The Pulse

According to the National Institute of Nursing Research (NINR), five million Americans are affected by chronic wounds each year. Chronic wounds are those that do not show measurable progress in wound healing with standard nursing care in 30 days. Individuals with diabetes, disability, and the elderly are among those at highest risk.

Patient Information: Male, Age 75

Patient Information: Male, Age 81

Diagnosis: COVID-19 / Acute Hypoxemic Respiratory Failure

History: This gentleman was referred to a skilled nursing facility for rehabilitation services due to severe debility and confusion after hospitalization for COVID-19. During hospitalization, he was found to have acute hypoxemic respiratory failure (not enough oxygen in the blood), as a result of COVID-19, and was intubated (placement of an artificial airway into the trachea) and placed on a ventilator (life support to assist breathing). During treatment he received convalescent plasma which led to removal of mechanical ventilation, but he required oxygen supplementation of three liters. Prior to his diagnosis of COVID-19, he lived at home with his wife and walked independently, no oxygen supplementation was needed.

Muscle strength decline is associated with normal aging and may be accelerated by illness, disease, or injury. Decreased physical activity resulting from COVID-19 mitigation efforts is exacerbating the incidence of muscle disuse atrophy in older adults. Strength declines may lead to functional and mobility deficits with increased risk of falls, injury, or death. According to the CDC, each year three million adults are treated in emergency departments for injuries related to falls. By 2030 fall deaths are anticipated to rise to seven per hour. Accurate assessment of strength using validated tests and objective measures is crucial to creating an appropriate treatment plan and achieving outcomes that reduce fall risk.

Speech-language pathologists (SLPs) are commonly involved in the rehabilitation of patients with cardiopulmonary disorders. Patients hospitalized with respiratory diseases such as COPD and heart failure (HF) are identified as at risk for development of oropharyngeal dysphagia. Additionally, patients who experience prolonged endotracheal intubation have an increased risk of developing dysphagia. (Malandraki et al., 2016) This is often seen in patients hospitalized for COVID-19.

Patient Information: Female, Age 77

Diagnosis: Left Knee Pain

History: This woman, a long-term care resident of a skilled nursing facility, was referred to therapy due to knee pain and a decline in functional activity and ambulation. Prior to this recent decline, she was independent with ambulation throughout the facility.

Physical and occupational therapists treat many individuals who present with impaired coordination, motor control, balance and tone. These individuals may have a wide range of diagnoses, from neurologically involved, such as cerebral vascular accident (CVA) and Parkinson’s disease, to orthopedic involvement such as post-total knee replacement (TKR). The common goal of improving functional mobility and outcomes may be achieved by the addition of research-supported cycling and biophysical agents.

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.