SAQ 2020 – Elderly patient with fever, fall and acute confusion

An 85-year-old woman presents by ambulance after dizziness and fever at home. She fell in the garden earlier with no initial injury but now has vague mild lower back pain.

Ambulance measured temperature 38.9 C and gave paracetamol 1 g. Observations are BP 125/80 mmHg, HR 110/min, SpO2 99% on room air and GCS 14 (E4 V4 M6). History includes dementia, rheumatoid arthritis and hypertension.

She later has mild right flank pain. Urine shows >1000 leucocytes, <10 epithelial cells, 50 red cells and 2+ bacteria. FBC: Hb 104, WCC 15, platelets 210. Chemistry: Na 137, K 4.9, urea 23, creatinine 236, eGFR 23. LFTs are unremarkable. Medicines include aspirin, rosuvastatin, irbesartan and methotrexate.

She becomes more confused with GCS 12 (E3 V3 M6) and SBP 80 mmHg.

Complete the table of issues for this patient and what should be done for each.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Issue</th> <th>Management</th> </tr> </thead> <tbody> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> </tbody> </table> <p>

/ 4

List your management of the deterioration.

(Marked out of 4.0)

/ 4

After discussion with her son a decision is made to palliate. Complete the PRN symptom control medication chart.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Symptom</th> <th>Medication</th> </tr> </thead> <tbody> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> </tbody> </table> <p>

/ 4

Total Score: 0 / 12

Percentage: 0%