Case Study: The Willows at Ramapo Rehabilitation and Nursing Center (September 2018)

Patients Age: 71-years-old
Admission Date: 08/23/2018
Admitted From: GSH
Discharge Date: 9/20/2018
Discharged To: Home
Length of Stay: 28 Days
Reason for Stay: Hypertension and Chronic Obstructive Pulmonary Disease
How did this patient hear about The Willows at Ramapo? The Hospital referred him.

Fred was admitted to The Willows at Ramapo after being in Good Samaritan Hospital. Fred entered The Willows with a diagnosis of exacerbation of chronic obstructive pulmonary disease (COPD). Fred has a history of hypertension and chronic obstructive pulmonary disease. He lives with his ex-wife who acts as his primary caregiver. Fred is primarily homebound due to the severity of his COPD and being on continuous supplemental oxygen.

Upon Fred’s arrival to The Willows, he was welcomed by the director of concierge services and his nurse. Shortly after, the dietitian came to speak with him and reviewed his diet and discussed his likes and dislikes. Later in the day, he was evaluated by his physical, occupational, and respiratory therapists. Based on his evaluation, past medical history, and his current living status, a plan was made by the disciplines and goals were set to help facilitate a successful discharge home for him. Due to the progression of his COPD, most of his functional issues revolved around his breathing and respiratory status. In his initial early sessions, he had a very low tolerance for, not only standing or ambulating exercises, but seated exercises as well. He had the potential to be highly functional, but his respiratory status held him back from being able to progress at a higher level.

The key components to Fred’s therapy sessions were pacing and energy conservation. His initial distances for ambulation were very short and resulted in decreased oxygen saturation, shortness of breath, and extended recovery times. A large focus was on his breathing techniques. During the exercises, he was taught the pursed-lipped breathing method to help decrease shortness of breath and increase his oxygen intake. He was also given an incentive spirometer for him to use at his bedside throughout the day. This exercise helped promote air movement and to assist in controlling his breathing pattern.

From session to session, Fred started improving day after day. Ambulation became longer, shortness of breath was decreased, and his work of breathing improved. Due to his condition, there were some small setbacks. There were days where he took a step back, but he was usually able to make up for it in the next day’s session. Despite of his condition, he kept up a good outlook on his future and worked hard every single session. As his time here at the Willows came to an end and a discharge plan was made, a focus was put on strategies for a daily routine that were put into place to help him plan his day from the time he got up until he went to bed.

When it was time for his discharge from The Willows, Fred had met the goals set by all the disciplines. He was set to return back home with the tools, tips, and strategies for a successful and healthy life.