Mrs. Mina is an 73-year-old woman who was admitted to the palliative care unit 17 years after her original diagnosis of Breast cancer. She had modified radical mastectomy with immediate reconstruction. Chemotherapy and radiation performed as additional treatment options post-surgically. A year ago the cancer, metastasis to cervix within the pelvis, and she underwent a radical hysterectomy, chemotherapy and radiotherapy. She also had continued bladder damage, radiation cystitis, and ultimately needed permanent IDC.
Mrs. Mina was visited by her gynecologist on 17 March for regular checkup. She complained of some symptoms including, tiredness and discomfort in the area of the liver. She was advised to be hospitalized for further investigation as her liver enlarged. In the hospital she had Liver ultrasound followed by Imaging Multiphasic helical CT scan from her liver and blood tests. The surveillance of tests indicated to liver metastatic cancer. Medical team considered her as a palliative patient. She is on daily observation and for comfort measures; however, she requires taking her regular medications as well as PRN Endone 5 mg TDS.
Mrs. Mina has been suffering from bipolar disorder since 1970 for which she has been on lithium 300 mgs. . She also has the medical history of recurrent UTI. She is on Panadol osteo 1gr 6 hrly to control pain. . Her weights 109 kg and is 170 cm in height She is mobile with 4WF.
On day five of admission: Mrs. Mina’s observation is as follows: temperature 38.2 °C, pulse 76/min and regular, respirations 22/min, blood pressure 138/68 mm and spo2 95% in the room air. Mrs. Mina was given 1 gr paracetamol nurse initiative medication for fever. The nurse found that Mrs. Mina expresses difficulty maintaining attention, with disorganized thinking and agitation. The nurse asked her son to describe her mother’s usual cognitive state. He stated, she is always coherent and very calm as her bipolar disorder well managed by medication. From the data the nurse suspected to onset of delirium. Mrs. Mina had a fall on the toilet in same day. There are some bruises on her left arm and her face. Brain CT scan performed indicated no abnormality detected…