Billy A.

Billy A.

Billy, a 73-year-old male, was admitted with acute respiratory failure following a brainstem stroke. When admitted to the ICU, he presented with right sided weakness and facial droop, dysphagia, dysarthria, and delirium. Billy had a tracheostomy requiring mechanical ventilation and a Percutaneous Endoscopic Gastrostomy (PEG) tube for nutrition. He required max assistance with two people to roll left-to-right and sit up on the edge of the bed. He spent several days in the ICU prior to being medically appropriate to transfer to the Medical Surgical floor.

Billy was followed closely by our Pulmonary Medicine Associates (PMA) group, physicians, nursing,
respiratory therapy team, dietitian, rehab team, and case management. During his stay he was able to wean from the ventilator, breathing independently, with supplemental oxygen via tracheal mist. He was in the process of speaking valve trials when discharged.

Billy made significant progress in all areas of rehab. At the time of discharge, he was able to transfer
from his bed to a chair and bedside commode, walk 150 ft. using a front wheeled walker, and climb 10 stairs all with minimal assistance from the therapist or nursing staff. He was participating in activities of daily living such as grooming, dressing, and toileting with minimal to stand-by assistance. Billy improved in his cognitive-linguistic abilities and could communicate effectively by mouthing words and/or writing. He was unable to start an oral diet, but tolerated PEG tube feedings, and worked very hard by dedicating time outside of therapy, practicing oral motor exercises to improve his swallow function for anticipated future success with eating.

Our case management team worked diligently to have Billy continue with intensive rehab at Sutter Rehab Institute (SRI) once he was medically stable and able to tolerate this level of rehab. He was discharged to SRI on 8/17/16 to continue his recovery.