1
2
3
4
Orthopedic
Case Study
82-year-old male admitted to Yardley Rehabilitation and Healthcare Center from Jefferson Torresdale Hospital, where he initially presented after a fall. Patient found to have right rib fracture #3-8, right pulmonary contusion, right apical pneumothorax, right chest wall hematoma along with L1-L3 vertebral body fracture. Neurosurgery consulted for L1-L3 vertebral body fracture and recommended conservative management. For the rib fractures no treatment recommended, plan to continue pain medications as needed and monitor oxygen saturation. Past medical history is significant for atrial flutter, tachycardia, hernia repair, knee arthroscopy and right wrist arthroplasty. The patient was transferred to Yardley Rehab for continued medical optimization and therapy services.
Interventions:
Medication Management – Lovenox, Cardizem, Lidocaine patch, Aspirin
Close Monitoring of Vital Signs including pulse ox
Therapy Interventions: Followed closely by PMR attending Dr. William Bonner.
Goals: Patient’s goals were to “get stronger and walk”.
Initial Evaluation: Upon admission, he required assistance for mobility, including Mod A for bed mobility, transfers, and ambulation 30 feet with RW. He also required assistance for his activities of daily living including Mod A for lower body dressing and community ADLs, and Min A for toileting and medication management.
Interventions: Comprehensive therapy program was developed consisting of physical and occupational therapy.
Discharge Evaluation: He made significant gains to regain his independence. At discharge, he was Mod I for bed mobility, standby assistance for transfers, contact guard assistance to ambulate 150 feet with RW and able to safely ascend/descend 4 steps with Min A. He also regained his independence with his activities of daily living including Mod I for upper body dressing, set-up assistance for upper body bathing, and supervision for lower body bathing and dressing.
After a successful stay in short term rehab at Yardley Rehab, the patient was discharged home to Oxford Crossing with support from St. Mary Home Care. He will continue to follow with his PCP, Dr. Angelo Ratini in the community.
Pulmonary
Case Study
51-year-old male admitted to Yardley Rehabilitation and Healthcare Center from Fox Subacute at South Philadelphia, where he had resided for the last 9 months. Patient initially presented to Thomas Jefferson University Hospital after being found down at home. He was intubated in the emergency department for respiratory failure and chest CT showed pneumonia with cavitation. Hospital course complicated by continued ventilator dependent respiratory failure s/p failed extubation and he was eventually s/p tracheostomy. Patient with history of multiple sclerosis and neurology was consulted who felt that this was not related to MS flare but more of a gradual decline. After being successfully liberated from the ventilator, he was transferred to Yardley Rehab until a suitable long-term disposition is established.
Interventions:
Medication Management – Atorvastatin, Flomax, Ofatumumab injection, Lasix, Eliquis
Close Monitoring of Vital Signs including pulse ox
Wound Care – daily wound care to left great toe surgical wound and tracheostomy stoma
Respiratory Therapy Interventions:
Patient was followed closely by our Pulmonologist, Dr. Mitchell Jacobs and our in-house Respiratory Therapist. Patient was admitted with #7 Portex with PMV as tolerated. While in-house, capping trials were initiated which he tolerated. He was then successfully decannulated without incident.
Therapy Interventions:
After a prolonged hospitalization, the patient was found to be extremely debilitated and required extensive assistance to complete mobility and the activities of daily living. Upon admission, he required Max A for dressing, bathing, bed mobility, transfers and was able to ambulate 5 feet with RW. An individualized therapy plan was developed consisting of physical and occupational therapy. Currently, he can perform sit-stand transfer with Mod A x2 and ambulate 5 feet with Mod A and RW. With set-up assistance, he can complete upper body bathing and requires Mod A for lower body bathing.
Patient is doing great and feels at home at Yardley Rehab!
