Orthopedic
Case Study

84-year-old female was admitted to Alexandria Rehabilitation and Healthcare Center from Inova Mount Vernon Hospital, where she initially presented after a fall. She recently underwent a right total hip arthroplasty and has been experiencing worsening right hip and lower back pain since her fall. Orthopedic consulted. No acute fracture seen on hip Xray. Patient maintained TTWB right lower extremity. Lumber spine Xray with scoliosis and extensive lumbar spondylosis. Past medical history significant for HTN, HLD, COPD, hypothyroidism, OSA, and bipolar disorder. Patient was admitted to Alexandria Rehab for medical optimization and ongoing therapy services.

Nursing Interventions:

Medication Management – Amlodipine, Depakote, Synthroid, Bupropion, Gabapentin, Oxycodone PRN, Lovenox
Close Monitoring of Labs including CBC and BMP

Therapy Interventions:

Followed by our PMR Provider, Rubeena Vincent, CRNP.
Goals: Patient’s goal was “to return to her prior level of function”.

Initial Evaluation:

Patient is TTWB on right lower extremity. Upon admission, she was independent for bed mobility and required contact guard assistance for transfer. She also required assistance for self-care including supervision for upper body dressing, Min A for
toileting, and Mod A for lower body dressing.

Interventions:

Individualized therapy plan was developed consisting of physical and occupational therapy.

Discharge Evaluation:

She made significant gains with therapy to regain her independence. At discharge, she advanced to supervision to ambulate 200 feet with RW and safely ascend/descend 12 steps. She also regained her independence with self-care including Mod I for bathing, toileting, and dressing.

After a successful stay at Alexandria Rehab, the patient was discharged home with support from Esprit Home Health. She will continue to be supported by her PCP, Dr. Adeline Viyuoh in the community.

Orthopedic
Case Study

87yearold female was admitted to Alexandria Rehabilitation and Healthcare Center from Inova Mount Vernon Hospital, where she presented with COVID on Paxlovid, s/p syncopal episode and fall, resulting in bimalleolar right ankle fracture. Orthopedic consulted and she underwent ORIF of right ankle. Past medical history includes HTN, HLD, GERD, PVD. Because of new deficits in functional mobility and selfcare, she was admitted to Alexandria Rehab for medical optimization and ongoing therapy services.

Nursing Interventions:

Medication ManagementClonidine, Metoprolol, Oxycodone, Pantoprazole Close Monitoring of surgical incision site, to include assessing for s/s of infection and providing prescribed wound care.
Maintain Safety – patient at risk for falls.

Therapy Interventions:

Followed by our PMR Provider, Rubeena Vincent, CRNP.
Goals: Patient’s goal was “To be able to walk again.”

Initial Evaluation:

Patient NWB on right lower extremity, fall risk. Upon admission, she was stand by assist for bed mobility and required contact guard assistance for transfers. She also required assistance for selfcare including supervision for upper body dressing, Mod A for toileting, and Mod A for lower body dressing.

Interventions:

Individualized therapy plan was developed consisting of physical and occupational therapy.

Discharge Evaluation:

She made significant gains with therapy to regain her independence. At discharge, she advanced to supervision, ambulating 200 feet with TwoWheeled Walker and safely ascend/descend 4 steps. She also regained her independence with selfcare including Mod I for bathing, toileting, and dressing.

After a successful stay at Alexandria Rehab, the patient was discharged home to The View Alexandria Assisted Living Facility. She will continue to be supported by her PCP, Dr. David Gehring in the community.

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