PatientAssessmentDay1:Residentisan84yearoldJapanesemale.

Residentappears

appropriatetoage,fairskinintact,wellnourished,severeHOH,utilizesahearing
amplifierandblindLt.eyew/whitedischarge.Residentsleeping,unabletowaked/ta
restlessnight.AttemptedtogetOOB2x.Frequentlyspeakswhilesleeping.SKIN:Color
tanpinkw/hyperpigmentationonUE,face,head,&uppertorso.Noted2cmx1cm
hematomaRt.posteriorforearm.ColorlightbrowninLE.Positiveskinturgor,caprefill
<1sec.,180clubbinghands&feet.Rt.halluxw/odistalphalanxandnailbed.0.5cmx
0.5cmcrustsuperiortoRt.earandmediastinumw/driedoutscab.HEAD:
Normocephalicw/nolesions.Skinistaut,scalpthinofgray&whitehairw/slight
dandruff.EYES:Residentunabletoopeneyes.EARS:Equalplacement,size,andshape.
Nocerumen,hairextendsoutofearcanal.Lt.earimpactedw/cerumen.NOSE:No
deformity,narespatent,mucosapink.MOUTH:Residentunabletoopenmouth.Breath
odorous.NECK:Swellingofnecksuperiortotrachea.Tracheamidline,fullROM.
CHEST:Anterior;Chestexpansionsymmetric,musclesdeveloped.BSclear,no
adventitioussounds,steadydepth&rhythm.HS:splittingS1overaortic&pulmonary
areas.Irregularrhythmovertriscupid&mitralareas.HR152irregulartachycardic.HR
76followingmedication&rest.Posterior;Chestexpansionsymmetric,BSclear,no
adventitioussounds,mediumdepth&steadyrhythm.ABDOMEN:Positive
BSx4QUAD,nodistention,raisedtannevussuperiortoumbilicus,andsoftonpalpation.
UE:ResidentunabletoperformROM.Symmetricbilaterally,musclesdeveloped.Pulses
radial&brachial+2bilateral.LE:ResidentunabletoperformROM.Pulsesdorsalis
pedis,posteriortibialis,popliteal+2bilateral.

AssessmentDay2

Residentisawake@0800,unawareofsurroundings,AOx2(person,object),unableto
pronouncenameappropriately&understandcertainquestions.Moodisappropriate&
compliant.Rememberssleepingforthepastfewdays.SKIN:discrete,smallredbumps
onscalp.EYES:PERRLA,bilateralrelaxationofuppereyelidsw/Lt.lidmore
prominent.Clearbilateraldischargew/Lt.dischargemoreprominent.Lefteye
surroundedbyrednessonlowerlid.MOUTH:Gingivalrecession,fissuresmidlineof
tongue,bottomleftlateralincisorloose&c/ointermittentpain.CHEST:HRRWNL.S1
&S2.BSclear.Bilateralsymmetricchestexpansion.
C/opainonleftknee.Appearsslightlybruised,darkyellowishbrown.
AllotherfindingssimilartoDay1.
LOC:followingactivities,residentisrestless.Unabletorecognizeroom,stateswantsto
gohome,becomesaggressiveandshouts.