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.
80-year-old female DIRECTLY admitted to West Chester Rehabilitation and Healthcare Center from the Emergency Department at Chester County Hospital. She initially presented with lower extremity swelling and increased left knee pain that was unrelieved by pharmacologic interventions. She was also having difficultly bearing weight on her LLE d/t the pain. Left lower extremity ultrasound negative for DVT but did show large Baker’s cyst. PMH includes hypertension, CHF, obesity, COPD on CPAP, DJD, RA and hx of falls. Patient transferred to West Chester Rehab for continued medical oversight and therapy.
Medication Management – Lasix, Prednisone, Budesonide, Metoprolol, Amlodipine, Hydroxychloroquine
Diet – Heart Healthy Diet
Close Monitoring of Vital Signs and Weights
Patient was followed closely by our in-house Physiatrist, Dr. Kreb, along with physical and occupational therapy.
Goals: Prior to admission, she lived alone in 2-story house with 2 STE and 1st floor set-up. Patient’s goals included to be able to return home to prior level of functional independence with gait, increase LE ROM and strength while minimizing falls.
Interventions: Upon admission, pt was ambulating CGA 20ft. She actively participated in PT/OT. Upon discharge, pt was Mod I ambulating 150ft w/ RW and able to safely ascend/descend 8 steps with supervision.
After a successful stay in short term rehab, the patient returned home with support from Penn Medicine at Home for PT/OT. Patient will continue to follow with her PCP, Dr. Melanie Ice from Penn Medicine.
86-year-old male was admitted to West Chester Rehabilitation and Healthcare Center from Chester County Hospital, where he initially presented for elective endovascular abdominal aortic aneurysm (EVAR) repair including exploration and revision of left common femoral artery. Patient s/p EVAR. Hospital course c/b mesenteric ischemia requiring superior mesenteric artery stent placement. Course also c/b moderate sized pleural effusion s/p thoracentesis with drainage of 1400ml, low grade temperature and partial ileus. Nephrology consulted while at Chester County Hospital for dialysis. Past medical history significant for HTN, HLD, COPD, Glaucoma, ESRD on iHD and dementia. Patient transferred to West Chester Rehab for medical optimization, therapy services and on-site dialysis services.
Medication Management: Atorvastatin, Plavix, Metoprolol, Cefpodoxime
Monitoring Dialysis Access Site – Monitor q shift
Maintain Safety – hx of dementia, pleasantly confused at baseline
Upon admission, the patient required Min A for transfers and was able to ambulate 15 feet with RW. For the activities of daily living, he required Min A for bathing and LB dressing and Mod A for toileting. He was independent with self-feeding. He actively
participated with PT/OT. Upon discharge, he was Mod I for bed mobility, transfers and able to ambulate 150ft with a RW. He was also able to regain his independence with his activities of daily living. He was able to advance to standby assistance for bathing,
toileting and UB dressing.
After 19-days at West Chester Rehab, the patient discharged to home to Hershey Mills with support from his wife and Main Line Health Home Care. He will continue to be followed by his PCP, Dr. Lawrence Aldo Notaro and receive dialysis at DaVita Westtown in the community.