Pulmonary
Case Study

80-year-old female admitted to Oxford Rehabilitation and Healthcare Center from Select Specialty Hospital in Willingboro, where she initially presented for complex medical management and ventilator management after a cardiac arrest at OSH. Patient with extensive past medical history including heart failure, CAD, diabetes, HLD, obesity, and OSA. While at Select Specialty Hospital, the patient was medically optimized and liberated from the ventilator and tolerating trach collar. Patient transferred to Oxford Rehab for continued medical optimization and tracheostomy management.

Nursing Interventions:

Medication Management – Hydralazine, Aspirin, Amlodipine, Carvedilol, sliding scale and prandial insulin, Lantus, Eliquis, Allopurinol, Modafinil, and Gabapentin,
Close Monitoring of Vital Signs including pulse ox and Accu-Checks
Ensure Adequate Nutrition – initially patient was tolerating pureed diet with thin liquids and receiving supplemental TEN via PEG. She actively worked with SLP to advance her diet as tolerate. TEN has been discontinued. Patient is now tolerating consistent carbohydrate diet regular texture with thin liquids with Glucerna daily.

Respiratory Therapy Interventions:

Patient was followed closely by our Pulmonologist, Dr. Bruce Dershaw and our in-house Respiratory Therapist. While in-house, her respiratory status was closely monitored. She advanced to tolerating tracheostomy capping trials with eventual decannulation. While in-house a sleep study was performed which revealed moderate to severe sleep apnea. Post-decannulation a CPAP was obtained. The patient was educated on the importance of utilizing the machine and has remained stable from a respiratory perspective.

Patient feels right at home at Oxford Rehab!

Pulmonary
Case Study

80-year-old female admitted to Oxford Healthcare and Rehabilitation Center from St. Mary Medical Center, who initially presented to the ER with c/o worsening dyspnea. Patient admitted for further evaluation and management. Subsequently found to hypercapnic respiratory failure 2/2 bronchospasm with BiPAP initiated, elevated troponin s/p cardiac Cath, metabolic alkalosis with respiratory acidosis and hyponatremia d/t SIADH. PMH includes left lobectomy 2/2 tuberculosis as a child, pulmonary hypertension, sleep apnea, chronic hypoxic respiratory failure on 4L NC at home and T2DM. Patient transferred to Oxford Rehab for BiPAP management, medical optimization under the supervision of her physician Dr. Tej Kokroo.

Nursing Interventions:

Medication Management – Lasix, Lovenox, Sildenafil, Diomax, Metoprolol
Lab Monitoring – CMP, BMP
Monitoring vital signs, pulse ox and Accu-Checks

Respiratory Therapy:

Patient was followed closely by our in-house Pulmonologist, Dr. Bruce Dershaw, and our in-house full-time Respiratory Therapist. While at Oxford Rehab, Dr. Dershaw adjusted the patient’s BiPAP
settings to marginally improve ventilation.

After a successful stay at Oxford Rehab, the patient discharged safely home with support of family and St. Mary Home Care. Prior to discharge all necessary DME was ordered and delivered to the patient’s home. Patient will continue to follow with her PCP, Dr. Tej Kokroo in the community.

Pulmonary Rehab
Case Study

74-year-old female admitted to Oxford Rehabilitation and Healthcare Center from Jefferson Torresdale Hospital with admitting diagnosis of Acute Respiratory Failure and COPD. Patient has a history of AFIB, Hypertension, and wears chronic oxygen at 4lpm prior to hospitalization. She arrives to Oxford newly requiring Trilogy AVAPS-AE Therapy.

Nursing Interventions

Medication Management-Atorvastatin, prednisone, Spiriva, Dulera, Xarelto
Monitor Labs – CBC, BMP, CMP

Respiratory Interventions

Tolerance of AVAPS Therapy – GOAL MET
Maintain Adequate Oxygenation DB&C Exercises – Incentive Spirometry to prevent Atelectasis
Pacing and Endurance Training – RT daily collaboration with Therapy.

Under the Leadership of Oxford Onsite Pulmonologist, Dr. Bruce Dershaw in partnership with Oxford’s Full time Respiratory Therapist, the patient continued to progress, gain strength and tolerance to the use of her AVAP’s Therapy. Patient progressed to ambulating 40 feet with a roller walker and Contact Guard.

This was the patients first experience in short term rehab; she reports feeling much improved and appreciative of the care and education she received. Upon Discharge, She will continue to be followed by PCP, Tricia Loehrig; Pulmonologist, Dr. Steven Geller, Bayada Home Health Services and Community Surgical to supply to AVAP’s Therapy.

Oxford Pulmonary Rehab… Where we set our patients up for continued success! #Trilogy #AVAPS Breathe Easy… Think Oxford.

Rehabbing Care / Ortho
Case Study

64-year-old female admitted to Oxford Healthcare and Rehabilitation Center from Jefferson Bucks Hospital who initially presented after a fall. Pt found to have unstable right trimalleolar fracture. Realignment was unsuccessful in the ER and patient was taken emergently to the OR for external fixation on 7/6, subsequently followed by external fixation removal and ORIF on 7/12 by Dr. Robert Norton. Patient remains NWB on her right lower extremity. PMH includes morbid obesity, HTN, paroxysmal Afib on Eliquis, hyperlipidemia and history of left ankle ORIF. Patient transferred to Oxford Rehab for continued PT/OT.

Nursing Interventions:

Maintain Safety – initially NWB RLE then advanced to WBAT RLE
Maintain Proper Nutrition – dietician following, patient with healthy weight loss
Treat Infection – Macrobid and Pyridium for recurrent UTI and dysuria
Pain Management
Monitor Labs and Vital Signs

Therapy:

Upon admission, patient was Mod A for bed mobility and dependent for transfers. Patient actively participated with PT/OT 5-days week. Patient was followed by PMR physician, Dr. John Furrey for knee paint s/p steroid injection. During her stay at Oxford Rehab, the patient’s weight being status was advanced to weight bearing as tolerated on right LE in ankle boot. Upon discharge, patient was able to ambulate 100ft supervision with SPC.

After a successful stay at Oxford Rehab, the patient discharged safely home with support of family and St. Mary’s Home Care services.

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