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
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