Cardiac / Pulmonary Case Study
84-year-old male, J.B. admitted to Cambridge Healthcare and Rehabilitation Center from Virtua Memorial Hospital. Admitting diagnosis of chest pain, and SOB with a diagnosis of pulmonary embolism and DVT. The patient has an extensive history including HTN, Diabetes, CVA, and Obstructive Sleep Apnea.
Nursing Interventions
Dietary & Vitals Monitored – Close monitoring of hemodynamics, Heart Healthy Diet. Dietitian education including healthy choice foods.
Medication Management and Pain Management
Diagnostic Tests – Inhouse EKG, Chest X-ray, labs including close cardiac monitoring
Respiratory Care – Initial assessment revealed patient was on 4L of oxygen via N/C.
The patient’s goal was to return to his prior level of not having to use supplemental oxygen. The plan of care consisted of incentive spirometry, coughing & deep breathing exercises, optimize oxygen conservation interventions, and compliance with Nocturnal CPAP for his OSA diagnosis. Upon discharge, the patient met his goal of returning to his prior level of not having to use supplemental oxygen.
Reviewed weekly at IDT led by Virtua Cardiology, Dr. Delcine Sood; PCP Dr. Nisha Kumar, Physiatrist, Dr. Michael Rhee, In-house FT RT Laura Blachewicz, along with the daily clinical care of the nursing team.
Therapy Services
On admission, the patient required moderate assistance with functional tasks, able to ambulate 10′ with the rolling walker. He worked hard with the therapy department and the in-house Respiratory Therapist to obtain his goal of returning home with his family. On discharge, he was at a supervised level with all functional tasks and able to ambulate 100′ with the rolling walker.
The patient was discharged safely to home with the support of his wife and Moorestown VNA Home Care Services. All follow-up appointments were made prior to discharge including his Community PCP Dr. Mohammad R. Abdeljawad and Pulmonologist Dr. Patrick Mulhall.
Clinical Outcome Study
69 years old, female (I.W.) patient admitted to Cambridge Rehabilitation and Healthcare Center after a 20-day LOS at Acuity Hospital in Willingboro. This followed a prior stay at Virtua Camden with admitting diagnosis of Acute on Chronic Respiratory Failure, Perforated Bowel with Fistula and Dysphagia. She has a history of Bipolar and Schizoaffective Disorder, COPD and DM. Patient arrived with Right-Sided Colostomy, Left-Sided Fistula and a Wound Vac to her abdomen.
Nursing Interventions
Monitor Fluid Balance and proper nutrition: 1200ml Fluid Restriction, Daily Weight Monitoring, Glucerna, Ensure and Magic Cup.
Wound Healing: Abdominal wound 13.3 x 3.3 x 2.7
Education on Wound treatment and Colostomy Training
Aspiration Precautions: Admitted on Puree Solids and Nectar Thick Liquids
Maintain Adequate Oxygenation: Admitted on 3 lpm
Medication Management: Lasix 40mg BID, Spironolactone 50 mg BID, Hydralazine 25mg Q12, Insulin, Coreg
Monitor Labs: BBG’s TID, BMP
Therapy
Upon admission, Patient required maximum assistance with all self-care tasks and was unable to ambulate. Patient Actively participated in Therapy for several weeks, progressed slowly but at a steady pace until upon discharge, she was independent with all self-care tasks, able to ambulate 300 feet with a rolling walker and ascend/descend 5 stairs independently.
Patient’s Abdominal Wound was Resolved, Oxygen Therapy was weaned and Weights remained stable throughout stay. Patient had no unplanned hospitalizations while in Cambridge’s Care.
Patient returned home with her sister and home health. Her PCP in the community is Dr. Thomas Lee. It was recommended to follow up with Pulmonary and Sleep Associates of South Jersey for Sleep Study Evaluation.
