Carol Decker, Part 1 Mrs. Decker is a 79-year-old who was admitted to the nursing home where you are

Carol Decker, Part 1 Mrs. Decker is a 79-year-old who was admitted to the nursing home where you are medical director. She spent several weeks in the hospital before transfer, during which she was treated for an acute stroke, delirium, pneumonia, and chronic renal failure. Two days before transfer, a gastrostomy tube was placed because the patient was unable to take adequate fluids and a swallowing study demonstrated aspiration. Before her hospitalization, she had lived at home with her husband but needed 24-hour supervision and assistance with dressing and bathing because of multi-infarct dementia. The family has been informed that she will require permanent nursing home care. On admission the patient is somnolent, cachectic, and bedbound. She has a 3 × 3 cm stage II decubitus on her coccyx. She is incontinent and unable to stand without assistance. Initially she refuses to answer questions and closes her eyes, but on prompting she nods in response to simple questions and indicates that she is not in pain. Finally, she speaks, asking you to leave because she is tired. Her admission orders include haloperidol, aspirin, atenolol, and 24-hour tube feedings. Study Questions 1. How would you set care priorities for Mrs. Decker? 2. What would you tell the family about her prognosis?

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