The Pulse

Patient Information: Female, Age 80

Diagnosis: Mixed Incontinence

History: This woman, an independent living resident with a 40-year history of incontinence, was referred to outpatient therapy due to increased incontinence episodes. She had mixed incontinence (impaired urge sensation and pelvic floor muscle weakness) resulting in decreased socialization. She was considering the use of a pessary (a insertable prosthetic device that may help with stress incontinence) and took medication for overactive bladder.

Patient Information: Male, Age 77

Diagnosis: Oropharyngeal Dysphagia / Hypoxic Respiratory Failure / Childhood bulbar polio
with paralyzed vocal cord

Patient Information: Male, Age 49

Diagnosis: Pneumonia / Neuropathy

History: This gentleman was found by EMS unable to get out of bed and covered in soiled bedding with insect infestation, and reported he hasn’t been out of bed for “quite some time.” He
was admitted to the hospital with pneumonia, then transferred to a skilled nursing facility
for rehabilitation services.

Patient Information: Male, Age 96

Diagnosis: Fall / Compression Fracture

History: This gentleman was referred to a skilled nursing facility following hospitalization due to a fall in his garage which resulted in a thoracic compression fracture of the spine. Prior to the fall, he lived at home and was independent with ambulation, driving and mowing his yard.

Patient Information: Female, Age 76

Diagnosis: Chronic Obstructive Pulmonary Disease (COPD) / Chronic Heart Failure (CHF) / Diabetic Neuropathy

History: This woman was referred to home health therapy services due to numerous falls, poor balance, and a decline in functional mobility. Over several months she became wheelchair-dependent in part due to fear of falling. Prior to this decline, she was independent with transfers and able to walk with a rolling walker to the dining room for meals in her assisted living facility.

Patient Information: Female, Age 70

Diagnosis: Left Femur Open Reduction Internal Fixation (ORIF) / Pain

History: This woman was admitted to a skilled nursing facility for rehabilitation services following hospitalization due to a fall at home resulting in a left femur fracture requiring surgical repair. Prior to her fall, she lived in a 2-story home with her husband and was independent with walking and all activities of daily living.

Patient Information: Male, Age 87 Diagnosis: Pressure Ulcer / Type II Diabetes

History: This gentleman was transferred to a skilled nursing facility for long-term care with a long standing pressure ulcer. Nursing referred him to therapy for wound care intervention due to this non-healing stage IV (full thickness) coccyx (base of the spine) pressure ulcer despite being treated weekly be a wound care doctor and receiving daily wound care by nursing for almost 2 years (643 days). He also has type II diabetes and poor sitting posture which contributed to his slow healing.

Patient Information: Female, Age 81

Diagnosis: Distal Femur Fracture / Fall Risk / Dementia

History: This woman was hospitalized for a surgical repair of her right femur, which she fractured in a fall. Following hospitalization, she was referred to a skilled nursing facility for rehabilitation to address decreased functional mobility and safety. Previously, she also had a hip and knee replacement on the same side. Prior to her fall she lived at home with her spouse and walked independently, including up and down four steps at the entrance of the home.

Patient Information: Male, Age 57

Diagnosis: Cognitive Communication Deficit / Chronic Obstructive Pulmonary Disease /
Chronic Heart Failure

History: This gentleman was admitted to a skilled nursing facility and referred to speech therapy for decreased cognitive function and failure to thrive following bilateral above knee amputations. Previously, the gentleman lived at home.

Patient Information: Female, Age 83

Diagnosis: Acute Encephalopathy / Chronic Heart Failure / Morbid Obesity

History: This woman was referred to a skilled nursing facility due to declining health, functional mobility, and ability to care for herself. Thirteen months prior, she was hospitalized due to encephalopathy and complications from chronic heart disease, she was then referred to a skilled nursing facility for rehabilitation. She had poor adherence and participation in therapy. At that time, her son and daughter-in-law took her home despite requiring assistance for all transfers, mobility, and most daily living activities. Once home, her activity level and health further declined and she was re-admitted to the hospital and subsequently back to the skilled nursing facility. Prior to initial hospitalization, she was able to propel herself in her wheelchair up to 100 feet and was able to assist with transfers and self-care.