History of osteoarthritis in both lower extremities and diabetic neuropathy

Ms. Henderson is a 73-year-old woman with severe dementia, HTN, and Diabetes. She was recently admitted to a long-term care facility. Ms. Henderson has a history of osteoarthritis in both lower extremities and diabetic neuropathy in both of her feet. The first week Ms. Henderson was in the nursing home she was actively participating in physical therapy, loved to listen to music and sing along, and was very calm in her interactions with staff. She eagerly looked forward to her meals and especially enjoyed an evening snack.

Ms. Henderson’s medication list includes insulin, Cozaar, and Gabapentin.

During Ms. Henderson’s second week in the facility, she is agitated and very guarded when staff attempted to help her out of bed. She can often be heard moaning. She yells out at night and will only take a few bites at each meal. She was often seen rubbing her right knee and yelling “Ow,” sometimes with tears in her eyes. One of the nurses who has been caring for Ms. Henderson stated that the “honeymoon” phase is over and now they have a “difficult,” resident on their hands.

You are the nurse caring for this patient today. While reviewing the EMR, you notice Dr. Jones, the nursing home physician, wrote an order for Tramadol (an opioid/narcotic) regarding the pain Ms. Henderson is experiencing in her knee. The physician tells you that as people age, they commonly have more pain, and patients with dementia don’t feel pain like younger patients.

Ms. Henderson has a daughter Jane who was out of town and just came to visit her mother. Jane is very distraught by the condition she sees her mother in. She was the primary caretaker for Ms.Henderson until she was admitted to the facility. She explains that she was not displaying these behaviors at home. When the patient’s daughter stated that her mother was not displaying the current behaviors at home, as the nurse, what information would you want to ask the daughter?

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