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Confusion

67 year old female came to MD office with daughter with complaints of confusion.  Patient’s daughter reports patient forgetful over past couple of months, forgetting to take medications, forgetting to eat or bathe.  She is concerned.  MD drew labs, reviewed medications did an exam and sent patient home with home health referral. 

SN arrived and admitted patient to services.  Upon performing medication reconciliation, nurse found numerous old prescriptions in all rooms of the home.  Daughter was present and education provided to daughter and patient on importance of discarding old prescriptions especially those that are expired.  Daughter took home prescriptions that patient is no longer using.  Nurse found several medications that daughter as well as PCP were not aware of.  MD was contacted and some were discontinued while others were approved.  Nurse completed her assessment and planned to visit daily for first week to monitor confusion and new medication regimen.  Also, a Home Health Aide care plan was created to assist patient with bathing, meal reminders and reminders to take medications. 

On subsequent visits, nurse learned that patient had undergone recent dental surgery and discussed with daughter possible side effects of anesthesia.  Nurse also saw vast improvement in patient’s care and noted some complaints from patient of depression.  This was reported to daughter as well as MD. 

Patient improved dramatically in 8 weeks and gained back app. 5 pounds with regular meals.  Patient was able to take medications without reminders and also remembered to make meals 3 times daily.  Patient was also given referral to local adult day care centers to improve socialization and keep patient engaged.