Please utilize the resources in the readings and this activity to answer the following questions for

the initial post*:

1. What are Millie’s strengths?

Some of Millie’s strengths are that she keeps a close relationship with her daughter, Dina, as she is
her biggest support system. She’s very familiar with her medications and how it’s important to take
them. Millie is diligent with going to her primary care provider to have her routine and follow-up 
care, as this is important for older adults especially managing their chronic conditions.

2. What are your concerns about Millie?

The concern that I have about Millie is that she expresses a lot of concern of affording her
medications especially after her husband’s passing. This can place her at risk of not wanting to refill
her medications and continue to take them. Another concern is that she has stress incontinence and
often needs to wear depends. She expresses a great amount of embarrassment about having to
worry about the smell. Lastly, she relies a lot on her daughter Dina, which can place her daughter at
risk for caregiver fatigue.

3. What is the cause of the concern?

She specifically stated that after Harold’s passing, that she hasn’t receive his pension anymore which
placed a strain on her ability to afford her home medications. Additionally, with her stress
incontinence she may not be effectively emptying her bladder, which placed her at risk for a urinary
tract infection. My other cause of the concern is that Millie relies a lot on her daughter, which can be
a good and bad thing at the same time. This would place her daughter at a risk for caregiver fatigue.

4. What information do you need?

In the information I would need would be the onset of these symptoms and what were the
medications Millie currently takes at home to help manage her conditions. I would want to ask more
questions to her daughter, Dina about Millie’s overall habits at home such as was she drinking
enough fluids or if Millie expressed any concerns. I would also ask if this has happened before in
where Millie hasn't been acting like herself.

5. What are you going to do about it?

This can present more information on what is going with Millie and can be easily communicated to
the provider in regards of what would be the next course of action to help prevent this from
occurring again in the future. Another aspect is protecting Millie currently, as she's a high fall risk
due to her new onset of confusion. 

6. What is Millie experiencing?

Millie mostly likely is experiencing a urinary tract infection, as well as possibly dehydration. Millie
presented to the ED with new onset of confusion and it wasn’t determined if Millie was effectively
taking her medications. UTIs often have non-specific symptoms, such as confusion, which why  the
first step for a provider is to suspect that it's related to a urinary tract infection (UTI) and it often
continues to be the first diagnosis prior to any other potential causes (Mayne, Sundvall &
Gunnarsson, 2019). However, until there's a positive culture, the diagnosis could be related to
another potential cause which is can also be related to dehydration. Previously, Millie was
concerned about having more incontinence episodes and was probably not drinking enough, as well
as not following her medication regime as recommended. One aspect came to mind was that if
Millie was effectively taking her furosemide appropriately and may have been missing her doses, as
she was experiencing hypernatremia. Generally, furosemide is given to treat water retention as well
as removing any excess salts. By addressing her UTI and educating her how to it’s important to take
her home medications as prescribed would be the best course of action.

Reference

Mayne, S., Bowden, A., Sundvall, P.-D., & Gunnarsson, R. (2019). The scientific evidence for a
potential link between confusion and urinary tract infection in the elderly is still confusing - a
systematic literature review. BMC Geriatrics, 19(1), 32. https://doi.org/10.1186/s12877-019-1049-7