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72-year-old female admitted to University City Rehabilitation and Healthcare Center from The Hospital of the University of Pennsylvania. Patient with history of small cell carcinoma of left tonsil. Patient s/p L TORS radical tonsillectomy, L ND, trach/DHT placement and L RFFF reconstruction and STSG by Dr. Gregory Weinstein and Dr. Robert Brody. Post-op course c/b venous anastomosis thrombosis s/p neck exploration and revision. Past medical history significant for diabetes, HTN, HLD, and former smoker. Patient transferred to University City Rehab for continued medical optimization and tracheostomy management.
Medication Management – ASA, Glipizide, Atenolol, Levothyroxine, Metformin, Simvastatin,
Surgical Incision Monitoring and Wound Care – left neck incision OTA, left forearm donor site daily dressing change, left neck JP drain
Close monitoring of Vital Signs including Accu-checks and pulse ox
Maintain Adequate Nutrition – initially patient was NPO tolerating bolus tube feeds with Nutren 1.5 TID and supplemental Argiment BID via DHT. While in-house, patient s/p FEES with eventual DHT removal, her diet was advanced as tolerated. At discharge she was tolerating regular diet with pureed textures and nectar thick liquids. Maintained on aspiration precautions.
Patient was followed closely by our full-time in-house Respiratory Therapist and our Pulmonologist, Dr. Michael Korman. Patient maintained on trach collar and wearing PMV as tolerated. While at University City Rehab, the patient had a follow up appointment with ENT where she was decannulated and JP drain removed.
After a short stay at University City Rehab, the patient was able to safely discharge home alone. She will continue to follow with her PCP, Dr. Britta Hansen in the community.
78-year-old female admitted to University City Rehabilitation and Healthcare Center from Temple University Hospital, with admitting dx of acute on chronic hypoxic respiratory failure likely secondary to flare of combined pulmonary fibrosis with emphysema. Pt was initially worked up for possible lung transplant, deemed not a candidate d/t advanced age and PVD. Patient transferred to University City Rehab for continued medical optimization and oxygen titration with a goal to return to her prior level of function.
Medication Management – HCTZ, Prednisone, Bactrim, Trelegy, Insulin
Monitor Skin – wound care following, multiple skin tears d/t fragile skin, high risk for skin breakdown
Chronic Nose bleeds – d/t nasal cannula. Educated on the importance of utilizing humidification with oxygen
Upon admission, patient required 8L NC at rest, 10L NC to transfer from bed-commode and 15L NC with exertion, where she experienced symptomatic desaturations with lightheadedness. Patient was followed closely by our On-Site Pulmonologist, Dr. Michael Korman, and our On-Site Full Time Respiratory Therapist. At the time of discharge, patient weaned to her baseline 4L NC at rest, 8L Oxymizer with ambulation for 300ft without experiencing desaturation and lightheadedness had resolved.
Patient was discharged home with support from family and our partners at Bayada Home Health. Patient will continue to follow with her PCP, Dr. Richard Harootunian and Temple Lung Center in the community.
55-year-old male admitted to University City Healthcare and Rehabilitation Center after a stay at Hospital of the University of Pennsylvania after a fall, subsequently found to have relapsed acute lymphoblastic leukemia (ALL) with CNS involvement. Patient s/p Ommaya placement. Hospital course c/b CVA subacute infarcts with hemorrhagic conversion and associated delirium, new onset tremors thought to be secondary to drug-induced parkinsonism, pancytopenia secondary to chemotherapy, cerebellar ataxia and dysarthria secondary to cytarabine toxicity and heart failure. Patient was admitted to University City Rehab for continued PT/OT to maximize functional independence and mobility.
Medication Management – Acyclovir, Bactrim DS, Seroquel
Monitor Vitals – Monitoring of Hemodynamic
Maintain Safety – hx of recurrent falls, non-verbal at baseline; promote safety
Heart Failure Monitoring – monitor weight, monitor volume status
Patient actively participated with physical, occupational, and speech therapy 5 days a week. Upon admission, the patient required Mod A for transfers and was ambulating 20 feet with Min A with HHA. Upon discharge the patient was able to ambulate 240 feet with RW and ascend/descend 12 steps at a supervision level.
Patient was discharged home with his wife and support of Bayada Home Health after a successful stay at University City Rehab!
65-year-old female admitted to University City Rehabilitation and Healthcare Center from Penn Presbyterian Medical Center with acute on chronic ambulatory dysfunction in setting of lower extremity pain. Podiatry consulted, while at PPMC. Patient found to have recurrent left distal fibula fracture and dislocation, indicative of post-traumatic arthritis vs. possible lateral ankle instability and possible ligamentous laxity/sprain. Rec NWB in CAM boot with ACE wrap to reduce swelling. Significant past medical history includes ESRD on iHD, COPD, OSA, HFpEF, NSTEMI s/p PCI x4 and pacemaker placement, SVC thrombus on apixaban, T2DM, and recurrent MDRO UTI. The patient was then transferred to University City Rehab for continued medical optimization, on-site dialysis and therapy services.
Medication Management – Plavix, Torsemide, Carvedilol, Eliquis, Valacyclovir
Maintain Safety – initially NWB LLE in CAM Boot and knee immobilizer, WB status liberated to WBAT in CAM boot and knee immobilizer
Vital Sign Monitoring – including M/W/F weights and Accu-Checks ESRD Management – On-Site dialysis
Upon admission, the patient was Min A for bed mobility, Mod A for supine-sit and Max A for sit-stand and transfers. Patient participated in therapy. While at University City Rehab, the patient had a follow up appointment with orthopedics and her weight bearing restriction was liberated. Upon discharge, she was Mod A for sup-sit and Mod x2 for bed to wheelchair transfers.
After a successful stay in short term rehab, the patient was discharged home with support of family and our partners at Penn Medicine at Home. Patient receiving dialysis at Fresenius Northwest, and she will continue to follow with her PCP, Dr. Larry Finkelstein in the community.
