Case Studies

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


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.


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.


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.

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