Urgent SNF Case Study
This is a 65-year-old male who presented to Franklin Square Medical Center with complaints of thigh pain and diagnosed with left hip septic arthritis. Patient had a prolonged hospitalization complicated by a thigh abscess, DVT and PE. A call was made for an Urgent SNF referral to Orchard Hill Healthcare and Rehabilitation Center, and was admitted for Rehab and Wound Care Services the SAME DAY.
Nursing Interventions
Maintain Safety – Fall Risk
Pain Management
Monitor Labs and Vitals – Weekly BMP, CBC, and CMP
DVT Propholaxis – Apixaban
Wound care – Daily wound care and weekly rounds
Therapy
Due to functional decline, upon admission the patient required moderate assistance with mobility, transfers and all self-care tasks. He was receiving Occupational and Physical therapy 5 times a week. Upon discharge, he was independent with all self-care tasks, climb 12 stairs, and was able to ambulate 200+ ft with a walker.
Patient was safely discharged to home with Community Home Health and will be followed up by his community Physician Dr. Deepak Seth.
Urgent SNF Case Study
A 77-year-old female was discharged home after being hospitalized at University of Maryland Rehab & Orthopaedic Institute. Unfortunately, the patient kept experiencing falls at home. A call was placed by our partner, Home Call Home Health to the Urgent SNF Hotline and the patient was admitted to Orchard Hill Healthcare and Rehabilitation Center the same day. She has a PMH of Rheumatoid Arthritis, Hypotension, T2 Non-Displaced Odontoid Fracture, and Cervical Stenosis.
Nursing Interventions
Monitor Labs – Including CBC, CMP, BMP
Medication Management – Aspirin, Hydrocodone-Acetaminophen, Gabapentin, Lisinopril, Oxycodone
Maintain Safety – S/P Falls and C-Spine Fracture, Cervical Collar
Monitor Vitals
Therapy
Upon admission, Patient exhibited functional decline due to decreased musculoskeletal condition and fatigue requiring moderate assistance with ADL’s and ambulation. Patient was receiving occupational and physical therapy 5 times a week. Upon discharge, she was independent with all self-care tasks, and able to ambulate 300+ feet with supervision.
Patient returned home safely with her nephew. She will be seen by Home Call and continues to work with therapy at home.
Urgent SNF Case Study
An 83-year-old female presented to Franklin Square Emergency Department to treat an infection s/p hip replacement. The patient had recently relocated to Maryland and planned to move into her daughter’s home, but soon realized the home was not ready to accommodate the patient’s needs. A call was made for an Urgent SNF referral to Orchard Hill Healthcare and Rehabilitation Center. The patient was directly admitted from the Emergency Room, receiving nursing and rehabilitation care.
Nursing Interventions
Wound Care
Maintain Safety Awareness
Monitor diagnostic testing & laboratory studies
Medication Management – Antibiotic treatment & Pain Management
Therapy
Upon admission, patient exhibited functional decline due to decreased musculoskeletal condition and fatigue requiring moderate assistance with ADL’s and ambulation. Patient is receiving occupational and physical therapy 5 times a week. She is now able to ambulate 120+ feet with a rollator and stand by assist.
Patient continues to work with therapy
Pulmonary Case Study
A 56-year-old female (P.D.) admitted to Orchard Hill Rehabilitation and Healthcare Center after hospitalization at Life Bridge, Sinai Hospital of Baltimore, with admitting diagnosis of COPD, OSA, Diabetes, and Anemia. She was admitted in need of further testing of her OSA.
Nursing Interventions
- Monitor Fluid Balance – Lasix 20mg BID and Ace Wraps to BLE,
- Diet Modification – CCHO Diet, Dietician educated on optimal food choices.
- Monitor Labs – CMP, CBC weekly
- Medication Management- Coreg, Combivent, Eliquis
- Wound Healing – bilateral lower extremity Cellulitis
Respiratory Interventions
- 4 channel Sleep Study- Conducted in Center to assess continued need upon discharge
- Maintain Adequate Oxygenation- O2 @ 4 LPM on Admission
- Maintain Nocturnal Support- Patient using Bipap at 16/11 for Sleep Apnea
- Pacing and Endurance with all exertional activity
Plan of Care Reviewed weekly with our Cardiac and Pulmonary IPC Teams led by Cardiologist, Dr. Jeremy Pollock and Pulmonologist, Dr. Schwartz. The onsite respiratory therapy and the ability to test the continued need for Nocturnal Support made Orchard Hill the campus of choice for this patient.
The patient plans to return home when her rehab stay is complete. She has been managed well by the team at Orchard Hill and is proud to report she has had a continuous, uninterrupted stay.
Pulmonary Case Study
46-year-old unfortunate male (E.H.) admitted to Orchard Hill Healthcare and Rehabilitation Center after an extended stay at University of Maryland Medical Center with admitting diagnosis of Traumatic Brain Injury secondary to Motor Vehicle Crash requiring the need for mechanical ventilation. Patient arrives with Trach and Peg tube.
Nursing Interventions
Provide Peritoneal Nutrition- Wean PEG tube and advance diet as tolerated
Educate patient and family on care of PEG tube upon discharge
Monitor Vitals and Labs- Blood Sugars
Respiratory Interventions
Maintain Patent Airway- Wean as Tolerated- GOAL MET
Maintain Adequate Oxygenation- Wean as Tolerated- GOAL MET
Therapy
Patient is non-ambulatory and continues to make small gains in therapy. He requires assistance with all ADL’s and continues to make gains in self feeding and grooming.
Orchard Hill’s On-Site Respiratory Therapist worked alongside the Speech Language Pathologist as well as the other members of the Clinical Care team and are excited to share he has been successfully trach weaned.
Through weekly collaboration of our clinical team and the Leadership of our In-House Pulmonologist Dr. Mitchell Schwartz, the patient’s trach tube was removed, and oxygen therapy was discontinued.
Due to the patient’s overall complexity and continued care needs, Patient currently continues with Long Term Care at Orchard Hill. The Caring Clinical Team and Engaged Activity Department make the Environment at Orchard Hill #NextToHome
Cardiopulmonary Renal Case Study
59-year-old, male (W.C.) admitted to Orchard Hill Healthcare and Rehabilitation Center after a 22-day hospital stay at Sinai with Admitting Diagnosis of Acute CHF, UTI and Acute on Chronic Renal Failure requiring dialysis.
Nursing Interventions
Monitor Fluid Balance– 1200 ml Fluid Restriction
Dialyze three times weekly
Treat Infection– IV Cefepime UTI
Maintain Hemodynamic Stability– BP’s Vary- frequent Medication titrations needed
Maintain Proper Diet– Renal Low Sodium
Respiratory Interventions
Daily Respiratory Therapy Oversight on Campus
Maintain Nocturnal Support– Auto-Cpap 5-20 at Hour of Sleep
Maintain Adequate Oxygenation– 4 LPM via Nasal Cannula
Patient required frequent medication adjustments, diligent fluid restriction and increased weight monitoring.
At Orchard Hill, we are able to #TreatInPlace under the Leadership of our Multi-Disciplinary Specialty Physicians. Orchard Hill’s Campus of Excellence Operates Under the Guidance of On-site Cardiologist, Dr. Jeremy Pollock; Nephrologist, Dr. Kamel Sewar and Pulmonologist, Dr. Mitchell Schwartz.
This Patient’s overall care needs exceeded his ability to care for himself at home and he decided The Care at Orchard Hill was #NextToHome. With our on-campus dialysis center, the patient could enjoy more quality in his days with less travel time therefore less fatigue to and from Dialysis Treatments.
Pulmonary Rehab Case Study
59-Year-Old Admitted to Orchard Hill Healthcare and Rehabilitation Center after a Hospitalization at GBMC for Acute on Chronic Respiratory Failure and CHF. She has a history of Sleep Apnea and Diabetes.
Nursing Interventions
Medication Management-Insulin, Lisinopril, Metoprolol, Torsemide and Coumadin
Monitor Fluid Balance- Daily Weight monitoring, Diuretic therapy
Monitor Labs- BBG and INR monitoring
Decrease Anxiety
Pulmonary Interventions
Maintain Adequate Oxygenation- Chronic Oxygen therapy @ 4LPM on Admit.
Maintain Nocturnal Support- Bipap 18/8 at hour of sleep and as needed
Bronchodilation- Duoneb Q4H and PRN and Advair
Pacing and Endurance with ambulation and all exertion
Secretion Clearance Device- Flutter valve TID x 10 breaths
Weekly Education with Guide to Living with Lung Disease Handbook
Patient was discussed and followed weekly by our in-house Pulmonologist, Dr. Mitchell Schwartz. Her day to day plan of care was guided by our Clinical team, including our own in house, Respiratory Therapist.
Therapy
Upon admission, Patient was moderate to max assist to roll in bed. She worked hard and with the assistance of our PT and OT 5 days a week, patient was able to slowly make gains. Upon discharge to home, patient was ambulating 40 feet with a roller walker.
Patient returned home with her daughter 30 pounds lighter and requiring less oxygen therapy than prior to the hospitalization. Patient returned home on 3 liters per minute and continued with her Bi-pap treatment regimen. She will continue to follow with her community Pulmonologist, Dr. Rhee.
Pulmonary Rehab Case Study
62-year-old female admitted to Orchard Hill Nursing and Rehab Center after a 7 day stay at Good Samaritan. She was admitted with Acute Exacerbation of COPD with hypoxia. Patient was bed bound prior and was being treated for severe back pain s/p spinal surgery.
Nursing Interventions
Medication Management: Baclofen for muscle spasms, pain management
Prednisone for edema
Monitor Vitals and Labs
Pulmonary Interventions
Maintain Nocturnal Support: Our in-house Respiratory Therapist assisted with Bipap Daytime Compliance Trials and taught the patient how to self-apply
Maintain Adequate Oxygenation: Patient weaned from 3 LPM on Admission to Room Air on DC
Bronchodilitation: Nebulized therapy was given QID upon initial admission then switched to MDI for portability on discharge.
Smoking cessation education was provided.
Dr. Schwartz, Pulmonologist, followed patient in center weekly and lead our Pulmonary IDT team round table discussion.
Therapy
Upon admission, Patient required maximum assistance for transfers secondary to chronic back pain. She was able to ambulate in PT. OT worked with her muscle atrophy. Upon Discharge, she was successful in ambulation 30-60 feet without assistance.
Patient returned home alone with help from her supportive daughter after a 36-day LOS in Orchard Hill Nursing and Rehab. She understands how to use her Bipap can now self-apply.
She will be followed up by her Primary Physician Michael Zang and her Pulmonologist, Dr. Dubin.
