Course Project Case Study: Mrs. Davis is a 78-year-old Caucasian resident of a long-term care facility. She shares a private room with her husband of 50 years who also resides at the facility. Her husband is receiving hospice care and has a medical diagnosis of advanced dementia and type 1 diabetes. She has a past medical history of vascular dementia, dysphagia, CVA, asthma, and acute viral bronchitis. She is considered obese and has a current stage III pressure ulcer to her sacrum. She has right sided weakness following the stroke. She transfers using a Hoyer lift. Lately, she has a poor appetite and is refusing to get out of bed.
Orders include:
- Do not resuscitate
- Up to chair as tolerated
- Ensure high protein shake BID
- Mechanical soft, nectar thick liquids
- AFO to RLE on in AM, off at HS
- OT consult for R arm brace/splint
- Perform AROM and PROM q shift
- Negative Pressure Wound Therapy to sacral wound at 125mmHg continuous
- Change dressing three times weekly and PRN
- Notify physician for wound drainage >100 mL in one hour
Medications Include:
- Hydrocodone 5/325 q 6 hours for moderate to severe pain
- Docusate sodium 100 mg daily PRN
- Clonidine 0.1 mg PO TID
- Metoprolol 25 mg PO daily
- Aspirin 81mg PO daily
- Albuterol inhaler: 180 mcg (2 puffs) every 6 hours PRN