An 82-year-old man recently returned to the long-term care facility after hospitalization for open reduction internal fixation of the right hip. He has been divorced for over 50 years and has two adult children who visit him frequently in the nursing home. He has a 5-year history of mild to moderate dementia and known urinary tract infections. His last recorded mini mental state examination (MMSE) registered 18, which was 3 months ago. While in the hospital, he did have an indwelling catheter for 4 days. He has been incontinent since his return to the hospital but the staff their attributes this to the catheter and his deconditioned state following hospitalization. His medications include donepezil, memantine, and acetaminophen for pain and fever as needed. He has no other known medical problems except a history of multiple urinary tract infections and throughout his lifetime that, according to his son, have required extensive antibiotic treatment as well as a history of chronic renal failure. He enjoys drinking regular coffee throughout the day, and says it is a habit he has had since his days in the service years ago. His family members and the nursing staff report that he has been very restless and has been unable to use the urinal on time the past couple of days. Vital signs: T 99°F, HR 80, RR 18, BP 128/78, BMI 22.
Questions
What additional subjective information will you be asking the patient?
What additional objective findings would you be examining the patient for?
- What are the differential diagnoses that you are considering?
- What laboratory tests will help you rule out some differential diagnoses?
What is your plan of care?
What additional patient teaching may be needed?
Will you be looking for a consult?
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