Nursing Home Care Case Studies

I attended two physician appointments on 2/2/18 Neurosurgery and 2/20/2018 Neurology with Mr. Noveloso, his sister and his son Bernard. Parking fees were also paid for each clinic appointment of $2.00 for each appointment. Mr. Noveloso’s sister had come from Germany when the accident occurred and had been assisting them. She had prepared meals and her brother was able to reheat them. I inquired about what she had noticed as she was a nurse. She replied that she had noticed her brother’s memory deficit was the biggest thing at the moment. He was able to dress himself and needed reminders on medications as the home care nurse was filling the medication tray. His gait had improved with PT. I inquired if OT had Mr. Noveloso perform any cooking

He was concerned as there were times when he came home from work and inquired about his father’s day, his father had difficulty recalling. There were times when they are in church and individuals come up to them he has to tell his father who it is as he has difficulty recalling them. Mr. Noveloso has not experienced any further seizure since the accident. Mrs. Fromes replied that the EEG revealed spikes which indicate that Mr. Noveloso is at risk for seizures and the slow waves which can be the result of structural changes in the mass or lesion. The left temporal area which is behind his ear is certain the area of seizures. Mrs. Fromes informed Mr. Noveloso that it was wise to continue the medication Keppra. Keppra has low side effects, so the physician prescribe this medication as it is beneficial. Mr. Noveloso’s medication had previously been increased when he was in the hospital to 3000mg/day (2 tablets 750 mg (1500mg) by mouth twice a day. Mr. Noveloso inquired about why he had a seizure in November. It was explained that maybe the previous dose of Keppra was inadequate and he had not reached the blood level but now the dose has been increased. Mr. Noveloso also thought the medication would affect his Gout and Mrs. Fromes replied that the medication has nothing to do with the feet or Gout. It was confirmed he was started on Gout medication with the past hospitalization. Mr. Noveloso inquired

Fromes asked Mr. Noveloso to recall the day of the week, the location he was at and the month and year. Mr. Noveloso responded appropriately. As she was completing her examination it was noted that Mr. Noveloso appears to be weaker on his right side. His leg shook and had slower movement when she had her hand on his knee asking that he pull his leg towards his head. Mr. Noveloso informed her that his finger had spasmed one day after he worked on the computer. When his son inquired when this occurred Mr. Noveloso replied yesterday when I was at Charlie’s house. In fact, Mr. Noveloso was not at Charlie's the day before but resided at Bernard’s home. It was a week ago when he was at his other son’s house. Mr. Noveloso had no further spasm. His headaches were relieved by Tylenol. Mr. Noveloso also informed her that he had dizziness and inquired about hearing aids as he thought it would do something with him having seizures, so he was not wearing them. Mrs. Fromes replied that the seizures wouldn’t be caused by them and if he wore them, it would help him hear, focus on what is being said and help him with testing. Sleep deprivation was discussed and he was advised that he needed to have adequate sleep as this could promote