PRESENTATION OF THE SITUATION

NAME: MILLAN, LEONIDES

DIAGNOSIS: OSTEOARTHRITIS
SITUATION: Patient A is 82 years of age with a history of congestive heart failure, glaucoma, hypertension, and osteoarthritis. During the appointment to his orthopedic doctor,
the patient complains of persistent arthritic pain in his knee. The physician prescribes the NSAID meloxicam (7.5 mg per day) for pain and inflammation. Patient A has a good
working relationship with his primary care provider, who has instructed her to contact him regarding any changes in his medication regimen. Aside from pharmacotherapy, the
patient is scheduled with a physical therapist to create a safe exercise plan, including strengthening and range-of-motion exercises.

NAME: CARDINAL, ISAGANI

DIAGNOSIS: Post Hip Replacement/ Overdose of Warfarin
SITUATION: Patient B is a man, 78 years of age, who resides in Por Cristo. One year ago, he fell and fractured his left hip and underwent surgical repair. He returned to the
nursing facility, completed rehabilitation, and regained most of his prior function. After the surgery, Patient B was prescribed warfarin to prevent deep vein thrombosis (DVT)
after surgery. However, during a routine survey, a state surveyor discovers that Patient B is still being administered warfarin. After further investigation, it is discovered that the
warfarin was never discontinued after the appropriate duration after the hip fracture repair. After contacting the attending physician, the warfarin is promptly discontinued.

NAME: IMPERIAL, JAMES

DIAGNOSIS: Bronchitis
SITUATION: Patient J is a man, 84 years of age, who resides in a long-term care facility. He has been diagnosed with congestive heart failure, hypertension, arthritis, and
hyperlipidemia and has a history of two myocardial infarctions (eight and two years previously). He requires minimal assistance with his activities of daily living and remains
ambulatory with a cane. At baseline, he takes 10 medications/supplements. Patient T is transferred to the emergency department for increased shortness of breath. He is
diagnosed with bronchitis and spends 24 hours in the hospital for observation before being transferred back to the long-term care facility for ongoing care. Physical assessment
reveals an elderly debilitated man who is in no acute distress (He is alert and oriented and answers questions appropriately. His intake of food and fluids has been poor since his
return from the hospital, and he is using oxygen per nasal cannula at 2 L/minute. As noted, Patient T's new diagnosis is bronchitis, and he does not appear to be having an
exacerbation of his CHF.
NAME: SALVADOR, ROBERTO
DIAGNOSIS: DIZZINESS/SYNCOPE
SITUATION: Mr. Salvador is an 84 year-old Asian male who lives in Por Cristo along with other elderly. Although previously outgoing and social, Mr. Salvador recently has been
limiting his outside activities. Mr. Ying stated that for the past year he has felt dizzy when he stands up after sitting or lying down and that he often needs to “catch himself” on
furniture or walls shortly after standing. His dizziness is intermittent but happens several times per week. He says there is no pattern and he experiences dizziness at different
times during the day and evening. He denies experiencing syncope, dyspnea, vertigo, or pain accompanying his dizziness. Mr. Salvador also remarks that, independent of his
dizziness symptoms, he feels unsteady on his feet when walking. He requires help with bathing and has started using a cane but doesn’t like to use it inside. When asked about
previous falls, he says he hasn’t fallen. However, he says his elderly neighbor recently fell and is now in a nursing home. Now he’s fearful about falling. Although Mr. Salvador has
spinal stenosis, a recent steroid injection has relieved severe low back pain. Now he suffers only from lower back stiffness for several hours in the morning. He denies any
specific weakness in his legs.

NAME: NAVARRO, FERDINAND

DIAGNOSIS: Right BKA D/t Ischemic Foot
SITUATION: The patient is 79 years old. Before the amputation he could still move about provided that there are railings for him to hold on to. Recently (in a last few months) he
has significant reduction of mobility, and was able to walk indoors with a two wheeled walker independently, only for short distances (such as - from one room to another, to
the bathroom, etc.). Also, he needed help in BADL (shower, getting dressed) and IADL (cleaning, cooking, general housekeeping), and got the help for 4 hours each day from a
nurse at Por Cristo. His comorbidities are Diabetes, Chronic Ischemic Heart Disease, Moderate Tricuspid Regurgitation, Pacemaker implantation, Right Carotid Endarterectomy
D/T Symptomatic ICA Stenosis, Arterial Hypertension, Parkinson's, Benign Prostatic Hypertrophy, Obesity. 5 days after the amputation he seemed sad (which is a normal part of
dealing with a limb loss), and hopes he will get prosthesis and relearn to walk again.

NAME: DIZON, CARMELITA

DIAGNOSIS: Fall Injury (2 cm Abrasion on R Forehead/ Sore R Shoulder)
SITUATION: – 87 years old woman with a history of hypertension, osteoporosis, osteoarthritis, mild cognitive impairment and Type 2 diabetes. She ambulates with a walker,
requires assistance with activities of daily living (ADLs); bathing, grooming, toileting. 2 days ago, care providers are alerted by hearing a loud crash and yelling in the client’s
room. Her roommate witnessed the fall. At 1pm, Anne is found lying on her right side on the floor at the bedside in front of the night table. She denies loss of consciousness, but
is not sure if she bumped her head. She has a 2 cm abrasion on the right side of her forehead that is oozing blood. She is moving all her limbs and complains of pain at 6/10 for a
“sore right shoulder”. A large amount of bruising noted to the right shoulder. Vital signs are BP 130/86, T 37.1 C (t), P94, R 22. O2 sat is 95% on room air. PEARL. Anne also tells
care provider that she was trying to get the magazine from her night table so she could get up and read in her easy chair. When she got up, she became dizzy and fell. She is
awake and aware of her surroundings after the fall. Her speech is clear and coherent and hand grips are strong bilaterally. Anne is assisted back to bed with a second care
provider. Anne is instructed to ask for help when she gets up to read or to use the bathroom. She is to call the care provider if in pain. The client is left in bed in a safe position.
NAME: BAYAN, HELENA
DIAGNOSIS: Right Sided Stroke/Vascular Dementia
SITUATION: Mrs. Bayan is an 85 year old woman who had returned from being admitted to Butuan Doctors Hospital after being found lying in front of the toilet. On admission,
Mrs. Bayan was diagnosed with a right sided stroke, which has left her with moderate weakness in her left arm and leg. A diagnosis of vascular dementia was also made, which is
overlaid on a pre-existing diagnosis of Alzheimer’s disease. Her medical history includes Alzheimer’s disease; type II diabetes; hypertension; high cholesterol and osteoarthritis.
This last admission was the third hospital admission in the past year. Other admissions have been for a urinary tract infection, and a fall in the context hypoglycemia, both of
which were complicated by episodes of delirium.

NAME: Ybarra, Geraldine

DIAGNOSIS: Congestive Heart Failure
SITUATION: Mrs. Ybarra is a 70-year-old woman resident of Por Cristo. She was recently admitted to the hospital two months ago with heart failure. Since her discharge, nurses
have been monitoring for symptoms of heart failure and see that Mrs. Ybarra is continuing to manage well on her own. Upon nursing rounds, you and the nurse immediately
notices that Mrs. Ybarra’s legs are very swollen. She states, “I noticed they were getting a bit bigger. They are achy, too.” The nurse weighs Mrs. Yates and she has gained 10
pounds. Additional assessment findings indicate that Mrs. Ybarra gets short of breath when ambulating from one room to the other (approximately 20 feet) and must sit down
to catch her breath. Her oxygen saturation is 95% on room air. Bibasilar crackles are heard when auscultating her lung sounds. Her pre-existing conditions are Hypertension
(HTN); heart failure (HF, CHF); coronary artery disease (CAD); myocardial infarction (MI) five years ago;