Protecting the Elderly


I often wonder if we do enough to protect the frail elderly. Case in point was a patient I took over from another nurse on Sunday. She was a 67 year old female Alzheimer’s patient who had been left supposedly in her grown children’s care while her caregiver husband took a long-deserved overnight fishing trip up north. Her usual state is pleasantly confused and ambulatory. Unfortunately, the daughter never went to the house, but called Mom and told her to take her pills, which apparently she did, and she did, and she did, etc. When the grown children finally arrived to the house around noon the next day, they found her nonambulatory, aphasic, and with an altered mental status. They called the ambulance. The ambulance ALS’d her by only putting in a saline lock and cardiac monitor. (No neuros, no O2) When she arrived, the MD did all the usual labs, CMP, CBC, CIP, Salicylate, Acetaminophen, UA; EKG, CXR and CT head for altered mental status. All the findings were negative except the Na and Cl were low, but CO2 was fine. When the off-going nurse gave me report, she told me the patient was restless, not following commands. She had put in a Foley and had a good output. She made the comment “But she has dementia.” Of course the side rails were up. I went in to do my assessment and introduced myself to the patient and the children. The patient was responsive only to verbal stimuli and made little eye contact and had expressive aphasia. She demonstrated tremors. She was unable to identify her daughter. I asked the family if any of that was her usual state and they said no. I initiated seizure precautions and asked the MD if he minded if I called Poison Control (which are customary nursing interventions in our ED anyway) and of course he said “go ahead.” I updated him on the assessment and he was clueless. I obtained an order for some Ativan. Poison control gave me some parameters. Since some of the meds were BuSpar and Seroquel which could both affect CNS and cardiac systems; I had been right in my gut reaction, but not that familiar with the adverse effects of Seroquel OD. We initiated NS to correct the electrolyte imbalance and she started perking up. Her husband finally arrived and she was bright, cheerful and alert! He was obviously angry and upset, and we talked a long time. I felt bad. I was upset with my co-worker for pigeon-holing my LOL just because she had dementia; she could have had a bad outcome. But should I as a mandated reporter called this in as neglect on the part of the children? After all, the husband had assumed he had left his beloved spouse in good hands for some much needed respite. He was fighting back the tears when he was talking to me.

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