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59-year-old female was admitted to West Chester Rehabilitation and Healthcare Center from Thomas Jefferson University Hospital, where she initially presented with abdominal pain. CT abdomen revealed small bowel obstruction. Surgery consulted and no surgical intervention recommended at this time. Plan for strict NPO for bowel rest. Patient s/p PICC line placement and TPN initiated. Past medical history significant for retroperitoneal fibrosis, chronic pancreatitis, sigmoid volvulus s/p ileosigmoid anastomosis, ileostomy with subsequent reversal and prior PEG tube placement c/b gastrocutaneous fistula. Patient was admitted to West Chester Rehab for continued medical optimization.
Medication Management – Lovenox, Aspirin, Atorvastatin
Ensure Adequate Nutrition – continued TPN while on bowel rest, prior to discharge patient’s diet was advanced to regular diet with thin liquids and TPN was d/c’ed
Close Monitoring of Labs including CBC, BMP, Mg and PO4
Wound Care – followed closely by our Wound Care team, Gastrocutaneous fistula – ostomy bag in place, Nephrostomy drainage bag in place.
Upon admission, the patient required assistance for mobility and self-care. An individualized therapy plan was developed consisting of physical and occupational therapy. She made gains to regain her independence. At the time of discharge, she was Mod I for bed mobility, transfers and able to ambulate 400 feet with RW. She was also able to safely ascend/descend 4 steps with supervision. She was also able to regain her independence with self-care including set-up assistance for bathing, dressing, and toileting.
After a successful stay at West Chester Rehab, the patient was discharged home with support from family and Mercy Home Health. She will continue to be supported by her PCP, Dr. Patrick Anderson in the community.
88-year-old female was admitted to West Chester Rehabilitation and Healthcare Center from Riddle Memorial Hospital, where she initially presented with complaints of shortness of breath and dyspnea on exertion in setting of RSV bronchiolitis refractory to Prednisone taper. Patient found to have acute on chronic respiratory failure s/p IV Solumedrol with improvement in symptoms. Past medical history is significant for COPD, HTN, HLD, HFpEF, and diabetes. Patient was admitted to West Chester Rehab for medical optimization and therapy services.
Medication Management – Lisinopril, Aspirin, Crestor, Farxiga, Lasix, Norvasc, Cymbalta, Toprol XL, sliding scale insulin,
Close Monitoring of Vital Signs – including pulse ox, Accu-Checks, and weekly weights
Patient followed closely by our Pulmonologist, Dr. Anthony Flaim, and our full-time in-house Respiratory Therapist. Patient with new oxygen requirement likely due to her acute exacerbation of COPD which was caused by recent RSV infection. The patient’s respiratory medications were optimized, and she remained stable
on 2L oxygen via nasal cannula.
Upon admission, she was independent for bed mobility and required contact guard assistance for transfers and to ambulate 25 feet with RW. She also required assistance to complete her activities of daily living including Min A for dressing and Mod A for bathing and toileting. An individualized therapy plan was developed consisting of physical and occupational therapy. At discharge, she advanced to Mod I for stand pivot transfers, was able to safely ascend/descend 8 steps x2 with use of handrail and supervision along with being able to ambulate 80 feet with RW and standby assistance. She also made significant gains with her activities of daily living including Mod I for grooming, independent for toileting, and dressing and supervision for bathing.
After a successful stay at West Chester Rehab, the patient was discharged home with support from family and Bayada Home Care.
74-year-old female was admitted to West Chester Rehabilitation and Healthcare Center from Chester County Hospital. Patient presented with weakness and productive cough x3 days, found to have pneumonia s/p antibiotic course and maintained on baseline 3L oxygen via NC. Patient has been receiving dialysis for 7 months on Tue/Thur/Sat schedule at a dialysis center in Maryland. Patient resides in Pennsylvania and no longer has transportation to Maryland for dialysis and she is requesting a new dialysis center be established in Pennsylvania. Past medical history significant for ESRD on iHD, PAF not on AC, CHF, hypertension, PE, gout, and diabetes. Patient transferred to West Chester Rehab for medical optimization, therapy services and establishment of local dialysis center.
Medication Management: Atorvastatin, Allopurinol, Bupropion, Metoprolol Monitoring Vital Signs and Pulse Ox
Monitoring Dialysis Access Site – Monitor q shift
Diabetes Management – tolerating carb-controlled diet, blood glucose monitoring, insulin management
Upon admission, patient required contact guard assistance for bed mobility, transfers and was able to ambulate 20ft. She also required Min A for completion of ADLs. After a successful stay in short term rehab, she was Mod I for bed mobility, transfers, and able to ambulate 150ft with RW. She was also Mod I with ADLs.
After a 7-day LOS at West Chester Rehab, the patient discharged to home with support from family. She will continue to be followed by her PCP, Dr. Mary-Anne Ost and upon discharge she will be receiving dialysis at DaVita Jennersville as an outpatient.
64-year-old female was admitted to West Chester Rehabilitation and Healthcare Center from Chester County Hospital. Patient with history bilateral total knee arthroplasty course c/b instability of internal left knee prosthesis and infection of the anterior aspect of the left knee resulting in chronic knee pain that has progressively worsened leading to difficulty ambulating and limiting daily activities. Patient now s/p revision of left total knee arthroplasty by Dr. Andrew Old. Patient WBAT on LLE, no flexion with LLE knee immobilizer. PMH includes chronic pain, DVT, PE, depression, COPD, CHF, pulmonary HTN, spinal stenosis, and DJD. Patient transferred to West Chester Rehab for medical optimization and therapy services.
Medication Management: Lovenox-Coumadin Bridge, Lasix, methadone, Xanax, Oxycodone, Gabapentin
Frequent lab monitoring: PT/INR
Wound Care – close monitoring of surgical incision, daily dressing changes
Upon admission, pt was ambulating Min A 40ft RW, was Min A for bed mobility, however, therapy was severely limited by pain with movement. She also required assistance completing her ADLs. She was Mod A for LB Dressing and Min A for toileting. Patient activity participated with therapy. Upon discharge, she was able to ambulate 200ft x2 SBA/supervision with a RW, completed bed mobility with supervision and transfer with SBA. She also made significant gains with ADLs. She was able to complete UB dressing with set-up assistance, LB dressing with supervision, and toileting with set-up assistance.
After a successful stay at West Chester Rehab, the patient discharged to home with support from Penn Medicine at Home. She will continue to be followed by her primary care physician, Douglas Atlas in the community.
