Pulmonary Case Study
A 71 year old female was admitted to Woodbine Rehabilitation & Healthcare Center following a stay at Vibra Richmond with Vent Dependent Respiratory Failure as a result of Sepsis pneumonia and COPD Exacerbation. She has a history of Heart Failure, Hypertension, Hyperlipidemia and Anemia. She was admitted to Woodbine requiring a Ventilator, Tracheostomy and PEG tube.
Nursing Interventions:
- Maintain Proper Nutrition – Wean Peg Tube and Advance diet as tolerated
- Educated Family of Nutritional Tube Care
- Treat Infection – Pseudomonas Pneumonia – RESOLVED
- DVT PROPHYLAXIS – Heparin
- Monitor Labs, Vitals and Diagnostics – WBC, H&H, BUN, Creatnine, CXR
Respiratory Interventions:
- Ventilator Weaning – GOAL MET
- Maintain Patient Airway – Wean as tolerated – GOAL MET – Tracheostomy Removed!
- Maintain Adequate Oxygenation – Wean as tolerated – GOAL MET
- Aspiration Precautions – Downgraded diet – Dysphagia Stage 3 and thin liquids
Therapy:
Resident benefited extensively from skilled physical, occupational, speech, and respiratory therapy. Daily collaboration with the Care Team assisted to #CareSafely for her, allowing for a discharge home. Her strength improved daily and progress was made. She was discharged home ambulating 60 feet with a roller-walker stand by assist.
Accomplishments:
Successfully weaned from ventilator and trach weaned shortly thereafter. Patient Diet Advanced to Thin Liquids and Dysphagia Stage 3 Consistency.
The patient was discharged home with her supportive family. She will continue to be followed by Care Advantage – All About Care Home Health in the community. The team’s Multi-Disciplinary Approach to Care Allowed for a Successful Discharge.
Pulmonary Case Study
A 77-year-old male was admitted to Woodbine Rehabilitation & Healthcare Center from Inova Alexandria Hospital after a recent hospitalization S/P Fall, Aspiration Pneumonia and Acute Respiratory Failure and Pneumonia. Patient has a history of ALS.
Nursing Interventions:
- Medication Management – Rilutek, Amiodarone, Hydrochlorothiazide, Losartan, Xarelto, Metoprolol, Amioderone
- Maintain Safety – S/P Fall
- Maintain Proper Nutrition – Via Peg Tube and Advance PO trials as tolerated
- Treat Infection – IV Antibiotics for Pneumonia
- Aspiration Precautions – Advance Diet as tolerated; admitted on Advanced Texture/ Nectar Thick liquids
Respiratory Interventions:
- Maintain Adequate Oxygenation – 6 lpm via nasal cannula
- Maintain Patent Airway and Trach Wean trials under direction of Pulmonologist, Dr. Khouri.
- Maintain Noctural Support – AVAPS-AE at hour of sleep and as needed while awake
- Pacing with Activities
Therapy:
Under the Daily Direction of our in-house Nurse Practitioner as well as the weekly Leadership by Pulmonologist, Dr. Alkhouri and Physiatrist, Dr. Tiffany Vu, DO: Patient gained strength needed to return home.
FEE’s- in house testing allowed for Advanced PO Diet with Regular and thin liquid resumed.
Increased Compliance and Ability to Self- Apply Nocturnal AVAPS-AE Trilogy Support.
Resident benefited extensively from skilled physical, occupational, speech, and respiratory therapy under the multidisciplinary approach to care. The patient gained the strength needed to return home.
Accomplishments:
After a 15-day Short Term Rehab Stay, patient returned home with family and continues to be followed in the community by Roberts/ Adapt Health for Trilogy and Portable Oxygen Concentrator Management and Encompass Home Health in Springfield.
Pulmonary Case Study
A 61-year-old female was admitted to Woodbine Rehabilitation & Healthcare Center from Virginia Hospital Center after a long course of Pneumonia and Acute Hypoxemic Respiratory Failure Secondary to Covid 19. She has a history of Pulmonary Fibrosis. She has a trach and PEG tube in place at the time of admission. She was bed-bound requiring total assistance.
Nursing Interventions:
- Wound Healing – DTI to Heels
- Maintain Proper Nutrition – Wean Peg Tube and Advance PO trials
- Treat Infection – IV Antibiotics for Pseudomonas Pneumonia
- Monitor Labs and Vitals
Respiratory Interventions:
- Ventilator Weaning
- Maintain Patent Airway and Trach Wean trials under direction of Pulmonologist, Dr. Khouri.
- Maintain Adequate Oxygenation
- Secretion Management
- Aspiration Precaution – Enteral
Accomplishments:
Under the Direction of Pulmonologist, Dr. Alkhouri, Patient Successfully Weaned from Ventilator 2 weeks into stay and trach weaned on week three, Wounds Resolved, Advanced to PO Diet with Regular and thin liquid resumed and Peg Tube removed.
Therapy:
Resident benefited extensively from skilled physical, occupational, speech, and respiratory therapy under the multidisciplinary approach to care. Patient was moderate assist of 2 for bed mobilities. Her strength improved. Upon discharge, she was moderate assistance of one to roll and to sit EOB for 20 minutes. She returned home with family and is followed in the community by a PCP in the community.
Pulmonary Case Study
This unfortunate 52-year-old female (D.V.) admitted to Woodbine Rehabilitation & Healthcare Center from Henrico’s Doctors Hospital with Vent Dependent Respiratory Failure S/P Overdose and Aspiration Pneumonia. She was admitted with a trach and PEG tube in place.
Nursing Interventions:
- Maintain Proper Nutrition- Wean Peg Tube and Advance diet as tolerated – MET
- Treat Infection- Pseudomonas Pneumonia – Resolved
- Monitor Labs and Vitals
- Maintain Safety
Respiratory Interventions:
- Ventilator Weaning – MET
- Maintain Patent Airway and Trach Wean trials under direction of Pulmonologist, Dr. Khouri – MET
- Maintain Adequate Oxygenation – MET
- Aspiration Precaution – downgraded diet – Advanced
Accomplishments:
Successfully weaned from ventilator 2 weeks into the stay and trach weaned on week three. FEES testing with Thin Liquids and Regular Diet Advancement; Peg Tube removed
Therapy:
Resident benefitted extensively from skilled physical, occupational, speech, and respiratory therapy. Daily Collaboration with the Care Team assisted to #CareSafely for her allowing for a rapid discharge to home. Her strength improved daily, and progress was made. She was discharged to home ambulating 20 feet with a Roller-walker stand by assist. The team’s multi-disciplinary approach to care allowed for an expedited successful discharge to home. She returned home with her husband and will continue to be followed by PCP in the community.
Pulmonary Case Study
A 27-year-old male admitted from the hospital to Woodbine Rehabilitation & Healthcare Center with Chronic Hypoxemic Respiratory Failure Secondary Drug Overdose. His medical history also included complications from kidney injury, pulmonary embolism and myoclonus dystonia with a questionable vocal cord paralysis. Thus, he had a trach and PEG tube in place at the time of admission.
Nursing Interventions:
- Maintain Safety – Fall prevention and seizure monitoring
- Wound Healing and Maintain Proper Nutrition
- Pain management and drug overdose intervention
- Prevent Infection
Respiratory Interventions:
- Maintain Patent Airway – Trach Weaning trials under direction of our in house Pulmonologist, Dr. Khouri
- Maintain Adequate Oxygenation
- Aspiration Precautions
- Bronchodilitation
Accomplishments:
Successfully weaned from trach after 3 weeks of admission • Oxygen Discontinued prior to Discharge • Wounds resolved • PO Diet with Regular and thin liquid Resumed, and Peg Tube removed
Therapy:
Upon admission resident was bedbound requiring total assistance; he was NPO- medications and nutrition provided via PEG tube; he also had dysphagia and dysphonia with tracheostomy tube in place. Resident benefitted extensively from skilled physical, occupational, speech, and respiratory therapy and the multidisciplinary approach to care. His strength improved greatly and soon he was able to transfer off TCU to step down and shortly after was ambulating independently in the halls with a walker.
COVID 19/Pulmonary Case Study
59-year-old male admitted to Woodbine Rehabilitation & Healthcare Center from Bridgepoint Hospital National Harbor with Acute Hypoxemic Respiratory Failure secondary to Covid 19. He suffered from complications from Pseudomonas Pneumonia, Hypertension, and Sacral Decubitis. He has a trach and PEG tube in place at the time of admission. He was bed-bound requiring total assistance.
Nursing Interventions:
- Wound Healing – Sacral Decubitis
- Maintain Proper Nutrition – Wean PegTube and increase PO trials
- Treat Infection – Pseudomonas Pneumonia
- Monitor Labs and Vitals
Respiratory Interventions:
- Ventilator Weaning
- Maintain Patent Airway and Trach Wean trials under direction of Pulmonologist, Dr. Khouri
- Maintain Adequate Oxygenation
- Aspiration Precautions – downgraded diet
- Bronchodilitation
Accomplishments:
Patient successfully weaned from ventilator 2 weeks into stay and trach weaned on week three. He benefitted extensively from skilled physical, occupational, speech, and respiratory therapy and the multidisciplinary approach to care. His strength improved and quickly he was ambulating 50 feet with a roller walker independently in the halls.
Therapy:
Resident benefitted extensively from skilled physical, occupational, speech, and respiratory therapy and the multidisciplinary approach to care. His strength improved and quickly he was ambulating 50 feet with a roller walker independently in the halls.
Patient was determined to return home as quickly as possible. The team worked to develop a personalized care plan to free him of ventilator as quickly as possible. The patient expressed sincere gratitude to the staff at Woodbine.
“One thing I have learned from the team is to be patient and wait for the Lord’s time. Whenever I would get anxious, they would say for me to relax. Now that I am going home, I can relax well.”
COVID 19/ Pulmonary Case Study
This is a 61-year-old female admitted to Woodbine Rehabilitation & Healthcare Center from Virginia Hospital Center after a long course of Pneumonia and Acute Hypoxemic Respiratory Failure Secondary to Covid 19. She has a history of Pulmonary Fibrosis. She has a trach and PEG tube in place at the time of admission. She was bed bound requiring total assistance.
Nursing Interventions:
Wound Healing- DTI to Heels
Maintain Proper Nutrition- Wean Peg Tube and Advance PO trials
Treat Infection- IV Antibiotics for Pseudomonas Pneumonia
Monitor Labs and Vitals
Respiratory Interventions:
Ventilator Weaning
Maintain Patent Airway and Trach Wean trials under direction of Pulmonologist, Dr Khouri
Maintain Adequate Oxygenation
Secretion Management
Aspiration Precaution- Enteral Nutrition on admission
Bronchodilatation
Accomplishments:
Under the Direction of Pulmonologist, Dr. Alkhouri
Patient Successfully Weaned from Ventilator 2 weeks into stay and trach weaned on week three, Wounds Resolved, Advanced to PO Diet with Regular and thin liquid resumed and Peg Tube removed.
Therapy:
Resident benefitted extensively from skilled physical, occupational, speech, and respiratory therapy under the multidisciplinary approach to care. Patient was moderate assist of 2 for bed mobilities. Her strength improved. Upon Discharge, she was moderate assistance of one to roll and to sit EOB for 20 minutes.
She returned home with family and is followed in the community by her PCP, Dr. J Ortiz Perez.
Pulmonary Rehab Case Study
This unfortunate 52-year-old female admitted to Woodbine Rehabilitation & Healthcare Center from Henrico’s Doctors Hospital with Vent Dependent Respiratory Failure S/P Overdose and Aspiration Pneumonia. She was admitted with a trach and PEG tube in place.
Nursing Interventions
Maintain Proper Nutrition- Wean Peg Tube and Advance diet as tolerated- MET
Treat Infection- Pseudomonas Pneumonia- Resolved
Monitor Labs and Vitals
Maintain Safety
Respiratory Interventions
Ventilator Weaning- MET
Maintain Patent Airway and Trach Wean trials under the direction of Pulmonologist, Dr. Khouri- MET
Maintain Adequate Oxygenation- MET
Aspiration Precautions- downgraded diet- Advanced
Accomplishments:
Successfully weaned from ventilator 2 weeks into the stay and trach weaned on week three. FEES testing with Thin Liquids and Regular Diet Advancement; Peg Tube removed
Therapy:
Resident benefitted extensively from skilled physical, occupational, speech, and respiratory therapy. Daily Collaboration with the Care Team assisted to #CareSafely for her allowing for a rapid discharge to home. Her strength improved daily, and progress was made. She was discharged to home ambulating 20 feet with a Roller-walker stand by assist.
The Teams Multi-Disciplinary Approach to Care Allowed for an Expedited Successful Discharge to home.
She returned home with her husband and will continue to be followed by PCP in the community, Dr. Manu Gadani.
