Case Studies
Case Study 1
A 77 year old male was admitted with multiple systems involvement including
COPD, CAD, renal disease, and hyperglycemia. He had failed numerous attempts to
wean from mechanical ventilation using conventional methods in the short-term acute
hospital. He was emaciated in appearance and was receiving his entire daily nutritional
intake via a G-tube. His physical condition was too impaired to meet accepted criteria
for the ventilator weaning.
While this patient was in our facility, he was seen by the rehabilitation department, dietary,
nursing and respiratory care. A coordinated approach was initiated with all disciplines involved to
facilitate weaning from mechanical ventilation. A intensive regimen of nursing care, nutritional support,
and respiratory, physical and occupational therapies was put in place, with a rigid schedule of activity.
Initially this patient required maximum assistance with all care. He could not feed himself independently,
and the extent of his physical strength was to sit on the edge of the bed with two caregivers in attendance.
Over a period of four months, his strength gradually increased until he was able to walk 100 feet with 25% assistance
of one person at his side. He was able to take at least fifty percent of his daily nutrition by mouth, and was able
to bathe and toilet himself. During this time he was weaned completely off the ventilator, and was subsequently discharged
home with the tracheotomy tube decannulated.
Case Study 2
A 72 year old female was admitted with diagnoses of lupus, respiratory failure, hyperglycemia, and dementia. She was
admitted to the facility on a 70% tracheostomy collar and admission blood gas levels showed a ph level of 7.35. At the
referring hospital this patient had failed numerous attempts to be weaned and the referring physician held little hope of
a successful ventilator wean.
A intensive regimen of nursing care, nutritional support, and respiratory, physical and occupational therapies was put in
place, with a rigid schedule of activity. Over the next 60 days, the patient was weaned completely off the ventilator. Within
another 30 days, the patient had the tracheostomy tube decannulated, and was placed on a 1 liter/minute nasal cannula. She
was discharged into a long-term care facility.
Case Study 3
A 65 year old female became ventilator dependent post surgery for a bowel obstruction. She had failed multiple attempts
to wean from mechanical ventilation at the referring hospital. She was extremely weak and was very fearful of any attempt
to wean off the ventilator.
A plan of care was developed between nursing, rehabilitation, dietary, and respiratory care. When this plan was initiated,
this patient could not sit up on the edge of the bed without maximum assistance of two therapists. While she could eat, she
took most of her caloric needs via G-tube. With aggressive therapy, she was able to walk with the assistance of one person
after sixty days. At that time, she was utilizing the ventilator with rest and night time sleep only. At ninety days, she
was able to walk 150 feet unassisted, but still required night time ventilation. At 120 days she was completely weaned off
ventilator support and had the G-tube removed. At 160 days, her tracheostomy tube was decannulated, and she was discharged
home on room air. |
