Sheila Long is admitted to the medical

Sheila Long is admitted to the medical unit with a primary diagnosis of pneumonia. She is 86 years old and lives with her daughter because she needs help with all activities of daily living (ADLs). For several months, Mrs. Long has been confined to bed. Her daughter reports that over 3 days, Mrs. Long became increasingly confused and agitated and had a temperature averaging 39.2 degrees Celsius. Then, during the past 24 hours, she became extremely lethargic and had little urine output. Her daughter brought her to the emergency department; Mrs. Long was admitted and started on intravenous antibiotics. Health History (obtained from daughter) Current health status: Client appears to be in state of gradual decline. Shows less and less interest in what is going on around her and is confused, often not recognizing relatives. Daughter rarely gets her out of bed because she is afraid client will fall. Daughter has noticed reddened areas on both heels and buttocks and has been “rubbing these aggressively to ensure good circulation.” Past Health History: Client’s only major diagnosis is Vascular Dementia Has been hospitalized six times in the past three years for urinary tract infections and pneumonia. Before the past few years, client was never hospitalized. Her only childbirth was uncomplicated and occurred at home Has a known history of allergies to Penicillin – Urticaria results. Has no history of specific skin disorders, including eczema, psoriasis, seborrhea, or skin cancer. Because the client does not leave the home and is never directly exposed to infections, daughter wonders how the client keeps getting sick. Immunizations include a pneumonia vaccine three years ago and an annual flu shot. She has had 2 doses of Covid-19 vaccine and 2 booster doses. Takes Bisoprolol 5mg daily for blood pressure and Donepezil 10mg daily for Dementia Family History: Daughter unsure of what problems led to maternal grandparents’ death, but says that they lived into their 70s and seemed in good health until very near death. Client had three siblings, with only one sister (age 81) still alive. Sister has history of breast cancer but otherwise lives independently in apparent good health. One brother died of a heart attack at age 59, and the other died in a car accident as a youth. Daughter is an only child and has hypertension and depression, both well controlled. Client has four grown grandchildren who live out of state and are all in good health. Psychosocial profile: Heath practices: Receives a thorough bath 3 days/week, when a home health aide comes to assist. Daughter gives her a quick sponge bath on other days. No self-care activities. Typical day: Spent in her bedroom. Daughter awakens her at 8 a.m. to change her brief and feed her. Client naps on and off throughout the day. TV is often on, and her daughter often talks to her about other family members and current events, although client rarely responds. Nutritional Patterns: Eats three meals a day, taking fair portions as long as she is fed. Daughter admits she doesn’t encourage her to drink because client previously had aspiration pneumonia. Activity/exercise patterns: daughter performs ROM exercises on client’s arms and legs once a day for 10 minutes. Other than that, only activity is spontaneous movement in bed. Sleep/ rest patterns: Usually sleeps through the night 9-11 hours. Personal habits: Takes two prescribed medications and over-the-counter medications when she has an acute illness. Has no intake of caffeine or alcohol and has never smoked. Environmental health patterns; Daughter knows of no environmental exposures. Daughter’s home is one-story and climate-controlled. Client’s bedroom is bright and airy, with large windows. Roles/relationships: Client occasionally responds to her daughter or son-in-law, but has little interaction otherwise, occasionally a neighbor or member of her church visits, but she does not recognize them. Physical Assessment General appearance: lethargic; frail appearance consistent with stated age; slender, with wrinkled, loose skin; inattentive to environment Vital Signs: Temperature 39.2 degree Celsius tympanic; pulse 116 beats/min, regular; respirations 28/min with slight effort; BP 112/68 mmHg. Integumentary: Skin: Warm and dry; turgor poor, with tenting evident over forehead, upper arm, and upper chest; loose and thin, with many wrinkles; coloring extremely pale pink; no visible freckles and few mole; all moles smaller than 0.5 cm and medium tan; 9-10 scattered small red papules, all smaller than 0.5 cm (cherry hemangiomas). Four raised brown lesions (seborrheic Keratoses) with well-circumscribed borders and rough surface texture with “stuck-on” appearance. Surrounding skin intact and consistent with general coloring. Three lesions on upper back and one on right upper anterior chest. All are 2- 3.5 cm in diameter. Both heels have a 2 cm reddened area that remains 30 minutes after heel pressure is relived by placing pillows beneath lower legs. Epidermis intact. Reddened area, 3 cm, over sacrum, with a 2 to 3 mm area of central denuding. Hair: Completely gray and sparse, yet evenly distributed, clean, long and in braid; scalp easily visible, pink, without lesions; several coarse, gray hairs along chin line. Nails: long, but edges smoothly filed; nail bed faintly dusky blue, firm to palpation; no hemorrhages evident; no clubbing. Capillary refill 4-5 sec. Make a concept map( connection lines in it) and genogram based on it.

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