Author: Freyia Mahon-Daly / Editor: Mark Winstanley, Steve Corry-Bass / Reviewer: Rafeeq Ahmed Sulaiman / Codes: ELC2, ELC4, ELP1, ELP9, IP1, IP3, NeuP1, ResP4, SLO1 / Published: 19/11/2022
Mrs Jones, an 84-year-old lady is brought into the Emergency Department (ED). She is unaccompanied as she lives in a nursing home which is currently understaffed, meaning no one can accompany her to hospital.
The paramedics explain that her carers report that she has ‘not been herself’ for the past 2 days. A few hours ago she was found to have a fever and the nursing home staff thought that she was coughing more than usual, and bringing up some yellow-green sputum.
Her file from the nursing home shows a list of medications and a summary of her GP records.
Medical history:
- Type 2 Diabetes mellitus – diagnosed aged 62
- Osteoporosis – diagnosed aged 76 following a neck of femur fracture
- Recurrent urinary tract infections
- Dementia (Alzheimer’s disease) – diagnosed aged 81
Medications:
- Metformin 500mg bd
- Calcichew 500mg od
- Alendronic acid 10mg od
She is profoundly confused and repeatedly asks who the staff are and where she is. The nurse-in-charge asks you to assess Mrs Jones. ‘She seems rather delirious to me’, they suggest on their way out of the cubicle.