Surgical Orthopedic Case Study
A 64-year-old male (A.S.) was admitted to The Jewish Home from the Centra State Medical Center with an admitting diagnosis of falling off a horse and sustaining a left tibial plateau fracture which required a surgical procedure (Open Reduction and Internal Fixation) and acute fracture of the 6th and 7th ribs. The surgery was performed by Dr. Garret Sobol. The patient has a history of BPH and hyperlipidemia.
Clinical Care Interventions:
Monitor Labs – CBC w/diff and CMP
Wound Management – Monitor and Care for Surgical Incision Site Daily
Maintain Safety – Fall Precautions, Left Lower Leg Immobilizer
Monitor Pain Management and Bowel Regimen
Monitor HTN Medication Management
The patient was followed closely by Dr. Gopal, Primary Care Physician, and Dr. Gregg Berkowitz Orthopedic, along with Dr. Stacey Miller-Smith, Physiatrist.
Upon admission, the patient presented with pain, Non-Weight Bearing to the Left Lower Extremity requiring moderate assistance with ADLs, transfers, and ambulating with a rolling walker. The patient worked with therapy to obtain his goal of returning home. On discharge, he was at supervisor level for transfers, ADLs, and ambulation with a rolling walker.
After a stay in short-term rehab at The Jewish Home, the patient returned home with VNA Home Care Services and the support of his family. He was managed in-house without any unplanned discharges. He is followed by his Primary Care Physician Dr. Hany Gendy in the community. Patients will also continue to follow up with the Orthopedic team on discharge.
Cardiac / Pulmonary Rehab Case Study
85 years old female patient admitted to The Jewish Home Healthcare and Rehabilitation Center from Jersey Shore University Medical Center Hospital with admitting diagnosis of pulmonary edema and s/p TAVR. Cardiac Surgeon Dr. Brook Dejene performed a Transcatheter aortic valve replacement (TAVR). The patient also has an extensive Cardiac history of NSTEMI, HTN, and Anemia along with a CVA.
Nursing Interventions:
Electrolyte monitoring: Daily weight management and dietitian oversite Medication Management: Diuretic, Beta Blocker, Statin, Anticoagulation, Supplements
Diagnostic Testing and Labs: Weekly laboratory monitoring including CBC and CMP, Inhouse EKG
Pain Management – Therapy modalities and interventions along with medications
Respiratory Management – Energy conservation and respiratory assessment
Reviewed weekly at IDT led by Cardiologist Garden State Heart Care, Dr. Aaron VanHise, and Nina Kotlyar APN; Cristina Tursi ADON, Specialty Program Coordinator and In-house Respiratory Therapist Deborah Meyer.
Therapy:
Upon admission, the patient required minimal assistance with transfers and moderate assistance for bed mobility and ambulation. She worked diligently with therapy to obtain her goal of going back to her home. On discharge, the patient was ambulating 100′ with rolling-walker standby assistance and was able to perform all self-care tasks with supervision.
Patient returned home to Sunrise Assisted Living Facility after completing 14-days of rehab at The Jewish Home. Prior to discharge, all follow-up appointments were made including Dr. Matthew Schoenfeld Cardiologist in the community.
Cardiac Rehab Outcome
96-year-old female admitted to The Jewish Home after a 6-day hospitalization at CentraState Medical Center. Diagnosis NSTEMI followed by Monmouth Cardiology Associates, Dr. Lance Berger. Other Diagnosis include S/P Fall, CKD, Hypertension, Chronic Back Pain, UTI and Heart Murmur.
Clinical Team Interventions:
Dietary / Weight Management – Heart Healthy (low fat/low cholesterol/
2-2.5gm Na, Frequent weights
Medication Management- Amlodipine, Atenolol, Aspirin
Infection Management – Antibiotic Therapy
Monitor Labs, Vitals and Diagnostics- CBC and CMP as ordered
Pain Management – Tramadol, Gabapentin
She was followed in the center by Garden State Cardiology Vennansha Williams, NP; weight management remained stable.
At time of admission, patient required assistance with ADL’s, transfers and ambulation. Upon discharge, supervision with ADL’s, walked with a walker 300 feet, able to climb 10-12 stairs with standby assistance.
Patient returned home with her daughter after a 25-day LOS in Short Term Rehab. She will continue to follow with PCP Dr. Kapoor in the community. Discharge to home with a live-in caregiver from Senior Helpers, VNA Services and support of her family. Fox Rehab Services as well at home upon conclusion of VNA Services.
#NEXTLEVELCARDIACCARE AT THE JEWISH HOME
Cardiac Surgery / Nephrology Outcome
90-year-old male admitted to The Jewish Home after a 17-days hospitalization at Jersey Shore University Medical Center. S/P Transcatheter Aortic Valve Replacement (TAVR) by Monmouth Cardiology Associates, Dr. Daniel Kiss. Diagnosis also include Heart Failure, HTN, CAD and CKD. The Shore Nephrology Group were also involved in patients care.
Clinical Team Interventions:
Monitor Fluid Balance- weights monitored daily and Lasix dose titration
Medication Management- Lasix, Bumetanide, Aspirin, Eliquis, Amlodipine Besylate, Metoprolol Tartrate, Retacrit and Potassium Chloride
Monitor Labs, Vitals and Diagnostics- CBC w/diff, CMP, BMP, Iron Studies
Patient was followed weekly in the center by Garden State Cardiology Vennansha Williams NP.
Upon admission patient was deconditioned. Required assistance with transfers, ambulation, and ADLs unable to do stairs. Patient discharged home with supervision for all ADL’s, ambulating 150 feet with a rollator at Stand-by assistance. Additionally, able to go up and down 4 steps with CGA to Minimal assistance.
Patient returned home with his wife and daughter after a 17-day LOS in Short Term Rehab at The Jewish Home. He will continue to follow with PCP, Dr. Shetty in the community and home health services will be provided by B/P Senior Care & VNA Home care for additional support.
The care at The Jewish Home is #nextlevelcare and #Multifocusspecialtyprogram!
Covid/Cardiac Recovery Outcome
86-year-old unfortunate male admitted to The Jewish Home after a 5-day hospitalization at Old Bridge Hospital S/P admission for acute hypoxic respiratory failure, Bacteremia and Bilateral Covid 19 Pneumonia. He has a history of CHF and Hypertension. He had AICD placement one month earlier.
Clinical Care Interventions:
Monitor Fluid Balance– weights monitored daily and Lasix dose titration
DVT Prophylaxis– Coumadin daily
Medication Management– Amiodarone, Metoprolol, Coumadin, Lisinopril
Treat Infection– Ampicillin IV for Bacteremia
Monitor Labs, Vitals and Diagnostics– EKG, CMP, BNP and INR
Wound Healing– Left Buttocks
Maintain Adequate Oxygenation– patient is new to oxygen at 3 lpm upon admission.
Emotional Support and Grieving– Loss of his wife while a STR patient with us
He was followed weekly in the center by Garden State Cardiology; He had a follow up ECHO conducted on site and weight management remained stable.
At time of discharge, Patient is ambulating 75 feet with a roller walker and climbing 7 stairs with bilateral handrails.
Patient returned home with his daughter after a 22-day LOS in Short Term Rehab. He was new to oxygen therapy on discharge and set up with Ocean Home Health. He will continue to follow with PCP, Dr. Matthew P. Terranova, Jr., in the community and home health services will be provided by Old Bridge Homecare.
Ortho Rehab Case Study
77-year-old female admitted to The Jewish Home after a 7-day stay at Jersey Shore University Medical Center with admitting diagnosis of S/P Right Hip Fracture. Patient has a history of Anemia and Thrombocytopenia. The Orthopedic Surgeon caring for the patient is Dr. David Polonet with University Orthopedists.
Clinical Care Interventions:
Monitor Labs – CBC, CMP and Iron Panel weekly
Monitor and Care for Surgical Incision Sites– Staples removed at F/U Ortho appointment on day 18 of her stay
Maintain Safety– History of Fall
Maintain Pain Free
DVT Prophylaxis– Lovenox
Medication Management– Iron, Omeprazole
Therapy:
Patient progressed to make gains in therapy. Upon discharge, she was ambulating 60 feet x 3 with roller walker and supervision for safety.
After a 19-day Length of Stay in Short Term Rehab at The Jewish Home, Patient returned to home with Excellence Home Care, her son and supportive daughter. She will be followed by PCP’s Dr. Shalom and Dr. Weinstein.
The Care at The Jewish Home is #NEXTTOHOME
Cardiac Rehab Case Study
91-year-old male admitted to The Jewish Home for Rehabilitation after a 7-day Hospitalization at Centra State with admitting diagnosis of Acute Hypoxic Respiratory Failure and palpitations. His medical history included Hypertension, Renal Failure, AFIB, CAD and Bradycardia.
Nursing Interventions:
Monitor Fluid Balance– Daily weights, Lung sounds every shift, Chest Xray to r/o CHF
Maintain Proper Nutrition– Dietician educated on good food choices, NAS regular and thin liquid diet.
Monitor Labs– Weekly BMP, Mag level BNP; Reviewed by Cardiologist.
Medication Management– Lasix increased to 40mg daily; Diltiazem HCI ER 240mg daily, Prednisone 20mg daily.
Reviewed weekly at Cardiology Lead IDT by Dr. Aaron Van Hise
Therapy:
Upon admission, Patient required maximum assistance with all self-care tasks. He Participated in extensive therapy 5 days a week. During his stay he was able to demonstrate marked improvements in his gait and able to ambulate over 200ft with rolling walker. He improved with his ADL’s to Independent.
Patient returned home with VNA services after 59 days LOS in STR. He was Managed In- House without any Unplanned Discharges. He is followed by PCP, Dr. Shetty in the community and will also continue to follow Cardiologist in the Community.
Ortho Rehab Case Study
89-year-old female admitted to The Jewish Home after a 5-day stay at CentraState Medical Center with admitting diagnosis of S/P Left Hip Intramedullary Nailing for Intratrochanteric Fracture. Patient has a recent history of Anemia, Congestive Heart Failure, A-Fib and Pneumonia.
Clinical Care Interventions:
Monitor Labs: BUN and Hemoglobin Weekly
Monitor and Care for Surgical Incision Sites
Maintain Safety: Multiple Falls
Treat Infection: Ceftin for Pneumonia
Monitor Fluid Balance: Lasix titration based on In-house Diagnostic CXR
Maintain Adequate Oxygenation: Oxygen at 2 lpm via nasal cannula as needed for hypoxia
Maintain Pain Free
DVT Prophylaxis
Reviewed weekly In-House by Orthopedist, Dr. Gregg Berkowitz.
Dr. Berkowitz weekly oversight assisted with advancement in her mobility while allowing for the convenience of care on The Jewish Home’s Campus.
Patient progressed in therapy ambulating 30-60 feet with roller walker and contact guard for safety. Patient returned home with Husband and Supportive Daughter. Daughter ultimately decided Mom was a lot to care for at home and chose
Long Term Care “with her family at The Jewish Home”.
Patient returned to The Jewish Home under the general care of Dr. Ayesha Chaudhary and Physiatrist, Dr. John Georgy.
The Care at The Jewish Home is #NEXTTOHOME
Explore the full list of our Clinical Services.
