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.
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
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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