Notes:

Caderina Piper is a 90-year-old woman has been a patient of the Beacham Ambulatory
Care Center of which you are a Charge Nurse.

Patient: Caderina Piper

Age: 90 year

Marital status: Widowed-the husband dies as a result of respiratory arrest

Social/family background: Only relative is a nephew who talks with her about once a
month.

Discharge: 03/01/2018

Diagnosis:

• Post Traumatic Stress Disorder

• Chronic conditions are pernicious anemia, osteoarthritis, and urinary
incontinence. She is fully functional and fully independent.

Medical history:

• October 2016, her home is broken into and is ausculted and robbed She was very
distressed, delusional and confused. She slowly improved over 2 months and was
discharged to a senior living building in a community in eastern Baltimore
County.
• In March of 2017, the patient is seen in the office. She is still very ill emotionally.
She is crying, depressed (not suicidal), and stressed about her new home. She
wants to move to a new Senior Housing unit because it would be on the bus
route making it easier to get around.
• In November 2017, 9 months after moving to a new facility, she becomes acutely
ill with psychotic symptoms and severe paranoia. She hallucinates that men and
women are in her bed and calls others all hours of the day. She is hospitalized on
a psychiatric unit and improves over about 14 days without antipsychotic
medication.
• One week following discharge from the hospital, symptoms rapidly recurred
when she returned to the senior apartment.

Medical management:
 • Haloperidol 0.025 – 1.0 mg/day
• cognitive behavioral therapy and exposure therapy

Nursing management:

• Encourage identification ineffective coping mechanisms and consequences

• Provide adequate time for pt to discuss and explore feelings
• Encourage acceptance of emotions
• Develop appropriate support systems/referrals for further therapies
• Administer meds as ordered

Discharge plan:

• Call the emergency number if she tries to hurt herself or others

• Call the doctor if she cannot sleep or sleeping too much

Writing Task:

Using the information given in the case notes, write a letter of discharge to Ms. Bhavna
Sandrine, the Charge Nurse at Palmer Home Care Facility, informing her about the
patient’s condition and her medical and psychological needs. Address your letter to Ms.
Bhavna Sandrine, Charge Nurse, Palmer Home Care Facility, Baltimore.

In your answer:

● Expand the relevant notes into complete sentences

● Do not use note form
● Use letter format

The body of the letter should be approximately 180–200 words.

Ms. Bhavna Sandrine

Charge Nurse

Palmer Home Care Facility

Baltimore

3rd January 2018