Case Studies

Cardiac Rehab Case Study

56 years old female (S.W.) admitted to Kearsley Healthcare and Rehabilitation Center from Penn Hospital with admitting diagnosis of Ischemic Cardiomyopathy- EF of 5-10% and CHF on Continuous Milrinone Infusion.

Nursing Interventions

Medication Management– Continuous Milrinone Infusion at 5.7 ml/hour, Lasix 80mg daily and Eliquis
Monitor Fluid Balance– Daily Weight, 1000 ml Fluid Restriction, Dietician educated on good food choices; NAS regular and thin liquid diet.
Family Education– Daily CADD Pump Cassette Change and Priming of Tubing
Maintain Safety– History of Falls
Maintain Infection Free– Right Upper Arm PICC
Monitor Labs
Wound Healing
– Sacral Wound treated with Meplix

Weekly Collaboration between our In-House Cardiologists, Dr. Droogan and Domsky; with Community Cardiologist, Dr. Rubin to ensure Appropriate Dosing of IV Milrinone.

Therapy

Upon admission, Patient required moderate assistance with all self-care tasks and was able to ambulate 40 feet with moderate assistance. She was receiving occupational and physical therapy for 5 times a week for 2 weeks. Upon discharge from Skilled Stay, Patient was independent with all self-care tasks, able to ambulate 300 feet with a rolling walker and ascend/descend 12 stairs w Supervision.

After a 20-day Short Term Rehab Stay, Patient returns home with Mother and supportive sister. Milrinone Infusion Management continues in the community by Penn Palliative Home Care and Penn Medicine Home Infusion. She will continue to be followed by Cardiologist, Dr. Sharon Rubin as well as The Heart Failure Clinic of Philadelphia.


Pulmonary Rehab Case Study

79-year-old female (MG) admitted after a 50 day stay at HUP with diagnosis of Acute Respiratory Failure secondary to Covid-19 infection and ARDS. Patient has a past medical history of CHF, SVT, and PPM placement. EF of 55-60%.

Nursing and Respiratory Interventions

Treat Infection– Continue Doxycycline for Sepsis Pneumonia
Maintain Patent Airway/Wean Airway as Tolerated– PMV trials advanced to Capping Trials which led to Trach Decannulation
Maintain Adequate Oxygenation– Trach collar at 5 lpm on admit; Room Air on Discharge

Cardiology Led Oversight

: By Dr. Drogan and Domsky (Assessed weekly in the center)
Medication Management– Lasix 40 mg BID, Metroprolol, Coumdin
Monitor Labs– PT/INR for Coumadin levels

Patient was trach weaned on day 20 of her short-term rehab stay. Her stoma healed and she is breathing well on room air.

Therapy

Upon admission, Patient required maximum assistance with all self-care tasks and was She was receiving occupational and physical therapy for 5 times a week for 6 weeks. She made little gains physically throughout her stay. Upon discharge, she is minimal-to moderate assist with bed mobility and non-ambulatory.

Patient returned home with her granddaughter after 51 days LOS in STR. She has home health VNA and her PCP is Dr. James Shepard in the community.


Cardiac Rehab Case Study

58-year-old male (DL) admitted to Kearsley Healthcare and Rehabilitation Center from Penn Medicine with admitting diagnosis of Ischemic Cardiomyopathy- EF of 5-10%, S/P LVAD placement.

Nursing Interventions

LVAD Management– MAP readings, Assess Line site for S/S infection, Dressing change weekly. Patient provided education of self-management in preparation for return to home
Medication Management– Coumadin, Valsartan and Coumadin
Monitor Fluid Balance and Daily Weight Monitoring – Dietician educated on good food choices; NAS regular and thin liquid diet and weight stable throughout stay
Monitor Labs– PT/INR every Tuesday and Friday; Followed by Cardiologist Weekly

Therapy

Upon admission, Patient required moderate assistance with all self-care tasks and was able to ambulate 100 feet with moderate assistance. He was receiving occupational and physical therapy for 5 times a week for 2 weeks. Upon discharge from Skilled Stay, Patient was independent with all self-care tasks, able to ambulate 200 feet with no assistive device and ascend/descend 24 stairs independently.

Patient was followed weekly by Cardiologist, Dr. Droogan and Dr. Domky in the Center.

After a 26 day Short Term Rehab Stay, Patient to discharge to home with his Mother and is followed by Dr. Reza, LVAD coordinator at Penn. Primary Care Provider is Health Clinic on 28th. He is followed by Penn Medicine Cardiology, Todd Hecht.

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