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.
