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The patient is a 65-year-old female who was brought to the emergency department by her father
when he found her on the floor confused and minimally responsive. At her baseline, the patient is
completely independent. The patients past medical history is significant for anxiety, bipolar
disorder, and COPD. Her father stated that the previous day she had visited her primary care
doctor where she was changed from Xanax to Klonopin at a higher dose. There is no past
surgical history or family history of neurological disorder. The patient was admitted to the NIU
for further observation and evaluation.
Discharge Diagnosis
The patient understands their hospitalization was due to an acute change in her mental status and
subsequent fall after her medication change. There are no core measures that need to be met for
this disease process. The patient was given educational materials on falls, anxiety and panic
attacks, and care for abrasions.
Medications
A reconciled list of medication was provided for the patient that included new medications she
should begin taking and those which she should discontinue. The list also included information
about when the last doses of the medications were given in the hospital. Side effects of the
medications were discussed and the patient demonstrated verbal understanding about their
indications.
Medications to continue after discharge:
Clonazepam (Klonopin)
Home Assessment
The patient currently lives with her 87-year-old father in a one-story home in St. Petersburg, FL.
The patient expressed that she feels safe within her home and there are no apparent safety
concerns that need to be addressed. Education was provided on how to prevent falls within the
home environment as she is on multiple sedating drugs. The patient is normally independent in
her self-care but did state that she is able to rely on her father for transportation to the doctor or
store if necessary. The patient states she is financially stable and has no financial concerns in
regards to her medications.
Follow Up
Physical therapy was included in the discharge of this patient and home health care was
encouraged however the patient declined this recommendation. No follow-ups are necessary.
The patient was instructed to return to the emergency department should she have any increased
pain, vomiting or fever, or any other concerning symptom.
Summary
The most important considerations to prevent readmission for this patient is education on
polypharmacy, compliance, and insuring the patient is properly educated on the indications and
side effects of her medications. The patient should continue to see her primary care physician
regarding efficacy of her medication dosages.