Heart Failure / Pulmonary / COVID Rehab Case Study
Female, B.A. 75 years old admitted to Willow Springs Rehabilitation and Healthcare center from Ocean University Medical Center with admitting diagnosis of COVD-19, UTI, Dysphagia, and SOB. The patient has an extensive cardiac history with an EF of 31%, Pacemaker, HTN, Chronic Kidney Disease, and Diabetes.
Nursing Interventions
Monitor Fluid Balance – Weight Monitoring, Dietician educated on good food choices.
Speech & Dietitian monitoring – The patient was initially admitted with a Diet texture ground consistency with Nectar thick liquids. Discharged home on a regular diet and thin liquids.
Labs and Diagnostic Testing – Weekly labs and Inhouse EKG, Chest X-ray
Medication and Pain Management including therapy modalities
Reviewed weekly by our IDT teams led by Cardiologist Dr. Todd Cohen, Shore Pulmonary Group, and Dr. Jennifer Scheick Physiatrist.
Therapy
Upon admission, the patient required moderate assistance with all self-care tasks, transfers, and ambulation functions using a rollator up to 10ft with minimal assistance. She worked hard with the therapy and clinical team to achieve her goal of returning home. Upon discharge, the patient was at a supervision level for all self-care tasks along with transfers. She was able to ambulate over 125ft feet with a rolling walker.
The patient returned to Chelsea Assisted Living, Toms River with the support of her family. All follow-up appointments were made prior to discharge including Primary
Care Physician Dr. A. Patel.
Cardiac Rehab Case Study
82-year-old male admitted to Willow Springs after a 16-day hospitalization at Hackensack Meridian Hospital for Acute on Chronic Systolic CHF, Acute Renal Failure with Hyperkalemia, CKD Stage 3 and history of Type 2 Diabetes. Patient admitted requiring IV Inotropic Therapy with Milrinone.
Nursing Interventions
Monitor Fluid Balance: Diuretic Therapy and Daily Weight Monitoring
Medication Management: Milrinone 0.375mcg/min continuous IV infusion for total dose 11.6ml per shift, Entresto 24-26 tablet QHS, Torsemide 20mg BID, Atorvastatin and Metoprolol
Aspiration Precautions: Patient received on nectar thick and chopped diet
Maintain Adequate Oxygenation: Oxygen therapy at 3 lpm on admission
Reviewed weekly in Cardiopulmonary round table team discussion and seen weekly by our In-center Cardiologist, Dr. Cohen
Therapy
Upon admission, Patient required maximum assistance with all self-care tasks and was able to ambulate 5 feet with maximum assistance and had marked Dyspnea on Exertion. He was receiving occupational and physical therapy 5 times a week for several weeks. Upon discharge, he was independent with all self-care tasks, able to ambulate 200 feet with a rolling walker and ascend/descend 4 stairs independently.
Patient’s weights remained stable throughout his stay, Diet was upgraded to Chopped and thin liquids. His Oxygen was weaned to 2 lpm continuous upon and set up for home upon discharge.
Patient returned home with his 24-home health aide after a 62-day LOS in STR. He is new to oxygen therapy and Milrinone Infusion. He lives in Greenbriar and receives visits from Mended Hearts Organization Volunteer. His Community PCP Dr. Martin Riss and will continue to follow with Dr. Cohen for Cardiology in the community.
