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