Dr Nicola Fawcett

Teaching, Research and Projects

Mar13 Antibiotic Use Poll - After Teaching Session

You are the clerking Doctor –

Gladys is an 89yr female lives in her own home with twice daily carers, and has a 2 day history of increased weakness. She has a history of dementia but is usually ambulant with a stick and can hold a conversation about the events on tv. Usually incontinent of urine and uses pads. She didn’t feel well yesterday, and today she felt too unwell to get out of bed, and hasn’t been eating or drinking much. The carers said they had noticed a cough, and the out of hours GP was phoned, who advised an admission to hospital ‘off legs and possibly dehydrated’.

PMHx – Dementia, Hypertension, no resp hx. Meds- bendroflumethazide, lisinopril NKDA

O/E – Haemodynamically stable. Apyrexial. Lying in bed, responsive but eyes shut.
Looks euvolaemic/possibly a bit dry. CVS/Resp/GI/Neuro normal. Wet but non-productive cough heard. GCS 14 (eyes shut) AMTS 4/10 Can take oral intake but requires encouragement.

Electrolytes are all normal, Cr 68, CRP 13 WCC 10

CXR – no obvious focal consolidation. Incontinent of urine so no dipstick available.

She has been in the EAU for 3 hours and her daughter who is with her says that she is not looking right, and the nurse asks you to talk to the daughter about the plan:

The plan:
  
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Part 2

Before you have a chance to talk to the daughter, you are called off to another job. During this time, she is seen by the rest of the team, and started on iv fluids and co-amoxiclav orally to cover chest or urine infections.

The next day she is looking much better on the ward round. By this time you have a urine dipstick which is negative, and the chest is clinically still clear. She is haemodynamically stable, eating and drinking and is more alert and looks better. Both she and her daughter want her to go home.

Your Registrar decides to use this as a teaching ward round and asks you – what do you think we should do now?

What should we do now?
  
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