1
2
3
4
Cardiac
Case Study
80-year-old male admitted to Lawrence Rehabilitation Hospital from The Hospital of the University of Pennsylvania, where he initially presented for cardiac surgical evaluation after a myocardial infarction with cardiac catheterization revealing 90% occlusion of the left main. Patient s/p CABG x3 with Dr. Christian Bermudez. Hospital course complicated by gross hematuria s/p cystoscopy, clot evacuation, bladder irrigation and prostatic fulguration with urology. Plan to maintain foley and follow up with urology as an outpatient. Hospital course further complicated by Afib s/p cardioversion. Past medical history significant for atrial fibrillation, enlarged prostate c/b urinary retention, and heart failure (EF 40%). Patient transferred to Lawrence Rehabilitation Hospital for comprehensive acute inpatient rehabilitation and medical optimization.
Rehabilitation Focus:
Mobility and self-care dysfunction with cardiopulmonary deconditioning – intensive physical and occupational therapy
Atrial fibrillation – Aspirin and Toprol-XL
Pain management – Tramadol PRN
UTI – s/p course of Cefuroxime
Hx of urinary retention and gross hematuria – foley remain in place, continue Oxybutynin and Finasteride
Therapy Interventions
Goals: Patient’s goal was to regain his independence and get home as quick as possible.
Initial Evaluation: Upon admission, he required Mod A for all mobility including sit to stand transfers, bed to chair transfer and to ambulate 14 feet with no assistive device. He also required assistance for self-care including Mod A for lower body bathing and lower body dressing.
Interventions: An individualized therapy plan was developed consisting of physical and occupational therapy.
Discharge Evaluation: The patient made significant gains with therapy to regain his independence. At the time of discharge, he advanced to supervision for bed mobility and sit-to-stand transfers. With Min A, he was able to ambulate 150 feet with RW. He also regained his independence with self-care including supervision for dressing toileting and bathing.
After 7-day length of stay in acute rehabilitation, the patient was discharged home with support from family. He will continue to be followed by his Cardiologist, Dr. Pirouz Parang in the community.
STROKE
CASE STUDY
46-year-old male admitted to Lawrence Rehabilitation Hospital from Robert Wood Johnson University Hospital New Brunswick, where he initially presented with garbled speech and right-sided weakness. Patient found to have acute left thalamic infarct with extension into the ventricles, hypertensive crisis with hypertensive encephalopathy resulting in right hemiparesis and expressive aphasia. Patient s/p IV Labetalol and Nicardipine with eventual transition to oral blood pressure regimen. Hospital course c/b bilateral pulmonary infiltrates s/p antibiotic course. Past medical history significant for diabetes, depression, and dyslipidemia. Patient transferred to Lawrence Rehabilitation Hospital for comprehensive acute inpatient rehabilitation and medical optimization.
Rehabilitation Focus
Cerebrovascular accident – intensive PT/OT, continue Lipitor daily
Hypertension – close monitoring of vital signs, continue Amlodipine, Enalapril, Hydralazine
Diabetes – continue Metformin daily and Accu-Checks 3 times daily
Depression – continue Zoloft daily
Anemia – continue low-dose iron
Duodenal ulcer – continue Prevacid q12hrs
Therapy Interventions
Goals: Patient’s goal was “I want to go home”.
Initial Evaluation: Upon admission, he required Max A for sit to stand and bed-to-chair transfer and to complete his activities of daily living. He also presented with severe expressive and receptive aphasia.
Interventions: Individualized therapy plan was developed consisting of PT/OT/SLP. He actively participated with therapy 5 days per week.
Discharge Evaluation: The patient made significant gains with therapy to regain his independence with mobility and self-care. At the time of discharge, he was independent for bed mobility and required supervision for sit-to-stand transfer. With contact guard assistance, he was able to transfer from bed-to-chair and ambulate 300ft with RW. He was also able to safely ascended/descend 12 steps with contact guard assistance. He was contact guard assistance for bathing and set-up assistance for dressing.
After a successful stay in acute rehabilitation, the patient was discharged home with support from family. He will continue to receive outpatient therapy at Lawrence Outpatient. He will continue to be followed by his PCP, Dr. Darshana Tawde in the community.
Major Multiple Trauma Case Study
19-year-old male admitted to Lawrence Rehabilitation Hospital from Capital Health Regional Medical Center, where he initially presented as a pedestrian struck by car. Upon arrival GCS of 3 and intubated and placed on a ventilator. Workup revealed R hip dislocation, L pelvic hematoma, L clavicle fx, L scapular fx, skull and sphenoid fx, C7-T1 transverse process fx and epidural hematoma. Patient s/p craniectomy for hematoma evacuation, R hip dislocation was reduced, and ORIF of L clavicular fx. Post-op course c/b respiratory failure s/p tracheostomy and PEG placement. He was eventually liberated from the ventilator and decannulated. Patient remains NWB on L upper extremity and WBAT on R lower extremity in unlocked R knee brace. Patient transferred to Lawrence Rehabilitation Hospital for comprehensive acute inpatient rehabilitation and medical optimization.
Rehabilitation Focus
Epidural hemorrhage/IVH/skull fx – s/p craniotomy and evacuation of epidural hematoma. s/p course of Keppra. Helmet when OOB. Plan for cranioplasty as an outpatient.
Dysphagia s/p PEG tube. Diet advanced as tolerated. PEG tube removed.
L clavicular fx – s/p ORIF. Remained in sling with NWB.
R hip dislocation – s/p closed reduction. WBAT, maintain total hip precautions.
Ambulatory dysfunction – continue intensive physical and occupational therapy.
Therapy Interventions
Goals: Patient’s goal was “I want to get better, get walking and back home to the person I was before”.
Initial Evaluation: With Max A he was able to complete for sit-stand transfer, bathing, and dressing. He was dependent to ambulate 10 feet with assistance of 2 and WC to follow.
Interventions: An individualized comprehensive therapy plan was developed consisting of physical, occupational, and speech therapy.
Discharge Evaluation: With Close Supervision he was able to complete sit-stand transfer, ambulate 300ft with quad cane, and safely ascend/descend 20 steps. For bathing he needed set-up assistance and was able to dress himself independently.
After a successful stay in acute rehabilitation, the patient was discharged home with support from his mom. He will continue to receive outpatient therapy at Lawrence Outpatient Center.
