Case Study: St. James Rehabilitation & Healthcare Center (May 2015)

Patients Age: 60
Admission Date: April 09, 2015
Admitted From: SBUH
Discharge Date: May 12, 2015
Discharged To: Home
Length of Stay: 33 Days
Reason for Stay: Valve Replacement
How did this patient hear about St. James? Hospital Case Manager

Patient was admitted to St. James Rehab Center after a redo sternontomy and mitral valve replacement. Due to her complicated past medical history of end-stage renal disease, post living donor renal transplant in 2000, CHF, hypertension, atrial fibrillation, and Diabete Mellitus, her hospital stay was complicated. She spent over a month in SBUH before coming to rehab. Upon his admission, she had increased weakness, decline in ADL function, difficulty transferring, and was unable to ambulate. Her weakness was not only contributed to her hospital stay and past medical history, but also due to her fluid overload. She was treated aggressively with diuretics, including IV push Lasix. Her fluid overload did resolve ultimately making working with PT and OT easier. She attended physical therapy 6 times a week for difficulty with ambulation, gait and therapeutic activities. She attended occupational therapy 6 times a week secondary to weakness for bed mobility, transfer, toileting, ADL’s w/c, stand balance, tolerance, safety , energy conservation. In addition to PT and OT she attended cardiac rehab and was monitored biweekly by the respiratory therapist for EKG during therapy. During her stay she was followed by the cardiologists of North Suffolk Cardiology due to her extensive cardiac history and fluid overload. Due to compliance with her medication regiment and progression in PT and OT, she made great strides both physically and medically. She came into the facility ambulating only 30 feet; after one month of PT and OT she was able to ambulate over 350 feet with a rolling walker. Upon discharge great improvements she surpassed all goals that were set by the interdisciplinary team.