The Pulse

Patient Information: Female, Age 72

Diagnosis: Cardiac Arrest / Pulmonary Embolism

History: This woman was referred to a skilled nursing facility for rehabilitation services due to severe weakness and debility following hospitalization. She had a pulmonary embolism (blood clot in the lungs) which required intubation and life support with extracorporeal membrane oxygen – ECMO (blood pumped outside the body to a heart and lung machine to remove carbon dioxide and send oxygenated blood back to the body). Prior to hospitalization, she lived at home and was independent with all mobility and self-care.

The rehabilitation of patients with and recovering from COVID-19 is evolving and will be an integral part of therapy for the foreseeable future. The American Physical Therapy Association (APTA) developed a task force representing all academies and sections to identify core outcome measures to be used with all patients diagnosed with COVID-19 throughout care, across all settings. These outcome measures are to be used with patients having goals associated with five constructs; function, strength, endurance, cognition, and quality of life. (APTA, 2020)

Patient Information: Female, Age 76

Diagnosis: Chronic Heart Failure / Generalized Muscle Weakness / Shoulder Pain

History: This woman was admitted to the hospital to address multiple medical issues. Following hospitalization, she was referred to a skilled nursing facility for rehabilitation to address her limitations in strength and mobility, with a goal to return home alone at her prior level of function, independent with all mobility.

Patient Information: Female, Age 68

Diagnosis: Respiratory Failure

History: This woman was referred to a skilled nursing facility due to severe deconditioning following a two-month hospitalization for pneumonia, during which she experienced respiratory arrest and required ventilation by tracheostomy intubation (surgical procedure inserting a breathing tube through the trachea to restore breathing).

Diaphragmatic breathing helps individuals use their diaphragm correctly while breathing and enhances oxygen exchange (Cleveland Clinic, 2020). With age, stress, poor posture, and illness breathing changes and becomes shallow with increased reliance on accessory muscles. Implementing diaphragmatic breathing may help improve oxygen delivery throughout the body, use less effort and energy to breathe, and decrease overall oxygen demand.

Patient Information: Male, Age 65

Diagnosis: Stroke / Oropharyngeal Dysphagia

History: This gentleman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to a stroke. He was diagnosed with oropharyngeal dysphagia (difficulty swallowing). His swallow initiation was inconsistent and he had difficulty managing his own secretions. He could not take any food or liquid by mouth and a feeding tube was placed. Prior to his stroke, he ate a regular diet.

Patient Information: Male, Age 69

Diagnosis: Chronic Heart Failure / Muscle Weakness / Kidney Failure

History: This man was admitted to a skilled nursing facility after a seven day hospital stay due to a decline in his ability to care for himself and his wife. He was referred to occupational and physical therapy to improve his strength and function, with the goal to return home and resume his role as the primary caregiver for his wife.

Part 1: Ethics and Considerations in Patient and Caregiver Perspectives