St. Joe's Collapse Case Study

The patient is a 81-year-old female who presented to the ED after a fall several days ago. The patient when she fell was found by the daughter on the floor and was taken to the emergency room at St. Joe's, evaluated and then sent home and since that time the daughter has found that the mother is needing more assistance with dressing and ambulation and other simple chores. There is a definite change in her ability although prior to that she was somewhat limited. Her past medical history calls for a number of allergies, hypertension, dyslipidemia, and some anxiety disorder. The only things on the physical is that she very pleasant but confused. She is in no apparent distress. She is tachycardic, blood pressure is stable. There is no major
abnormalities in any of her blood except that she is vitamin D defiecient. It is the impression especially of the psychiatrist that she does have some chronic memory impairment but she has had a relatively acute change in that which he feels is probably some to delirium the etiology of which is unclear at this time. She does have a small decubitus ulcer, which does not appear infected. It is the intent to psychiatrist to complete workup on her. Replenish the thyroid, B12, folate if they need replenishement. She also has a mild pill-rolling tremor which they feel might be caused by the Respirdol and that will be discontinued. I believe that this patient requires acute inpatient hospitalization to determine the reason for what appears to be very acute deterioration in her function ,although she was functioning at the mild level of dementia at the time of presentation.