax Daily and Dulcolax suppository PRN
Therapy Interventions
Upon admission, patient was Min A for supine to sit and able to ambulate Mod A 20ft with RW. During her stay at Roosevelt Rehab, the patient required encouragement to actively participate in therapy. At the time of discharge, she was able to transfer from bed-to-wheelchair with CGA and ambulate CGA 10ft with RW.
Patient was discharged home with support of family and Care First Nursing Home Care. Prior to discharge an outpatient dialysis center was established with Fresenius Kidney Care. Patient will continue to be followed in the community by her PCP, Dr. Steinhauser.
Dedicated Russian Program Pulmonary Rehab Case Study
58-year-old unfortunate male admitted to Roosevelt Healthcare and Rehabilitation Center after an extended stay at Kindred Phili and prior stay at Abington Hospital with admitting diagnosis of Chronic Respiratory Failure and COPD, Covid Pneumonia and Sepsis and S/P need for mechanical ventilation. Patient arrives with Trach and Peg tube.
Nursing Interventions
Wound Healing– Sacral Wound Healing- GOAL MET
Provide Peritoneal Nutrition– Wean PEG tube and advance diet as tolerated
Educate patient and family on care of PEG tube upon discharge
Monitor Vitals and Labs
Respiratory Interventions
Maintain Patent Airway– weaned successfully- GOAL MET
Maintain Adequate Oxygenation– GOAL MET
Therapy
Patient advanced in therapy to ambulate greater than 300 feet with a Roller Walker and stand by assist. He is able to navigate 12 steps with supervision and is independent with ADL’s.
Through weekly collaboration of our clinical team, inclusive of a Full-Time Respiratory Therapist and the Leadership of our In-House Pulmonologist Dr. Michael Korman, the patient’s trach tube was removed, and oxygen therapy was discontinued. Dr. Korman’s oversight at Kindred as well as at Roosevelt allowed for optimal execution of patient’s continued plan of care.
Patient returned home with his wife to a single level home with 4 steps to enter. He is followed in the community by PCP, Dr. Chekov and home health provider, Better Home Health. Patient will follow with Pulmonologist, Dr. Rudolf Khusid and Cardiologist Dr. Daniel Vile.
Cardiac Orthopedic Rehab Case Study
87-year-old female patient admitted to Roosevelt Healthcare and Rehabilitation Center after a stay at Jefferson Torresdale with admitting diagnosis of Left Femur Fracture and UTI. She has a history of CHF, Chronic AFIB and Hypertension.
Nursing Interventions
Maintain Safety: patient with documented repeated falls
Treat infection: patient on Cipro for UTI
Monitor Vitals, Labs & Diagnostics: CXR & Venous Doppler obtained
Medication Management: Lasix, Atorvastin, Amlodipine, Losartan, Albuterol
Therapy
Upon admission, Patient required maximum assistance with all self-care tasks and required maximum assist to roll in bed. She was receiving occupational and physical therapy 5 times a week throughout her stay. She was dependent upon admission and progressed to ambulate 50 feet with a roller walker with supervision.
Through keen Assessment by our Interdisciplinary Care Team and the Leadership of our In-House Cardiologist Dr. Pfeffer, the Patients Fluid Status Changes were managed In House and medications were adjusted appropriately. #TreatInPlace
Patient had no unplanned transfers to the hospital. Patient returned home with her daughter with follow up appointments secured with Orthopedic, Dr. Caruso and PCP, Dr. Darouso.
