Patient Summary

The patient is a 65-year-old female who was brought to the emergency department by her father
when he found her on the floor confused and minimally responsive. At her baseline, the patient is
completely independent. The patients past medical history is significant for anxiety, bipolar
disorder, and COPD. Her father stated that the previous day she had visited her primary care
doctor where she was changed from Xanax to Klonopin at a higher dose. There is no past
surgical history or family history of neurological disorder. The patient was admitted to the NIU
for further observation and evaluation.

Discharge Diagnosis
The patient understands their hospitalization was due to an acute change in her mental status and
subsequent fall after her medication change. There are no core measures that need to be met for
this disease process. The patient was given educational materials on falls, anxiety and panic
attacks, and care for abrasions.

Medications
A reconciled list of medication was provided for the patient that included new medications she
should begin taking and those which she should discontinue. The list also included information
about when the last doses of the medications were given in the hospital. Side effects of the
medications were discussed and the patient demonstrated verbal understanding about their
indications.
Medications to continue after discharge:

Buspirone (Buspar)Last dose: 3/7/14, 11:48

o Side Effects: dizziness, drowsiness, excitement, fatigue, HA, insomnia,
nervousness, weakness, blurred vision, nasal congestion, sore throat, tinnitus,
chest pain, palpitations, tachycardia, N/V.
o Patient Teaching:
-Instruct patient to take buspirone exactly as directed. Take missed doses as soon
as possible if not just before next dose; do not double doses. Do not take more
than amount prescribed.
-May cause dizziness or drowsiness. Caution patient to avoid driving or other
activities requiring alertness until response to the medication is known.
-Advise patient to avoid concurrent use of alcohol or other CNS depressants.
-Instruct patient to notify health care professional of all Rx or OTC medications,
vitamins, or herbal products being taken and to consult health care professional
before taking any Rx, OTC, or herbal products.
-Emphasize the importance of follow-up exams to determine effectiveness of
medication.

Duloxetine (Cymbalta)Last dose: 3/7/14, 10:25

o Side Effects: neuroleptic malignant syndrome, seizures, suicidal thoughts, fatigue,
drowsiness, insomnia, constipation, dry mouth, N/V, dysuria, SJS, serotonin
syndrome
o Patient Teaching:
-Take medication as directed at the same time each day. Do not stop medication
abruptly.
-Encourage patient and family to be alert for emergence of anxiety, agitation,
panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, hypomania,
mania, worsening of depression and suicidal ideation, especially during early
antidepressant therapy. If these symptoms occur, notify health care professional.
-May cause drowsiness. Caution patient to avoid driving or other activities
requiring alertness until response to medication is known.
GabapentinLast dose: 3/7/14, 11:48
o Side Effects: suicidal thoughts, confusion, depression, dizziness, drowsiness,
sedation, weakness, rhabdomyolysis, ataxia.
o Patient Teaching:
-Take medication exactly as directed. Do not double dose.
-Take gabapentin within 2 hours of an antacid
-Caution patient to avoid driving or activities requiring alertness until response to
medication is known.
Lamotrigine (Lamictal)Last dose: 3/7/14, 10:25
o Side Effects: aseptic meningitis, suicidal thoughts, ataxia, dizziness, HA, N/V,
photosensitivity, SJS
o Patient Teaching:
-Instruct patient to take medication exactly as directed. Take missed doses as soon
as possible unless almost time for next dose. Do not double doses.
-Advise patient to notify health care professional immediately if skin rash, fever,
or swollen lymph glands occur or if frequency of seizures increases.
-May cause dizziness, drowsiness, and blurred vision. Caution patient to avoid
driving or activities requiring alertness until response to medication is known. Do
not resume driving until physician gives clearance based on control of seizure
disorder.
-Caution patient to wear sunscreen and protective clothing to prevent
photosensitivity reactions.
Levothyroxine (Synthroid)Last dose: 3/7/14, 6:06
o Side Effects: HA, insomnia, irritability, abdominal cramps, sweating,
hyperthyroidism, weight loss.
o Patient Teaching:
-Instruct patient to take medication as directed at the same time each day. Take
missed doses as soon as remembered unless almost time for next dose. If more
than 23 doses are missed, notify health care professional. Do not discontinue
without consulting health care professional.

-Explain to patient that medication does not cure hypothyroidism; it provides a

thyroid hormone supplement. Therapy is lifelong.
-Emphasize importance of follow-up exams to monitor effectiveness of therapy.
Thyroid function tests are performed at least yearly.
Medications to discontinue after discharge:

Clonazepam (Klonopin)

Home Assessment
The patient currently lives with her 87-year-old father in a one-story home in St. Petersburg, FL.
The patient expressed that she feels safe within her home and there are no apparent safety
concerns that need to be addressed. Education was provided on how to prevent falls within the
home environment as she is on multiple sedating drugs. The patient is normally independent in
her self-care but did state that she is able to rely on her father for transportation to the doctor or
store if necessary. The patient states she is financially stable and has no financial concerns in
regards to her medications.

Follow Up
Physical therapy was included in the discharge of this patient and home health care was
encouraged however the patient declined this recommendation. No follow-ups are necessary.
The patient was instructed to return to the emergency department should she have any increased
pain, vomiting or fever, or any other concerning symptom.

Summary
The most important considerations to prevent readmission for this patient is education on
polypharmacy, compliance, and insuring the patient is properly educated on the indications and
side effects of her medications. The patient should continue to see her primary care physician
regarding efficacy of her medication dosages.