After Mrs. B’s delirium had cleared and the symptoms of her major depressive disorder with psychotic features continued to improve; cognitive and functional assessment revealed only mild deficits in short and long-term memory and instrumental activities of daily living. Mrs B’s ability to bathe, dress, use the toilet and eat meals remained steady at the level of requiring some assistance with planning and organising (motivating?) while able to complete the fine and gross motor tasks (praxis) without physical assistance.
Mrs B. is planning to go home to the hostel (“low care aged care facility”) section of the retirement community where she had previously had an assisted living apartment. Her constipation, dehydration and poor nutrition resolved in hospital. Her cognition improved now scoring 26/30 on the MMSE with mild deficits in short term recall, orientation f4tlate and a couple of minor errors in the language tests. Her hypothyroidism was corrected. Her BP was stable in hospital, so her antihypertensive was ceased (she hadn’t been taking it regularly when she was unwell at home). She responded well to anti-psychotic and anti-depressant medication.
Over time Mrs B gradually became more responsive and more engaged with recreational pursuits with some encouragement. She expressed no more thoughts of dying and was perplexed (embarrassed?) when asked about her previous expression of these thoughts. Her appetite and sleep stabilised. Episodes of anxiety were less frequent.
1. What could be done to assist the son emotionally and practically?
2. How might you interact with Mrs B. when she is anxious?
3. What are Mrs B’s mental health relapse indicators?
4. Using the ISBAR format, what information should be communicated to the Aged Care Facility immediately prior to discharge from hospital?
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