Question

A 94-year-old woman is admitted to your hospital with dehydration, trouble breathing, and possible kidney failure. She is clearly in advanced Alzheimer's, weighs about 95 pounds, and shows multiple bruises on her body. She cannot talk. Her caregiver attributes the bruises to a blood disorder that reduces clotting. What are your thoughts about this situation? What kind of investigation would you conduct? What actions would you take to be in compliance with ethical principles?

Answer 1

Medication like blood thinners or anticoagulants, NSAID can lead to decrease platelet levels and causes bruising but the patient with dehydration difficulty breathing and possible kidney failure cannot have symptoms like this.More over the blood disorder is not mentioned by the care giver because it is very essential and a must to know about patient medical conditions by a care giver to provide care.The patient cannot communicate. All this situation cam make a healthcare professionals to think about domestic violence or physical abuse.

The investigation which can be done are

• Blood investigations:to rule out electrolyte imbalance due to dehydration
• chest X ray to asses lung function
• Renal profile to assess its function
• History collection thoroughly to identify about abuse (like duration of problems, what home remedies is done ,family members, diet intake of the patient, etc.,)

The action which has to be taken to be in compliance with ethical principles are

• To follow principle of beneficence ,the actions which can benefit the patient (to meet the daily requirements)
• To report to the immediate senior or the supervisor and bring it to their attention
• To report to the Domestic violence (National center on elder abuse)