CASE SCENARIO

Mr. P is a 57 year old married retired Business man who is being

admitted to Rehap Hospital for strengthing. Mr. P has a history or
choric idiopathic Parkinson's approximately 5 yrs. , repair of a
Herinated disk, six months post-op, incision well healed but continues
to suffer severe chronic back pain and is currently been treated for
symtoms of a nagging cold which include fever and congestion. His
medications include Sinemet and Cogentin (for Parkinson' s disease),
Oxycontin (severe back pain) acetimenophen (fever- cold symtom).

Mr. & Mrs. P presently live in a condominium which has been renovated
to meet Mr. P's disability. Mrs. P is actively employeed as a CEO of a
large company and is extremely supportive and anxious to have Mr. P
return home. They have live-in care attendents . Prior to his back
surgery Mr. P was walking with the aid of a walker and his funtional
level was high to moderate . His Pakinsonian symtom (shuffling gait,
mild limb temors with moderate rigidity at times) were well controlled
by medication. Presently, Mr. P is wheelchair bound and needs assist
with his ADL's.

Mr. P is hoping with physical theraphy and strengthing he will beable to

return home.

DOCTOR'S ORDERS
Mr. P

Time: 14:30

November 10 2010
 •Sinemet 25/100mg po tid

•Cogentin 2mg po hs

•Oxicontin 20mg po q12h

•acetimenophen 500mg po q4-6h prn

Doctor's signature-----------------------------.

On the morning of the 5th day of Mr. P's rehab stay, he was very
difficult to wake. Once awoken he was confused, disorientated and
lacked his usual muscle co-ordination. Vitals showed Mr P's pulse and
B/P to be slightly lower than normal for this time of day. Mr. P was
questioned and it was discovered, after he complaint to Mrs. P that"he
was not sleeping at night", she had supplied Mr. P with an OTC sleep-
aid medication (Sominex) which he took and did not inform the nursing
staff that evening.

Mr. P takes Cogentin and Oxicontin both have a drug to durg

interaction with the use of Sominex (anthistamine) increasing the
anticholinergic effect (relaxed muscle) causing Mr. P to have
dangerous side-effects.

Mr. P was monitored accordingly. The medication was removed form

the bedside. The incident was report to the Physician and all nursing
staff. An Incident report was filed. The incident was discussed with Mr
& Mrs P by the Team Leader and further medication teaching (side
effect,medication compliance ect.) was given.