08-27-2010, 08:01 AM
An 85-year-old woman is brought to the ED by her
daughters because she has been acting strangely lately.
Her house is a mess, even though for most of her life
she has been quite fastidious. She has been calling her
daughters at odd hours of the night, upset, and insisting
that her youngest daughter is stealing her money.
During the day, she goes outside of her house in her
nightgown and housecoat, again quite unlike her usual
customs. Four months ago, her husband of 58 years
was diagnosed with a brain tumor. His condition has
deteriorated quite rapidly, and he is now in a nursing
home, and does not recognize his wife or daughters.
Because of these events, the daughters have attributed
your patient’s odd behavior to the stress she is under.
But as her symptoms have continued to worsen, they
are now quite concerned and decide they must bring
her in for evaluation.
In the ED, the patient is dressed in her housecoat
and slippers and appears disheveled. She is lying on a
cart, but she keeps trying to get up and leave. She is
angry at her two daughters who are with her, and she
is uncooperative with the physical exam. When you ask
her about what has been happening, she appears distrusting,
and her answers do not make sense.
If you determine that your patient’s symptoms are severe
enough for hospitalization. Her daughters agree, but
the patient is adamantly opposed and insists on returning
to her home.
How would you proceed?
A) Call hospital security and make plans to hospitalize
her. After all, she appears quite ill and cannot care
for herself. When she is well, she will understand
that it was the right plan.
B) Discharge her home, asking her daughters to take
turns staying with her until she is better.
C) Follow state-dictated protocol to attempt to obtain
a legal order for hospitalization against her will.
D) Follow national protocol (New World Order
Directive 55.12.A) to attempt to obtain a legal
order for hospitalization against her will.
E) Make a medical determination that she is not
competent, allowing you to hospitalize her despite
her objection.
In further discussions with the patient and her family,
you try to explain ECT and dispel some myths.
All of the following are potential complications
or adverse effects of ECT EXCEPT:
A) Delirium.
B) Nonsustained ventricular tachycardia.
C) Headache.
D) Dementia.
E) Fatigue.
daughters because she has been acting strangely lately.
Her house is a mess, even though for most of her life
she has been quite fastidious. She has been calling her
daughters at odd hours of the night, upset, and insisting
that her youngest daughter is stealing her money.
During the day, she goes outside of her house in her
nightgown and housecoat, again quite unlike her usual
customs. Four months ago, her husband of 58 years
was diagnosed with a brain tumor. His condition has
deteriorated quite rapidly, and he is now in a nursing
home, and does not recognize his wife or daughters.
Because of these events, the daughters have attributed
your patient’s odd behavior to the stress she is under.
But as her symptoms have continued to worsen, they
are now quite concerned and decide they must bring
her in for evaluation.
In the ED, the patient is dressed in her housecoat
and slippers and appears disheveled. She is lying on a
cart, but she keeps trying to get up and leave. She is
angry at her two daughters who are with her, and she
is uncooperative with the physical exam. When you ask
her about what has been happening, she appears distrusting,
and her answers do not make sense.
If you determine that your patient’s symptoms are severe
enough for hospitalization. Her daughters agree, but
the patient is adamantly opposed and insists on returning
to her home.
How would you proceed?
A) Call hospital security and make plans to hospitalize
her. After all, she appears quite ill and cannot care
for herself. When she is well, she will understand
that it was the right plan.
B) Discharge her home, asking her daughters to take
turns staying with her until she is better.
C) Follow state-dictated protocol to attempt to obtain
a legal order for hospitalization against her will.
D) Follow national protocol (New World Order
Directive 55.12.A) to attempt to obtain a legal
order for hospitalization against her will.
E) Make a medical determination that she is not
competent, allowing you to hospitalize her despite
her objection.
In further discussions with the patient and her family,
you try to explain ECT and dispel some myths.
All of the following are potential complications
or adverse effects of ECT EXCEPT:
A) Delirium.
B) Nonsustained ventricular tachycardia.
C) Headache.
D) Dementia.
E) Fatigue.