For Student

Mrs A: Scenario This is an elderly frail female patient with dementia who was known to local
community mental health trust and a private GP. She lived alone, was a life long smoker and was
admitted to hospital with fractured neck of femur. She was extremely anxious on the ward and
refused to engage with rehabilitation .
Drugs on admission: – quetiapine, mirtazapine,( antidepressant ) thyroxine, and pregabalin.

Tasks:
1.What might have happened to her?
Task 1 (5.0)
Delirium identified, anxiety can be reduced by ensuring good sensory awareness by ensuring
hearing aid and her spectacles were available to her
Encouraging engagement in activities (e.g. reminiscence/familiar object around her –
Encouraging good sleep pattern (using milky drinks at bedtime, exercise during the day if
possible ) rather than using night sedation.
Advice was offered to family and ward about delirium and management

2. What else can be explored?

Task 2 (5.0)What else can be explored? – Questionable prescriptions –
Meds rec revealed that pregabalin had been stopped several months previously.
Nicotine withdrawal – Patches were provided –
Adverse drug effects that could be contributing to her conditions. She had hyponatraemia
aggravated by antidepressants,mental state improved when corrected with delirium resolving. –
Community team was recommended to review quetiapine and mirtazapine after discharge.

Final score:
.