Pulmonary Rehab Case Study
74-Year-Old Female with Diabetes, Hypotension, Depression and Bipolar Disorder, admitted to Canterbury Rehabilitation and Healthcare Center after a stay at St. Francis Medical Center, s/p complex laparoscopic appendectomy with severe nausea & vomiting, resulting in Acute Renal Failure requiring Hemodialysis.
Nursing and Clinical Interventions: Onsite Hemodialysis
- Monitor Labs– CBC, CMP
- Medication Management– Folic Acid, Protonix, Midodrine HCL, Rosuvastatin, Januvia, Lispro, Quetiapine
- Monitor Fluid Balance– Hemodialysis onsite
- Dietary Education– Nutrition education provided on Cardiac/Renal diet
Additional Support:
With the support of our onsite Attending Hospitalist, Dr. Raja, Nephrologist, Dr. Naveed and in center Occupational and Physical Therapists, her hypotension, appetite, and renal function greatly improved, and she was able to be taken off hemodialysis; at discharge, she was modified independent in all ADLs and was able to ambulate with caregiver assistance and a walker.
The patient discharged to The Crossing at Iron Bridge Assisted Living Facility to continue rehab services.
Urgent SNF Case Study
A 79 year old male presented to St. Mary’s Hospital Emergency Department with worsening bilateral lower extremity edema, A-fib with RVR, urine and blood culture positive for E. Coli. Patient was then diagnosed with CHF, Cellulites, and Acute hypoxic respiratory failure. A call was made for an Urgent SNFTM referral to Canterbury Rehabilitation and Healthcare Center.
The patient was directly admitted from the Emergency Room within 2 hours, receiving nursing and rehabilitation care at Canterbury.
Nursing Interventions
- Wound Care
- Maintain Safety
- Monitor Diagnostic Testing & Laboratory Studies
- Medication Management – Pain Management
Therapy
Upon admission, the patient required moderate assist with mobility, transfers, and all self-care tasks. The team approach of care to include the support of our 24/7 on-site respiratory therapist, allowed the patient to participate in occupational and physical therapy 5 times a week. Upon discharge, he was independent with all self-care tasks, able to complete transfers with minimal assistance, and ambulate with contact-guard using a rolling walker.
The patient was discharged home with the support of Commonwealth Home Health, and will follow up with Dr. Douglas Klasset in the community.
Pulmonary Rehab Case Study
A 68-year-old-male admitted to Canterbury Rehabilitation and Healthcare Center from St. Mary’s Hospital after presenting to the hospital with septic shock, and hypoxic respiratory failure s/p tracheostomy. Patient has a past medical history of CHF, A-fib, chronic pancreatitis, and AKI due to bladder outlet obstruction.
Nursing Interventions
Maintain Proper Nutrition – Wean Peg Tube and Advance diet as tolerated
Monitor Labs and Vitals – CBC, BMP
Treat Infection – IV Antibiotics
Maintain Safety
Respiratory Interventions
Maintain Adequate Oxygenation – Pt admitted on 40% ATC – Weaned to RA
Maintain Patent Airway – Patient successfully Decannulated – GOAL MET
Bronchodilation – Albuterol & Atrovent
Aspiration Precautions
Deep breathing & Cough Exercises
Therapy
Upon admission, Patient was total dependent requiring maximum assistance with all self-care tasks. The team approach of care to include the support of our 24/7 on-site Respiratory Therapist, allows the patient to participate in Occupational, Speech and Physical Therapy 5 times a week. Upon discharge patient is able to walk and complete all self-care tasks with minimal assistance.
Canterbury has always been and continues to be your Pulmonary Rehabilitation of Choice in Richmond.
Pulmonary Rehab Case Study
60-year-old male admitted to Canterbury Healthcare and Rehabilitation Center after Hospitalization at Henrico’s- Forest S/P Acute Respiratory Failure with Hypoxia, COPD exacerbation, Pneumonia, and Anemia.
Nursing Interventions:
Medication Management – Prednisone taper, Wixela, Symbicort, Spiriva, Lovenox, Aspirin, and Atorvastatin
Monitor Labs – BMP, CBC
DVT Prophylaxis – Lovenox
Maintain Pain-Free
Respiratory Interventions:
Maintain Adequate Oxygenation – 3 lpm via nasal cannula
Pacing and Endurance training
COPD Zone tool Self-Assessment Education on Chronic Disease Management
Accomplishments:
With a multidisciplinary team-focused approach to care, inclusive of our full-time respiratory therapist, the patient improved and was able to return home. The patient received one on one education from our respiratory therapist and worked on pacing and endurance with activity.
Onsite Physiatry Services allowed for the ideal day-to-day pain and movement management. The patient returned home with his daughter after a 14-day stay in short term rehab.
Canterbury continues to be the Campus of Excellence in the care of the Complex Pulmonary Population
Pulmonary Rehab Case Study
60-year-old male (S.P.) admitted to Canterbury Healthcare and Rehabilitation Center after a stay at Henrico Doctor’s Pavilion Parham S/P Left sided C-Spine Mass with severe Cord Compression and spinal surgery. This patient was admitted with a Tracheostomy Tube “with no intention of removing due to ongoing need from overall weakness”.
Nursing Interventions
Maintain Patent Airway – wean as tolerated – DONE
Monitor Fluid Balance – Monitor Lasix 80 with Potassium Supplementation
Monitor Labs – BMP with GFR, CBC, BMP
Maintain Pain-Free – Baclofen, Celexa, and Voltaren Gel
Advance Diet – Diet advanced and ultimately now on regular and thin liquids
Respiratory Interventions
Maintain Patent Airway and Educate Patient on care of airway
• Maintain Adequate Oxygenation – Wean oxygen as tolerated
• Bronchodilitation – Incruse, Ellipta, Wixela and Guaifenesin
Accomplishments:
Under the Leadership of our In-House Pulmonologist, Dr. Kenneth Haft, and the day-to-day collaborative care inclusive of our full-time respiratory therapist, the patient gained strength, and the tracheostomy tube was removed.
Therapy:
Patient continues to make gains in therapy and is motivated by his accomplishments. He has voiced his appreciation in the caring staff of Canterbury and continues to work hard daily in hopes of returning home. He enjoys the fine dining and activities offered at Canterbury Rehabilitation Center.
Pulmonary Rehab Case Study
77-year-old male admitted to Canterbury Healthcare and Rehabilitation Center after a stay at Encompass Rehab and Vibra Hospital S/P Acute Respiratory Failure with Hypoxia, Cardiogenic Shock, Dysphagia, Laryngeal Stenosis and history of COPD and OSA.
Nursing Interventions
Medication Management-Wixela, Atorvastin and Guafenisin
Monitor Fluid Balance- Monitor Lasix 80 BID w Potassium Supplementation
Monitor Labs- BMP, CBC, CMP
DVT Prophylaxis- Plavix and Coreg
Respiratory Interventions
Maintain Patent Airway and Educate patient on care of airway
Maintain Adequate Oxygenation- Wean oxygen as tolerated
Bronchodilitation- Incruse, Ellipta, Wixela and Guaifenesin
Under the Leadership of our In-House Pulmonologist, Dr. Kenneth Haft, and the day-to-day care inclusive of our full-time respiratory therapist, the patient improved and was able to return home. Patient received one on one education from our respiratory therapist and learned the ability to self-perform trach care and suctioning.
Patient returned home ambulating 200 feet with roller walker and supervision. He continues to follow with James River Home Care and uses Adapt Health for his Trach supplies at home. He will continue to follow in the community with Pulmonologist, Dr. Haft.
COVID Recovery Case Study
91-year-old male (R.Z.) admitted to Canterbury Healthcare & Rehabilitation Center after a 3 day stay at Hunter Homes McGuire Hospital S/P fall and UTI. History of COPD, CHF & Bladder/Lung Cancer. Unfortunately, several days into his stay he was found to be weak, hypoxic and Covid-19 positive.
Nursing Interventions
Monitor Vitals – Monitoring of Hemodynamics & Encouraged Hydration
Medication Management – Dexamethazone, Vitamin C and Zithromax
Treat Infection – IV Antibiotic Therapy for UTI – 2 gram Ceftriaxone
DVT Prophylaxis – Eliquis
Monitor Fluid Balance – Lasix 40 mg daily
Respiratory Interventions
Maintain Adequate Oxygenation – admitted on home treatment regimen of Oxygen at 3 lpm, Increasing to 10 lpm via Oxymizer throughout his stay.
• Bronchodilitation – Incruse Ellipta, Wixela and Guaifenesin
• Aspiration Precautions
• Bronchodilitation
• Deep Breathing and Cough – Incentive Spirometry
Full Time Respiratory Therapy oversight assisted with treatment in place and close clinical team collaboration.
Patient is recovering safely avoiding any unplanned hospitalizations and has returned to his chronic oxygen therapy regimen of 3 lpm. The patient continues to be provided care at Canterbury that is #NextToHome and to work toward his final discharge goal as the team works to #CareSafely and guide his stay.
