Ruth parkhouse 312336 77 year old lady note tap form delirium on a background of dementia for ward based care but not for itu and not for cpr by doctor simon rolland consultant november 2025 and I agree with that past medical history iron deficiency anemia december 2025 alzheimer's dementia august 2025 with concomitant delirium urinary incontinence november 2025 nocturnal polymyalgia rheumatica september 2023 stroke 2019 right frontal lobe hemorrhagic stroke hip osteoarthritis gored with esophagitis 2000 total hip replacement 2016 medications list nitrofurantoin 100 mg modified release prescribed march 15 by out of our service mirtazapine 15 mg at night memantine 20 mg once a day prednisolone 2 mg once a day atorvastatin 20 mg at night ti cal d 3 1000 / 880 unit dual tablets 1 tablet once a day to prevent osteoporosis and reprazole 10 mg once a day investigations blood cultures negative so far ct head right anterior parietal lobe an area of acute interferonchymal hemorrhage measuring a maximum diameter of just over 2 cm no midline shift or hydrocephalus just posterior to that there's an area of subarachnoid hemorrhage which may represent extension into the subarachnoid space low density superior to this area of hemorrhage likely to represent previous infarction chest x-ray lungs and pleural space is clear b 12 and folate b 12 normal but folate to hemolyzed ferritin 75 tsh normal bone profile normal eosinase normal liver function test normal crp 12 urea normal magnesium normal inr 1 with fibrinogen 5.4 hemoglobin 115 with normocytosis neutrophils 16.63 venous blood gas ph 7.4 sodium 129 calcium 1.08 observations heart rate 62 sats 96% on air 17 blood pressure 74 over 40 was previously 85 over 55 note recent ct thorax abdomen and pelvis january 2026 for weight loss with mild gi disturbance and shortness of breath with a mildly raised qfit at 16 and the ct tap showed unremarkable appearances and no evidence of malignancy so was admitted in november 2025 with hyperactive delirium likely secondary to urinary tract infection because of lethargy of legs urinary incontinence and polyuria with bilateral leg pain she was given and discharged at that time and subsequently admitted again in december 2025 with flu a and iron deficiency anemia so the ed team say 3 days of worsening confusion on a background of alzheimer's with a live in carer reportedly more confused not raising her house and walking up to neighbors yesterday seen by gp starts to unnatural and towing yesterday this morning very confused with fever temperature greater than 40 with the paramedics with initial use of 15 lives with her husband and a live in carer so she's been referred to the neurosurgeons at daraford hospital no acute neurosurgical invention advised advised to manage locally under the stroke team hi ruth hi hi hi good to you I'm rob I'm 1 of the doctors can I have a listen to your chest is that okay breath yeah thank you any weakness in any part of your body at all very high speed high speed high high speed knee thank you very dry poor thing that's my that alright have you been eating some lately or not yearly yeah sure yeah really very blood pressure's getting a bit better it's 8 8 it's 42 now that's a bit better isn't it alright we can a little bit of your legs yeah yeah but you can see me through again got a very mild edema to your feet on both sides it was fine and then you start feeling the voice right how's your head does it hurt yeah I don't have to move any pain yet no that's strange I'm sorry no I'm pretty sure yeah that's a nice so we're gonna look after you in hospital unfortunately this scan showed you had a small bleeding at night no but you see a fracture the end the screen no and so we're gonna cover you for an infection infection okay not be in your urine intubate okay she's gonna be are you using the atabuto or do you use just the yes I use the okay good yeah as soon as they're done can you use the same thing yeah sure we'll do that now so that you're gonna so not not you're gonna gonna do that so impression is frontal hemorrhagic stroke at the site of previous hemorrhagic stroke fever urinary tract infection seems likely given lack of chest findings however vigilance for clear source of infection needed plan is admit to the stroke ward blood pressure control required however hypotensive at the moment so not requiring anything iv fluids for hypotension aiming map of over 65 clinically dehydrate as as clinically dry then the pumps for vt prophylaxis currently gcs 14 good power bilaterally arms and legs collateral from family needed for social history so looking at the ambulance sheet for a bit of collateral so at 03:00 this morning ruth's living carer found her upstairs in the bedroom floor lying on some pillows was able to help her up from the floor and back to bed around 06:00 she had ruth moving around so went to check on her and assisted her to the bathroom but on return to the bedroom ruth was weak with a high respiratory and temperature and so they called 999 her crew attended yesterday for acute confusion she'd left the property and was found outside by a neighbor observations were within normal parameters but and gcs was 14 and 15 at that time but over the last 3 days family have noticed she's been increasingly confused and so the crew yesterday arranged antibiotics for a suspected urinary tract infection with an out of house gp it's emma possibly lasting power of attorney for health and wealth care who would induce that the carers called in here and asked me if I can go away to ed would induce that hi is that emma hi my name is rob I'm 1 of the medical registrars here at clorvay hospital hi I'd I'm I'm calling about your mom ruth park house is it yeah fine I hope it's an okay time to call you sorry to call you out of blue how are you fine I must have missed you when you when you were here earlier I understand from the guys that you were here I'm sorry I missed you I I just I just didn't know how much you knew about her being in the hospital and things like that yeah yeah correct yeah it's still the same nothing much has changed she's still here we're still treating her for a nasty infection probably in her waterworks given her chest x-ray didn't show anything but we're keeping an open mind as to the source of infection but she's on some broad spectrum antibiotics that will cover everything to make her make her get better and then as you say unfortunately this scan is showing that she hasn't had a bleed in her brain I see I see yeah for 2 or 2 days she's been more confused would say yeah just needs to get clean which is why we're not planning yeah of course yeah oh yeah yeah okay oh hello hello sorry I lost you there for the second yeah sorry you said you got on the bed with me then I lost you uh-huh oh goodness sorry didn't think she hit her head yeah fine bet she did have a little tumble you never know I guess yeah fine yeah of course yeah I read about that yeah it does appear to be in a similar place yeah it it we didn't see any sign of an aneurysm or anything like that at the time of her previous bleed in terms of something that could have been treated at that time we certainly didn't see anything now but we wouldn't really because we only see the blood around it so the stroke team may want to do some further imaging down the line once that bleed has settled down and do do you mind me asking a bit more about her so she lives with live in carer is that right which is just for her her and your dad mhmm I see okay difficult of comb of course I can only imagine yeah mhmm yeah august I saw new week mhmm okay mhmm yeah okay mhmm okay thinking about '24 okay okay fine I heard about that as well get locked out yeah yeah okay yeah something's not right in what way not right hard to get them off on pmr slightly up yeah and she's had a nice small reassuring scan hasn't she back in december think it was in january it could I I don't know what her diet is is like and what she's thinking difficult does she good okay fine yeah of course wait so you're done at home yeah of course yeah lovely she that's worked and that's fantastic isn't it mhmm hopefully it's mostly the emotional stuff they help with so she's up a bit at night but they and they help her with cooking and I guess things around the house but in terms of personal care she does that herself is that fair to say they do support that's fine hello yeah okay yeah ecg normal sinus rhythm yeah of course yeah yeah well we might we might have the pleasure of meeting him I'm around so that'll be nice thank you so much for she's still in the resuscitation area in ed yeah yeah lovely alright we'll see you then okay thanks so much for your confirming that's really helpful thanks bye bye so collateral from the daughter emma she's been more confused over the last few days as documented by the ambulance crew has a live in carer which was where which looks after who looks after both her and her husband who has lewy body dementia and parkinson's disease he needs significant physical support support but she needs a lot of mental support she does have help with cooking cleaning things around the house as well as some personal care particularly with nocturnal incontinence but but no more than that