Case study
Marion Beck is a frail 87year old woman with moderate dementia.She rates 7, severely frail, on the CSHA Clinical Frailty Scale(she is completely dependent on others for activities of dailyliving). She has a history of osteoarthritis, back pain, and kneepain. For the past four months, she has taken morphine longacting,15mg po q12h
In the last several days, she became very agitated, refusingfood and resisting care. Marion no longer recognizes health careproviders whom she used to know. She is paranoid that someone iscoming to get her and has refused medications, saying they arepoison.
- Explain the potential implications of these changes in herbehaviour.
- Write notes for a verbal report that you will provide to thephysician / nurse practitioner, using the sbar format.
- Identify nonpharmacological comfort measures you couldimplement immediately.
- What concerns might the family have about Marion, hercondition, and the care that the team provides?
- If you identify the Marion is experiencing a delirium, would itbe appropriate to investigate the cause ? why or why not ?
Q:8- What is the significance ofMarion’s level of frailty for her prognosis, and how might herfrailty affect the decision to investigate or not investigate?
Q:9- In a group, Marion’s case anddiscuss the importance of involving the family in decision makingand care planning as much as possible.
Q:10- Why might delirium be anespecially difficult symptom for families to witness?
