Case Study: Forbes Center for Rehabilitation & Healthcare (June 2015)

Patient Age 68
Admission Date: May 13, 2015
Admitted From: UPMC Shadyside
Discharge Date: June 10, 2015
Discharged To: Home
Length of Stay: 28 Days

She is a 68 y/o woman with renal failure (on dialysis), insulin requiring diabetes, recent pneumonia, congestive heart failure and adult respiratory distress syndrome. She required a prolonged stay at a hospital intensive care unit on a breathing machine. Eventually she was taken off the ventilator and the breathing tube was removed. She came to Forbes with a persistent feeding tube, however – which had been inserted through her nose and lodged in her stomach. She was weak, sick and had difficulty swallowing; managing her own oral secretions and simply breathing was a challenge. Nevertheless she needed this tube for nutrition, hydration and maintaining a calorie balance necessary to accommodate her insulin schedule. She also required it to finesse delicate fluid management in a patient with end stage renal failure who also has congestive heart disease.

Forbes provided intelligent, persistent and professional care for this sick and fragile individual. Speech worked with her every day to help her regain her ability to communicate and eat. When her feeding tube accidentally came out of her nose, clinical staff wisely realized that replacing it would hamper progress in physical therapy, breathing, swallowing and speaking. The tube, though, was still needed to continue nutrition and prevent dangerously low blood sugars that could result from her diabetic regimen. Forbes arranged to place the tube directly into the stomach at the level of the abdomen (thereby avoiding the nose face and throat). This served all requirements – it afforded cautious feeding and hydration while allowing the mouth and throat to recover. Her swallowing and speech trouble resolved completely. Removing the tube from the nose also resulted in less inhibited interactions with family and peers while allowing greater participation in physical therapy.

She walked out of Forbes bright – with clear speech and confident strides. She was completely independent in her ability to care for herself and eat normally.