Behavioral DISTURBANCE Secondary Dementia

S – Situation

79 y.o. woman with dementia (with behavioral disturbance), Afib, HTN, CAD, HLD, DM. Brought from memory care facility SNF for escalating aggressive behavior. Currently admitted for AMS workup, awaiting medical clearance for Psych transfer.

B – Background

• PMHx: Dementia w/ behavioral disturbance, Afib, HTN, CAD, HLD, DM (diet-controlled since 2019), asthma, sleep apnea.

• PSHx: Gastric bypass (2004), lung lobectomy, carpal tunnel release, salpingo-oophorectomy, TAH-BSO for fibroids, tonsillectomy/adenoidectomy.

• FHx: HTN (father), cancer (maternal grandparents), stroke (paternal grandmother).

• SHx: Never smoker, no alcohol, no drug use, never sexually active.

• Allergies: Penicillins (rash), Sulfa (rash), Shellfish-derived (diarrhea/vomiting).

• Home Meds: Rivaroxaban (held), metoprolol, metformin, rosuvastatin, donepezil, divalproex, risperidone, venlafaxine XR.

A – Assessment

• Dementia w/ behavioral disturbance – escalating aggression; on divalproex, donepezil, risperidone, venlafaxine XR (taper). Psych admission once medically cleared.

• PAD/ vascular insufficiency – on heparin drip per vascular surgery; f/u vascular recs.

• Atrial fibrillation – on heparin drip for procedural flexibility; rivaroxaban held; continue metoprolol.

• Urinary retention – managed with straight cath PRN.

• HTN – on metoprolol.

• T2DM – on metformin.

• CAD/HLD – on rosuvastatin + metoprolol.

• Diet: Consistent carbohydrate; oral/enteral rehydration fluids 960 mL.

• Code Status: Full.

R – Recommendation / Plan

• Continue divalproex 250 mg PO daily, 500 mg PO QAM, 500 mg PO nightly.

• Continue donepezil 10 mg PO nightly.

• Continue risperidone 0.5 mg PO daily, 1 mg PO nightly.

• Continue venlafaxine XR taper (112.5 → 75 → 37.5 mg).

• Continue metoprolol succinate XL 100 mg PO daily.

• Continue rosuvastatin 5 mg PO daily.

• Continue metformin 250 mg PO BID WC.

• Continue heparin drip per vascular surgery recs.

• Maintain urinary retention protocol (straight cath PRN).

• PPx: Heparin infusion.

• Disposition: Transfer to Psych once medically cleared.