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P.M. - 71 y.o. - Male - DNR - Coggle Diagram
P.M. -
71 y.o. - Male - DNR
Hospitalized d/t exhibiting abnormal aggression & cognitive changes
Diagnosed w/ metabolic encephalopathy
Pathophysiology: Results from altered brain chemistry at both neocortical and brainstem ARAS centers. The specific cause can be hard to know, but it can be brought on by vitamin deficiencies, systemic illness, lack of glucose, or lack of oxygen.
Pt prescribed vitamins
Calcium-vit D, iron, and multivitamin given
Monitor O2 and respiratory status
Medications prescribed
divalproex and quetiapine given
Pt combative and distressed initially
Wrist restrains used
Restraints removed d/t condition improving
11/4/20: Patient calm, cooperative, and comfortable
Multiple comorbidities but hospice denied d/t improving condition
Metastatic lung and brain cancer
Lung surgery: R 1/3 lobe removed
Brain surgery
D/C planning: SW talking w/ son and working to get LCF placement
Previous LTC will not take pt back
NPH
Monitor for s/s of worsening mental status
Neurological assessments performed; GAS
11/4/20: A&Ox4
Dementia
Makes it more difficult to assess cognitive baseline
Nursing Intervention: Talk w/ family and staff at previous LTC facility to understand baseline
Forgetful even when A&Ox4
Incontinence
Remind pt to use call light when he needs to use the restroom
At risk for impaired skin integrity
Assess skin integrity q shift
Encourage pt to not cross legs
Pt doesn't understand why he can't leave the hospital yet d/t feeling better
Depression
Consider this when performing neurological assessments
Spoke camly w/ pt
Medications administered
citalopram
Has had only one visitor (son) in 14 day stay
May benefit from chaplain visit
11/4/20: son arrived from ND.
Strict I&O
Pt needs prompts to eat
Inadequate nutrition
Encourage patient eat and to drink boost
Nursing intervention: get dietary involved
Brought pt snacks
Enjoys cheese and grapes
Dysphagia
Give medications w/ carrier
Pt prefers applesauce
Anemic
Low HBG & HCT, Ca++,
BUN & BUN/Creat ratio, and Cl- elevated; GFR decreased
Pt possibly dehydrated
Encourage Fluid Intake
At risk for falls
Pt uses walker
Moderate assist
On multiple meds that can cause orthostatic hypotension
Quetiapine, citalopram, lisinopril
Previous hip and femur surgery